• Korean Journal of Clinical Pharmacy
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• v.21 no.2
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• pp.170-181
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• 2011

Purpose: There is considerable variability in rates of hospitalization for patients with community-acquired pneumonia (CAP) in part because of physicians' uncertainty in assessing the severity of illness at presentation. The purpose of the study was to examine the current treatment patterns and factors influencing the Pneumonia Severity Index (PSI) and clinical outcomes in the patient with CAP. Method: The retrospective data collection of the patients with CAP was conducted and the data were reviewed. The collected data included demographic, clinical, laboratory and microbiological medical information. All patients were stratified into three risk groups according to PSI: low risk (PSI score I-II), moderate risk (III) and high risk (IV-V) groups. The examined treatment patterns were the appropriateness of admissions, category of antibiotics used. The prognostic factors associated with PSI and clinical outcomes were examined. Results: One hundred and six patients' medical data were reviewed. The overall appropriateness of admissions was low presenting many of patients were admitted or intensely treated in the hospital despite of lower risk of prognosis and treated with intravenous antibiotics instead of oral fluoroquinolones. Primary pneumonia pathogens were Klebsiella pneumoniae (27%) and Streptococcus pneumoniae (21.6%). Mean LOS was 8.5 days and was significantly longer (10.0days) (p<0.001) in high risk group. The patients with age >65 (p<0.001), diabetes mellitus (p<0.001), mental alteration (p<0.001), and/or $PaO_2$ <60 mmHg (p<0.001) had a tendency to have higher PSI. The prognostic factors associated with longer LOS were age >65 years (p=0.008), mental status alteration (p<0.001), dyspnea (p=0.002) and PSI score (p=0.001). The prognostic factors associated with mortality were congestive heart failure (p=0.038), systolic blood pressure <90 mmHg (p=0.002) and arterial pH <7.35 (p=0.013). Conclusion: Most of patients were found to over-utilize medical service according to appropriateness of admissions. The elderly, mentally altered patients with low $PaO_2$ had higher PSI score with increased risk of LOS. The mortality could be increased in the patient with disease state of congestive heart failure, high blood pressure, and/or acidosis.

• The Journal of Internal Korean Medicine
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• v.22 no.4
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• pp.691-702
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• 2001

Objectives : This study was done to assess the effects of the clinical interchange between the Western Medicine and the Oriental Medicine for ischemic stroke patients. The patient outcomes include changes in neurologic function by modified NIH stoke scale, stroke pattern identification scale, and patient satisfaction, Methods : For the assessment of effects, this study was performed with 178 inpatients who had undergone the stroke care at three hospitals (W Hospital adopted western therapy, S Oriental Hospital adopted Sasang constitution medicine therapy, and H Oriental Hospital adopted mixed therapy according to a joint protocol on Western Oriental medical care) from November 1997 to December 1998. Patients were interviewed or written with self-entered questionnaire forms, and clinical data were obtained, Physicians or oriental doctors wrote clinical questionnaire forms according to the care process. Results : The patient outcomes within three hospitals at 2 stages (at admission and discharge in the modified NIH stroke scale. at admission and second weeks during admission in the stroke pattern identification scale) were found to be decreased, Especially in the results of hierarchical multiple regression analysis, the degree of improvement of modified NIH stroke scale of the stroke patients at W Hospital was significant large than it at S Oriental Hospital. Also, the degree of improvement of stroke pattern identification scale at W Hospital was significantly large than it at other two hospitals. However, the patient's satisfaction score at three hospitals wasn't significantly different. Conclusions : The result of this study suggested that the joint clinical research of Western & Oriental medical practitioners was possible even if there was a conflict between Western Medicine and Oriental Medicine. Therefore Western & Oriental medical practitioners share a mutual responsibility to apply evidence-based practice, to seek scientific empirical proof through randomized clinical trials between the multicenter.

• Korean Journal of Clinical Pharmacy
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• v.23 no.2
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• pp.89-96
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• 2013

This article aimed to introduce 'risk sharing' schemes for pharmaceuticals between drug manufacturers and healthcare payer. Published literature review was undertaken to summarize risk sharing concepts and collect information on existing scheme examples in other countries focusing on new anticancer drugs. Risk sharing schemes could be categorized into health outcomes-based and non-outcomes (financial) based ones. Outcome-based schemes could be broken down into performance-linked reimbursement and conditional coverage. Performance-linked reimbursement can be further broken into outcomes guarantee and pattern or process of care and conditional coverage included coverage with evidence development and conditional treatment continuation schemes. Non-outcome based schemes included market share and price volume at population level, and utilization caps and manufacturer funded treatment initiation at patient level. We reviewed the fifteen examples for anticancer drugs that risk sharing agreements in response to the inherent uncertainties and increased costs of eleven anticancer drugs. Of them, eight cases were coverage with evidence development schemes. The anticancer drugs except bevacizumab and cetuximab were all listed on the national health insurance formulary in Korea, with reimbursement criteria defined on the basis of approved indications and administrations. Risk sharing approach may be a useful tool to ensure values for drug expenditure, but there are a number of concerns such as high administration costs, lack of transparency and conflicts of interest, especially for performance-based health outcomes reimbursement schemes.

• Clinical and Experimental Reproductive Medicine
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• v.49 no.2
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• pp.127-134
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• 2022

Objective: This study aimed to investigate the impact of hyperandrogenism (HA) on the outcomes of ovulation induction (OI) using gonadotropin and intrauterine insemination (IUI) in patients with polycystic ovary syndrome (PCOS). Methods: This was a retrospective cohort study including 415 patients undergoing OI using gonadotropin and IUI treatment between January 2018 and December 2020 at a single infertility center. Baseline characteristics, clinical and laboratory parameters, and pregnancy outcomes were investigated. Results: Among the study population, there were 105 hyperandrogenic (25.3%) and 310 non-hyperandrogenic patients (74.7%). The live birth rate was lower in the HA group than in the non-HA group, but this difference did not reach statistical significance due to the limited sample size (14.3% vs. 21.0%, relative risk=0.68; 95% CI, 0.41-1.14, p=0.153). No predictive factors for live birth were identified through logistic regression analysis. Conclusion: HA did not negatively affect the outcomes of OI using gonadotropin and IUI cycles in Vietnamese women with PCOS. The result may not be applicable elsewhere due to the large variation in the characteristics of women with PCOS across races and populations.

• Journal of Audiology & Otology
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• v.25 no.2
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• pp.104-109
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• 2021

Background and Objectives: To assess whether the audiological and clinical outcomes of type 0 tympanoplasty (T0) performed using cartilage were comparable with those of ossiculoplasty in patients who underwent canal wall down mastoidectomy (CWDM). Subjects and Methods: This study included patients who had chronic otitis media with cholesteatoma and underwent CWDM with ossiculoplasty involving partial ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP), or T0. Anatomical success rates and hearing outcomes were analyzed. Results: Seventy-two patients were included in this study; 29 of them underwent CWDM with T0, 27 underwent CWDM with PORP, while 16 underwent CWDM with TORP. The difference in mean improvement in the air-bone gap (ABG) between the groups was not significant. The differences in the rates of ABG closure to ≤10 dB HL (p=0.030) and ≤20 dB HL (p=0.029) were significant. There were significant differences in improvements in the ABG at 3 kHz among the PORP, TORP, and T0 groups. Conclusions: The audiological outcomes of CWDM with ossiculoplasty seemed to be better than those of CWDM with T0 with no significant difference in the incidence of complications following ossiculoplasty and T0.

• Korean Journal of Audiology
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• v.25 no.2
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• pp.104-109
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• 2021

Background and Objectives: To assess whether the audiological and clinical outcomes of type 0 tympanoplasty (T0) performed using cartilage were comparable with those of ossiculoplasty in patients who underwent canal wall down mastoidectomy (CWDM). Subjects and Methods: This study included patients who had chronic otitis media with cholesteatoma and underwent CWDM with ossiculoplasty involving partial ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP), or T0. Anatomical success rates and hearing outcomes were analyzed. Results: Seventy-two patients were included in this study; 29 of them underwent CWDM with T0, 27 underwent CWDM with PORP, while 16 underwent CWDM with TORP. The difference in mean improvement in the air-bone gap (ABG) between the groups was not significant. The differences in the rates of ABG closure to ≤10 dB HL (p=0.030) and ≤20 dB HL (p=0.029) were significant. There were significant differences in improvements in the ABG at 3 kHz among the PORP, TORP, and T0 groups. Conclusions: The audiological outcomes of CWDM with ossiculoplasty seemed to be better than those of CWDM with T0 with no significant difference in the incidence of complications following ossiculoplasty and T0.

• Clinical Endoscopy
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• v.55 no.6
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• pp.742-750
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• 2022

Background/Aims: Cold snare polypectomy (CSP) is commonly used for the resection of colorectal polyps ≤10 mm. Data regarding the influence of snare type on CSP effectiveness are conflicting. Hence, this meta-analysis aimed to compare the outcomes and safety of thin- and thick-wire snares for CSP. Methods: A comprehensive search of the literature published between 2000 and 2021 was performed of various databases for comparative studies evaluating the outcomes of thin- versus thick-wire snares for CSP. Results: Five studies with data on 1,425 polyps were included in the analysis. The thick-wire snare was comparable to the thin-wire snare with respect to complete histological resection (risk ratio [RR], 1.03; 95% confidence interval [CI], 0.97-1.09), overall bleeding (RR, 0.98; 95% CI, 0.40-2.40), polyp retrieval (RR, 1.01; 95% CI, 0.97-1.04), and involvement of submucosa in the resection specimen (RR, 1.28; 95% CI, 0.72-2.28). There was no publication bias and a small study effect, and the relative effects remained the same in the sensitivity analysis. Conclusions: CSP using a thin-wire snare has no additional benefit over thick-wire snares in small colorectal polyps. Factors other than snare design may play a role in improving CSP outcomes.

• Journal of Physiology & Pathology in Korean Medicine
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• v.29 no.2
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• pp.115-126
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• 2015

The purpose of this paper is to explore the strategy of future Korean medicine(KM) clinical research through the study on the proposals for KM clinical research worldwide. In this study, the papers published in English through Pubmed were investigated mainly. Among them, we analyzed the methodological proposals from the clinical research papers that were published in the KM related fields. Various proposals for improving the problems in KM clinical studies are as follows. First, KM clinical research should be designed based on understanding for the theory, backgrounds, paradigms and worldviews of KM. In addition, considering the model validity, KM clinical research model should include the diagnosis, interventions and outcomes measurement methods reflecting the characteristics and real practice in KM. The internal validity and external validity should be also taken into account. One of the most important thing is to identify the contents about various and complex 'real practice' in KM. A prospective observational study was suitable for the purpose of this study. Finally, we suggested a few improvement directions for RCTs studies in KM. First, we would be able to improve the quality and the internal validity in KM clinical research using the checklists of CONSORT(Consolidated Standards for Reporting Trials) Statement and STRICTA(Standards for Reporting Interventions in Clinical Trials of Acupuncture). Second, we could use various clinical research methods and the modified research of RCTs such as PCT(pragmatic clinical trial) to reflect the characteristics of actual KM practice. Consequently, we would be able to improve the external validity. Third, the KM diagnosis and outcomes measurement methods should be developed based on an actual KM practice and it should reflect a real practice. The 'pattern identification(辨證)' is the core to KM diagnosis. But in order to be applied to the clinical research, the pattern identification(辨證) should be objectified and standardized. Future KM clinical research model should reflect the characteristics and a real practice in KM. In addition, it should include the advantage of rigorous RCTs research.Specially, the diagnosis, interventions and outcomes measurement methods in KM clinical research should reflect this view.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.4
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• pp.1847-1850
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• 2016

Background: It is reported that the percentage of smudge cells in the blood smear could be a prognostic indicator in chronic lymphocytic leukemia. However, the clinical significance of smudge cells in other hematological malignancies, solid tumors or non-malignant diseases is less clear. Hence, this study was conducted to survey the clinical significance of smudge cells in hematological cancers and other disorders. Materials and Methods: From January to November, 2015, the clinical data of patients who received blood examination with differential counts for clinical purpose and were found to have smudge cells in the peripheral blood film in Far Eastern Memorial Hospital were selected. The percentage of smudge cells and patient outcomes were evaluated for further univariate and survival analyses. Results: A total of 102 patients with smudge cells in their blood smears were included. Smudge cells were frequently presented in out-of-hospital cardiac arrest (OHCA; n=30), infections (n=23), hematological cancers (n=23) and solid cancers (n=10). There was no relationship between the percentage of smudge cells and the patient mortality in all diseases (OR: 1.08, 95% CI: 0.47-2.48, P=1.000) as well as the OHCA group (OR: 1.91, 95% CI: 0.38-9.60, P=0.694). It was observed that in patients with all cancers with the percentage of smudge cells less than 50% had a lower mortality rate in comparison with those who had the percentage of smudge cells of 50% or more (OR: 22.29, 95% CI: 2.38-208.80, P<0.001). Additionally, it was seemingly that patients with smudge cells of 50% or more had a lower survival rate than those with smudge cells less than 50% in all cancers with follow-up at 2-month intervals, but without statistical significance (P=0.064). Conclusions: Our survey indicated that in all cancers, those who had higher percentage of smudge cells were prone to have poor outcomes when compared with the subjects with lower percentage of smudge cells. This finding was quite different from the results of previous studies in which the race-ethnicity of most study populations was non-Asian; hence, further investigations are required. Besides, there was no apparent association of the percentage of smudge cells with patient outcomes in all diseases, including OHCA.

• Journal of Periodontal and Implant Science
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• v.43 no.1
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• pp.12-17
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• 2013

The purpose of this review is to examine the performance of attachments used in implant-supported overdenture (IOD) in both clinical and in vitro settings and report the compiled findings, comparisons, and trends in the research literature. Articles published in PubMed on IOD attachment systems and performance were reviewed. Non-original articles were excluded. For each article included, the type of study, number of implants, number of attachment systems, and study outcome were recorded. Of the 283 articles found, 158 met the inclusion criteria. Ninety-four articles were clinical studies and 64 articles were in vitro studies. Studies on retention were the most common for in vitro studies, and four or more attachment systems were compared in most articles with significant differences in outcome. A clinical outcome of one attachment system was most common for clinical studies, while most studies had neutral outcomes overall. Ball attachment was the most commonly tested IOD attachment system. The trend in the literature showed that there is a large discrepancy between the study designs and outcomes between the clinical and the in vitro studies for IOD. Further clinical studies that can validate in vitro research should be encouraged to address this discrepancy between the two areas.