• Journal of Korean Neurosurgical Society
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• 제67권4호
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• pp.467-476
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• 2024

Objective : To evaluate the usefulness of a cranial implantable chemoport, the H-port, as an alternative to the Ommaya reservoir for intraventricular chemotherapy/cerebrospinal fluid (CSF) access in patients with leptomeningeal metastasis (LM). Methods : One hundred fifty-two consecutive patients with a diagnosis of LM and who underwent H-port installation between 2015 and 2021 were evaluated. Adverse events associated with installation and intraventricular chemotherapy, and the rate of increased intracranial pressure (ICP) control via the port were evaluated for safety and efficacy. These indices were compared with published data of Ommaya (n=89), from our institution. Results : Time-to-install and installation-related complications of intracranial hemorrhage (n=2) and catheter malposition (n=5) were not significantly different between the two groups. Intraventricular chemotherapy-related complications of CSF leakage occurred more frequently in the Ommaya than in the H-port group (13/89 vs. 3/152, respectively, p<0.001). Intracranial hemorrhage during chemotherapy occurred only in the Ommaya group (n=4). The CSF infection rate was not statistically different between groups (14/152 vs. 12/89, respectively). The ICP control rate according to reservoir type revealed a significantly higher ICP control rate with the H-port (40/67), compared with the Ommaya result (12/58, p<0.001). Analyzing the ICP control rate based on the CSF drainage method, continuous extraventricular drainage (implemented only with the H-port), found a significantly higher ICP control rate than with intermittent CSF drainage (33/40 vs. 6/56, respectively, p<0.0001). Conclusion : The H-port for intraventricular chemotherapy in patients with LM was superior for ICP control; it had equal or lower complication rates than the Ommaya reservoir.

• Journal of Yeungnam Medical Science
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• 제41권1호
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• pp.39-44
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• 2024

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a significant concern, particularly among patients taking bisphosphonates (BPs), denosumab, and selective estrogen receptor modulators (SERMs) for osteoporosis. Despite the known risks, large-scale cohort studies examining the incidence and severity of MRONJ are lacking. We aimed to ascertain the incidence and risk of MRONJ among these patients, whom we stratified by age groups, medication types, and duration of use. Methods: We utilized data from the National Health Insurance Service's sample cohort database, focusing on patients aged 40 years and above diagnosed with osteoporosis. The patients were divided into three groups: those prescribed BPs only, those prescribed SERMs only, and those prescribed both. Results: The overall incidence rate of MRONJ was 0.17%. A significantly higher incidence rate was observed among those taking osteoporosis medications, particularly among females with a relative risk of 4.99 (95% confidence interval, 3.21-7.74). The SERM group also had an incidence rate comparable to that of the BP group. Severity was assessed based on the invasiveness of the treatment methods, with 71.3% undergoing invasive treatment in the medication group. Conclusion: This study provides valuable insights into the incidence and severity of MRONJ among a large cohort of patients with osteoporosis. It underscores the need for comprehensive guidance on MRONJ risks across different medication groups and sets the stage for future research focusing on specific populations and treatment outcomes.

• 대한통합의학회지
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• 제12권2호
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• pp.155-166
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• 2024

Purpose : This study aims to identify key factors for predicting dropout risk at the university level and to provide a foundation for policy development aimed at dropout prevention. This study explores the optimal machine learning algorithm by comparing the performance of various algorithms using data on college students' dropout risks. Methods : We collected data on factors influencing dropout risk and propensity were collected from N University. The collected data were applied to several machine learning algorithms, including random forest, decision tree, artificial neural network, logistic regression, support vector machine (SVM), k-nearest neighbor (k-NN) classification, and Naive Bayes. The performance of these models was compared and evaluated, with a focus on predictive validity and the identification of significant dropout factors through the information gain index of machine learning. Results : The binary logistic regression analysis showed that the year of the program, department, grades, and year of entry had a statistically significant effect on the dropout risk. The performance of each machine learning algorithm showed that random forest performed the best. The results showed that the relative importance of the predictor variables was highest for department, age, grade, and residence, in the order of whether or not they matched the school location. Conclusion : Machine learning-based prediction of dropout risk focuses on the early identification of students at risk. The types and causes of dropout crises vary significantly among students. It is important to identify the types and causes of dropout crises so that appropriate actions and support can be taken to remove risk factors and increase protective factors. The relative importance of the factors affecting dropout risk found in this study will help guide educational prescriptions for preventing college student dropout.

• Korean Journal of Radiology
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• 제20권6호
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• pp.880-893
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• 2019

Objective: To assess the technical performance of two-dimensional shear wave elastography (2D-SWE) for measuring liver stiffness. Materials and Methods: The Ovid-MEDLINE and EMBASE databases were searched for studies reporting the technical performance of 2D-SWE, including concerns with technical failures, unreliable measurements, interobserver reliability, and/or intraobserver reliability, published until June 30, 2018. The pooled proportion of technical failure and unreliable measurements was calculated using meta-analytic pooling via the random-effects model and inverse variance method for calculating weights. Subgroup analyses were performed to explore potential causes of heterogeneity. The pooled intraclass correlation coefficients (ICCs) for interobserver and intraobserver reliability were calculated using the Hedges-Olkin method with Fisher's Z transformation of the correlation coefficient. Results: The search yielded 34 articles. From 20 2D-SWE studies including 6196 patients, the pooled proportion of technical failure was 2.3% (95% confidence interval [CI], 1.3-3.9%). The pooled proportion of unreliable measurements from 20 studies including 6961 patients was 7.5% (95% CI, 4.7-11.7%). In the subgroup analyses, studies conducting more than three measurements showed fewer unreliable measurements than did those with three measurements or less, but no intergroup difference was found in technical failure. The pooled ICCs for interobserver reliability (from 10 studies including 517 patients) and intraobserver reliability (from 7 studies including 679 patients) were 0.87 (95% CI, 0.82-0.90) and 0.93 (95% CI, 0.89-0.95), respectively, suggesting good to excellent reliability. Conclusion: 2D-SWE shows good technical performance for assessing liver stiffness, with high technical success and reliability. Future studies should establish the quality criteria and optimal number of measurements.

• Journal of Preventive Medicine and Public Health
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• 제57권2호
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• pp.120-127
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• 2024

Objectives: The coronavirus disease 2019 (COVID-19) pandemic led to increased mortality rates. To assess this impact, this ecological study aimed to estimate the excess death counts in southern Iran. Methods: The study obtained weekly death counts by linking the National Death Registry and Medical Care Monitoring Center repositories. The P-score was initially estimated using a simple method that involved calculating the difference between the observed and expected death counts. The interrupted time series analysis was then used to calculate the mean relative risk (RR) of death during the first year of the pandemic. Results: Our study found that there were 5571 excess deaths from all causes (P-score=33.29%) during the first year of the COVID-19 pandemic, with 48.03% of these deaths directly related to COVID-19. The pandemic was found to increase the risk of death from all causes (RR, 1.26; 95% confidence interval [CI], 1.19 to 1.33), as well as in specific age groups such as those aged 35-49 (RR, 1.21; 95% CI, 1.12 to 1.32), 50-64 (RR, 1.38; 95% CI, 1.28 to 1.49), and ≥65 (RR, 1.29; 95% CI, 1.12 to 1.32) years old. Furthermore, there was an increased risk of death from cardiovascular diseases (RR, 1.17; 95% CI, 1.11 to 1.22). Conclusions: There was a 26% increase in the death count in southern Iran during the COVID-19 pandemic. More than half of these excess deaths were not directly related to COVID-19, but rather other causes, with cardiovascular diseases being a major contributor.

• Hip & pelvis
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• 제36권2호
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• pp.144-154
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• 2024

Purpose: The objective of this study was to assess postoperative direct medical expenses and medical utilization of elderly patients who underwent either hemiarthroplasty (HA) or internal fixation (IF) for treatment of a femoral intertrochanteric fracture and to analyze differences according to surgical methods and age groups. Materials and Methods: Data from the 2011 to 2018 Korean National Health Insurance Review & Assessment Service database were used. Risk-set matching was performed for selection of controls representing patients with the same sex, age, and year of surgery. A comparative interrupted time series analysis was performed for evaluation of differences in medical expenses and utilization between the two groups. Results: A total of 10,405 patients who underwent IF surgery and 10,405 control patients who underwent HA surgery were included. Medical expenses were 18% lower in the IF group compared to the HA group during the first year after the fracture (difference-in-difference [DID] estimate ratio 0.82, 95% confidence interval [CI] 0.77-0.87, P<0.001), and 9% lower in the second year (DID estimate ratio 0.91, 95% CI 0.85-0.99, P=0.018). Length of hospital stay was significantly shorter in the IF group compared to the HA group during the first two years after time zero in the age ≥80 group. Conclusion: A noticeable increase in medical expenses was observed for patients who underwent HA for treatment of intertrochanteric fractures compared to those who underwent IF over a two-year period after surgery. Therefore, consideration of such findings is critical when designing healthcare policy support for management of intertrochanteric fractures.

• 보건의료생명과학 논문지
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• 제10권1호
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• pp.111-118
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• 2022

본 연구는 임상병리사들의 성별, 연령, 경력, 병원 형태, 근무 형태에 대한 직무만족도, 근무환경, 대인관계, 교육수준, 소속, 여가, 이직 의도, 총 만족도 등의 차이를 알아보고, 특히 직무만족도와 이직 의도 간에 미치는 영양을 확인하고 향후 임상병리사들의 업무 효율성을 높이는데 기초자료로 활용 하고자 시도하였다. 연구결과 임상병리사의 총 만족도는 3.33±0.52점으로 나타났다. 요인 별로는 대인관계 만족도 3.83±0.52점으로 가장 높았고, 직무 만족도, 교육 만족도, 소속 만족도, 근무환경 만족도, 여가 만족도, 이직 의도 순으로 나타났다. 임상병리사의 직무 만족도는 나이와 경력이 많아질수록, 정규직일수록 만족도가 높았다. 임상병리사의 직무 만족도를 높이고 이직 의도를 감소시키기 위해서는 직무만족도가 가장 낮고, 이직 의도가 가장 높은 20대, 경력 1-3년차의 정규직, 비정규직 모두에서 복지, 임금, 근무환경 등의 실질적인 변화를 고려해야 할 필요가 있으며, 이러한 요인 분석을 토대로 이직 의도를 파악하고 효율적인 인사정책을 수립하는데 초점을 맞춰야 할 것으로 사료된다.

• 대한족부족관절학회지
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• 제28권3호
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• pp.87-95
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• 2024

This study examined the levels of satisfaction from medical staff and patients by analyzing 691 Supreme Court precedents on medical practice from legal disputes in Korea, which are developing into a dual medical system. In addition, the issues that can be prevented in the medical field through the flow and judgment of legal disputes in medical practice after the revision of the medical law are discussed. The concept of medical practice not specified in the Medical Law was examined and compared with the medical-legal systems of Germany, Japan, and the USA through international comparative analysis to assess the illegal factors occurring in the medical field by analyzing the legal approach, medical practice, and medical personnel qualifications of each country. An analysis of the Supreme Court's case law revealed the timing analysis of issues in legal disputes related to medical practice, the incidence rate among the subjects of the cases, and medical personnel to be significant. The meaning was studied by finding the law that applied to it. Important cases were identified, and their meaning was reviewed. The legal issues of medical practice in orthopedics were divided into five sections based on precedents, such as problems in consent to information at the start of treatment, problems in prior radiography before treatment, explanation of the consent process for surgical treatment, problems related to the qualification of operators in the operating room, and the responsibility for postoperative results. In the wake of the recent major crisis in the government's medical reform policy (Essential medical package), procedural problems and legal reviews of illegal medical practices and their qualifications in the medical field were conducted because of the lack of medical personnel.

• Clinical and Experimental Pediatrics
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• 제46권11호
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• pp.1073-1079
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• 2003

목 적 : 1,500 gm 미만의 극소 저출생 체중아에서 호흡부전시 인공 호흡기 치료에만 의존하던 과거와는 달리 신생아 집중치료의 획기적 발전과 의료환경의 개선으로 새로운 관점에서 인공 호흡기 치료의 시도가 요구되고 있다. 저자들은 1998년부터 기관내 삽관율과 인공 호흡기 치료기간, 합병증 등의 연도별 변화가 있는지를 조사하여 향후 인공 호흡기 치료 방향에 기초적 도움을 주고자 본 연구를 시행하였다. 방 법: 1998년 1월부터 2001년 12월까지 본원 출생아로서 1,500 gm 미만의 극소 저출생 체중아이며 신생아 집중 치료실에서 입원 치료한 뒤 퇴원한 환아 274명을 대상으로 하였으며, 대상아는 병력지를 기초로 재태 연령과 출생 체중을 분석하였고, 인공 호흡기 치료군에서 분만 방법과 임상 특징, 원인 질환, 인공 호흡기 설정시 초기 조건, 사용 방법, 기간, 합병증 등을 후향적으로 분석하였다. 결 과 : 1) 연도별 재태 주수에 따른 인공 호흡기 치료 빈도의 변화 : 27-29주 미숙아의 경우 최근 4년간 인공 호흡기 치료군은 큰 변화 없이 극소 저출생 체중아의 약 76.1%에 해당되었다. 30-33주 미숙아의 경우는 최근 4년간 인공 호흡기 치료 빈도가 감소하는 추세로 1998년, 1999년에 각각 61.9%, 52.9%에서 인공호흡기 의존도를 나타냈으나 2000년에는 48.6%였고, 2001년에는 37.5%에서만이 인공 호흡기의 의존도를 나타내었다. 또한 전체 환아에서 1998년은 69.7%에서 인공 호흡기 치료를 받았으나, 2001년은 42.5%로 감소하였다 2) 인공 호흡기 치료군에서 임상적 특징 : 평균 재태 연령, 출생 체중은 큰 변화가 없었으며, 4년간 모두 반 수 이상에서 남아이고, 분만 방식으로 제왕 절개술에 의한 분만이 60% 이상이었으며, 최근 증가하는 추세이다. 원인 질환으로 중등도 신생아 호흡 곤란 증후군 단독인 경우가 60% 이상이었고, 신생아 호흡곤란 증후군과 동반된 가사 및 무호흡이 있었다 3) 인공 호흡기 치료군에서 동맥혈 가스 분석, 인공 호흡기 설정 및 호흡 지표의 변화 : $PaO_2$는 42.4-44.8 mmHg였고, 평균 기도압은 5.7-6.0 $cmH_2O$, 산소화 지수(OI)는 9.2-11.6이었으며, 인공 호흡기 치료 24-48시간 경과 후 시행한 동맥혈 가스 검사에서 $PaO_2$는 89.3-92.5 mmHg로 호전되었고, 평균 기도압은 4.4-4.7 $cmH_2O$로 낮아졌으며, 산소화 지수는 2.3-2.6 정도로 호전되었다. 4) 인공 호흡기 치료 평균 기간 : 인공 호흡기 치료 기간은 최근 4년간 뚜렷이 감소하는 추세로 7일 이상 장기간 인공 호흡기 치료를 받은 환아는 1998년에 23.9%에서 2001년에는 6.4%로 감소하였고, 4일에서 6일 동안 치료를 받은 경우는 1998년에 76.1%에서 2001년에 9.7%로 감소하였다. 또한 3일 이하의 단기간 치료를 받은 군은 1999년에 28.1%이던 것이 2001년에는 83.9%로 증가하였다. 연도별 평균 치료 기간도 1998년, 1999년에 각각 6.0일, 5.5일에서 2000년, 2001년에 3.6일, 2.7일로 감소하였다. 5) 인공 호흡기 사용 방법과 주요 합병증 : 1998년에는 HFV와 IMV에 의한 인공 호흡기 치료가 주였고, 2000부터 비강내 CPAP을 활성화 하였으며, 2001년에는 HFV와 IMV, 비강내 CPAP의 병용 사용이 35.4%로 늘어났다. 인공 호흡기 치료를 받은 환아들의 주요 합병증으로는 동맥관 개존이 가장 많았으며, 병기 3이상의 미숙아 망막증, grade III 이상의 뇌실내 출혈, 공기 누출 증후군, 만성 폐질환, 뇌실주위 백질연화증 순으로 나타났다. 결 론 : 1,500 gm 미만의 원내 출생한 극소 저출생 체중아의 경우 중증의 신생아 호흡곤란 증후군이 감소하는 추세에 있으며, 인공 호흡기 의존율과 치료 기간 역시 점차 낮아지는 경향이다. 따라서 비강내 CPAP의 조기 사용으로 기도 삽관을 통한 침습적인 인공 호흡기 치료관리 기회를 줄일 수 있을 것으로 기대된다.

• KDI Journal of Economic Policy
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• 제30권2호
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• pp.99-128
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• 2008

민간보험은 공적보험과 보완적인 관계를 형성함에도 불구하고 우리나라의 민간보험은 소득계층에 따른 접근성 차이로 인한 사회적 불평등, 도덕적 해이로 인한 공적보험 재정악화 등의 우려를 낳고 있다. 그러나 이에 관한 실증적 분석은 그간 이루어지지 못하여 정책적인 방향을 정립하는 데 장애가 되어 왔다. 본 연구는 건강보험공단, 심사평가원, 민간보험사, 행정자치부 주민등록세대정보 등의 관련 정보를 종합하여 이에 대한 실증분석을 시도했다. 그 결과, 우리나라의 민간보험 가입률은 전 국민의 64%에 달하고 있으며, 고소득층과 저소득층 간에 민간보험 가입률의 차이가 나타나지 않았다. 이는 공적보험의 보장성이 미흡한 상황에서 저소득층 역시 갑작스런 의료지출에 대비하고 있으며, 민간보험이 의료접근성의 계층화를 초래하지 않고 있다는 것을 시사한다. 또한 민간보험 가입자는 평균적으로 미가입자에 비해 의료이용량이 높지 않았으며, Two-Part Model을 통해 다양한 변수를 통제했을 경우에도 동일한 결과가 나타났다. 연령대에 따른 차이로 미루어 이러한 결과는 노동시장과 연관된 한시적인 성격일 것으로 추측되나, 현재로서는 민간보험 가입에 따른 도덕적 해이가 강하게 나타나고 있다는 근거는 발견되지 않았다.