• Journal of Korean Medicine Rehabilitation
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• v.30 no.2
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• pp.139-152
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• 2020

Objectives To explore the traffic injury patients' experience on health care utilization of Korean Medicine (KM) practice and perception of health care system for developing a Korean medicine clinical practice guideline (CPG) of traffic injuries by survey method. Methods Two hundred ten patients in suffering from traffic injuries were surveyed from September 1st, 2019 to January 31th, 2020 at 2 University Hospitals (Pusan National Korean Medicine Hospital and Kyung Hee Korean Medicine Hospital at Gangdong) and 1 Spine Specialty Hospital (Jaseng Hospital of Korean Medicine). A structured questionnaire of experience on health care utilization of KM practice and perception of health care system of was distributed to responders by visits and all data were statistically analysed. Results Survey results showed high satisfaction of patients with the experience of KM treatments in order of daoyin exercise (7.8±2.3), chuna manual therapy (7.7±4.0), pharmacoacupuncture (7.4±3.0) etc. Safety concerns were reported in 9.1% subjects and 205 (97.6%) patients answered that collaboration with KM and western medicine is necessary for patients with traffic injuries. For the patients' requirement for extending insurance coverage, the most required therapy was chuna manual therapy (57.5%) and pharmacoacupuncture (42.0%). Conclusions This study presented the realistic patient-centered perception of KM practice and health care system in Korea. These results will provide basic data to be reflected in the process of adaptation for the revision of Korean Medicine CPG for traffic injuries.

• Tuberculosis and Respiratory Diseases
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• v.83 no.3
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• pp.242-247
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• 2020

Background: The purpose of this study was to evaluate the long-term survival rates of very elderly (age ≥80) critically ill patients admitted to a medical intensive care unit (MICU) at a regional tertiary-care hospital in Korea. Methods: We retrospectively analyzed data from patients who survived after discharged from the MICU of our hospital. Survival rates at 90 days, 1 year, 2 years, and 3 years were assessed between patients age ≥80 and those age <80. Survival status was evaluated using the National Health Insurance Service data. Results: A total of 468 patients were admitted, 286 (179 males, 97 females; mean age, 70.18±13.2) of whom survived and were discharged soon after their treatment. Among these patients, 69 (24.1%) were age ≥80 and 217 (75.9%) were age <80. The 90-day, 1-year, 2-year, and 3-year survival rates of patients age ≥80 were significantly lower than those in patients age <80 (50.7%, 31.9%, 15.9% and 14.5% vs. 68.3%, 54.4%, 45.6%, and 40.1%, respectively) (p<0.01). The Kaplan-Meier survival curves showed significantly lower survival rates in patients age ≥80 than in those age <80 (p=0.001). Conclusion: The poor rates of long-term survival in very elderly (age ≥80) and critically ill patients admitted to an ICU should be considered while managing and treating them.

• Korea Journal of Hospital Management
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• v.12 no.3
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• pp.120-144
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• 2007

In 1997, in the course of overcoming economic crisis caused by the shortage of foreign currency there was a significant phenomenon, the irregularization of human labour resources. There was no exception in hospital, either. Most hospitals put a lot of thought to solve the problem about irregular workers. Between employee and employer the problem of irregular workers has been raised as a main topic of all. The objectives of this study were to inspect the actual state of irregular workers and to understand the positive effect of protecting irregular workers, recently established and revised, on the human resources management of hospitals. After enacting irregular labours protection acts there were many opinions that the labour rules of hospitals would be changed.(56.7%). The plan to solve irregular worker's wage issues would he carried out step by step, but some hospitals have not examined the plan yet,(81.9%). Many hospitals had a plan that irregular worker's wage would be actualized in two or three years.(78.3%) The method, to solve the problem of irregular workers arc as follows: 1) the introduction of functional wage system, 2) the convert from automatic rising wage system to annual wage system, 3) the incentive grade system according to management result, 4) lower functional group wage system, 5) non-term contract wage system. From the point of the opening medical market and securing competitive power of hospitals, it is prospected that irregular works would be increased also in future. So to manage irregular workers effectively would be essential in maintain hospital's competitive power and improve medical service. The result, of this study were a, follow: (1) In hospital, the ratio of irregular workers in hospitals was lower than that of all irregular workers in Korea. (2) In hospital, the wage level of irregular workers was higher than that of irregular workers in Korea. (3) In hospital, the social insurance application ratio of irregular workers was higher than that of all workers in Korea. (4) In hospital, there seems to be no appropriate and active measures to improve labour condition of irregular workers, yet. (5) In many hospitals, the policy of irregular workers would be expected to revised for the law standards. In this study the actual conditions and problems of irregular workers were proposed and it was expected to contribute decisions-making in hospital management, especially when using human resources.

• Korean Journal of Biological Psychiatry
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• v.26 no.2
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• pp.39-46
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• 2019

Antidepressants are widely used to treat depression in Korea, however, only a few studies have focused on the provider of the treatment. The aim of the study is to compare the differences between patients who were prescribed antidepressants by psychiatrists and those who were prescribed antidepressants by non-psychiatrists in South Korea. Patients with a diagnosis of depressive disorder who had been newly prescribed antidepressants in 2012 were selected from the Health Insurance Review and Assessment Service database. They were classified into two groups depending on whether they received the antidepressant prescription from a psychiatrist or non-psychiatrist. Sociodemographic, clinical, and depression related cost has been investigated. Treatment resistant depression, which is defined as a failure of two antidepressant regimens to alleviate symptoms, was also investigated. Prescription adequacy was assessed based on whether a regimen was maintained for at least 4 weeks. Among the 834694 patients with pharmaceutically treated depression (PTD) examined in this study, 326122 (39.1%) were treated by psychiatrists. Patients who were treated by psychiatrists were younger and had more psychiatric comorbidities than those treated by non-psychiatrists. They had longer PTD duration (229.3 days vs. 103.0 days, p < 0.05) and a larger proportion of treatment resistant depression (9.3% of PTD) when compared to those patients treated by non-psychiatrists. The patients treated by psychiatrists had a smaller proportion of inadequate antidepressant use compared to those patients in the non-psychiatrist group (44.5% vs. 65.1%, p < 0.05). The costs related to depression corrected with PTD duration were higher in the non-psychiatrist group (32214 won vs. 56001 won, p < 0.05). Patients who receive antidepressants from psychiatrists are patients with more severe, treatment-resistant depression. Psychiatrists prescribe antidepressants more adequately and cost- effectively than non-psychiatrists.

• The Journal of Korea Institute of Information, Electronics, and Communication Technology
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• v.13 no.3
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• pp.219-225
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• 2020

With the aging population, the prevalence of musculoskeletal disorders in the elderly continues to increase. In addition, musculoskeletal disorders are the third most common social and economic loss among occupational illnesses in Workers' compensation insurance benefits as of 2015 standard and are also common among workers. In this study, a vest that can assist in the prevention and treatment of musculoskeletal disorders of the waist was produced, and it is intended to confirm the presence or absence of the effect through experiments. Diseases of the waist are closely related to core muscles. Therefore, the produced vest was made in a form that supports the core muscles. Before and after wearing the vest for effectiveness verification, the While performing 10-times of the Mackenzie exercises, a waist extension exercise, collected the EMG data of the internal oblique, Rectus abdominis, and Erector spinae, which correspond to the core muscles. The collected data were analyzed through the electromyography analysis program RM-3 to obtain RMS values for 10-times measurements of each muscle and to compare the average values. After comparing the data, to verify the significance, the technical statistical value of the measurement result was calculated and the average difference was verified through PASW ver18.0, And the paired t-test is performed on the experimental results to perform statistical processing. and Statistical processing was performed by setting the significance level to α=.05.

• Korean Journal of Oriental Medicine
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• v.16 no.1
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• pp.119-134
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• 2010

Objectives & Method：Based on the statistic from January 2008 to December 2008 include 66-year-old 375 people (159 men, 216 women) who got examined in National Health Insurance Corporation, this study set a goal to establish a new health index by analyzing the relation between the cardio-cerebra vascular disease and risk factor such as obesity, smoking, exercise, alcohol consumption, blood pressure, blood sugar and cholesterol. Results：1) Examine results, health status according to gender；People who are diagnosed as abnormal health status have higher risk for both men and women. As for the detailed diseases, high blood pressure was highest followed by hyperlipidemia and obesity. In case of the women, 96.3% in bone mineral density was highest. 2) Correlation of disease and health risk factors based on gender；Correlation of disease according to gender in the obesity(p<0.001), lipid abnormalities(p<0.001), kidney diseases(p<0.001), chest diseases(p<0.05), osteoporosis(p<0.001) showed a statistically significant difference. The analysis showed that the men have more obesity and lipid abnormalities as well as thoracic disease than the women, but the women have more kidney disease than the men. As for the osteoporosis examine which is conducted only for the women, most of the women were abnormal even though it cannot compare the result according to gender. Obesity(p<0.001), alcohol(p<0.001), smoking(p<0.001) and LDLcholesterol(p<0.001) showed statistical correlation between gender and health risk factor. And only high blood pressure(p<0.001) showed a statistical correlation between gender and risk of cardio-cerebra vascular disease. 3) Risk of cardio-cerebra vascular disease related to health risk factor characteristic；Obesity assessment(p<0.001), alcohol(p<0.05), smoking(p<0.05), blood pressure(p<0.001), glucose(p<0.001) showed correlation between health risk factor and stroke. Drinking(p<0.001), smoking(p<0.05), exercise(p<0.001), blood pressure(p<0.001), LDL cholesterol(p<0.001) showed health risk factor and myocardial infarction. Obesity assessment(p<0.001), smoking(p<0.05), blood pressure(p<0.001), glucose(p<0.001) and showed correlation between health risk factor and diabetes. Obesity assessment(p<0.001), blood pressure(p<0.001) showed correlation between health risk factor and high blood pressure. Conclusion：Therefore, we have to take one step farther after the health examination. In order to prevent and reduce the risk of disease, people have to understand their health status exactly first, and correct their habit with recognizing the amount of risk related to cardio-cerebra vascular disease.

• Journal of Preventive Medicine and Public Health
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• v.35 no.2
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• pp.99-106
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• 2002

Objective : Until now, there have been no evidence-based guidelines produced for the mass screening of hyperlipidemia cases in Korea. This study was done to find the most efficient strategy for a hyperlipidemia-screening program among Korean adults, Method : Seven alternative strategies for hyperlipidemia screening were formulated and compared ir terms of cost-effectiveness. Cost and effectiveness were estimated from social perspectives and using a two-stage screening process (initial testing and additional testing for positives from the first test). A computerized database (based on persons who had visited a health promotion center in one teaching hospital for a routine health check-up) was used to determine the cost and the outcome of various strategies. Official data was used in calculating direct and indirect costs. Effectiveness was measured according to the number of persons who needed clinical intervention for hyperlipidemia. A stratified analysis, considering age group and sex, was then done. Sensitivity analyses, focusing on several uncertain parameters, were also done. Results : Of the seven test alternatives available, the most cost-effective strategy was a screening program, which consisted of an initial test of total cholesterol, high-density lipoprotein cholesterol and triglyceride. There was some variation in the rank of the cost-effectiveness ratios for the seven alternatives dependent on age group or gender. Conclusions : Current hyperlipidemia screening practice, for National Health Insurance beneficiaries, tests only the total cholesterol level with a cut-off value of 260mg/dl as an initial screening test. It is not the best strategy for cost-effectiveness, and should be modified. Different screening strategies taking age group and sex into account should be developed and used for the efficient mass screening of hyperlipidemia cases among Korean adults.

• Journal of The Korean Society of Clinical Toxicology
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• v.8 no.2
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• pp.88-96
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• 2010

Purpose: Doxylamine is antihistamine drug that is used as a hypnotic. It is also used for suicidal attempts because it can be easily purchased at the pharmacy without a prescription. There were many articles about the complications after doxylamine intoxication such as a rhabdomyolysis, but only a few articles have reported on seizure. We reviewed the cases of doxylamine intoxication with seizure that were treated in the emergency department. Methods: We reviewed the medical records of the patients who were over 15 years old and who were intoxicated by doxylamine at 3 emergency medical centers from January 2006 to June 2010. We reviewed the patients' age, gender, the dose of doxylamine ingested, if gastrointestinal decontamination was done, the time from intoxication to hospital arrival, the seizure history, treatment of seizure, the electroencephalography (EEG) results, the brain computed tomography (CT) results and the blood test results. Results: There were 168 patients who were intoxicated by doxylamine during the study period. Twelve patients had a seizure episode. The differences between the patients who developed seizure and the patients who did not were the dose and the serum levels of sodium and creatinine. The only clinically meaningful difference was the amount of doxylamine. The amount of doxylamine ingested (>29 mg/kg) predicted the development of seizure with a sensitivity of 75% and a specificity of 92% on the ROC curve. One patient among the seizure patients expired in the emergency department. Conclusion: In case of doxylamine intoxicated patients, there is close relationship between seizure and ingested amount, so close observation needs to be done for the patients who ingest too much because doxylamine can cause death. Further prospective studies are needed for doxylamine intoxicated patients with a seizure episode.

• The Journal of Korean Medicine
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• v.40 no.3
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• pp.59-75
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• 2019

Objectives: The purpose of this study is to examine the current status of Korean medicine health technology assessment and explore realistic plans to activate it. Methods: We investigated all the applications for new health technology assessment related to Korean medicine from 2007 to 2016. The several expert meetings were held to draw out the barriers and improvement strategies of the new health technology assessment of Korean medicine field. Results: There were 31 cases in total except for duplications or reapplies falling into 3 main types. First, 19 of them were to try to enter a medical market and be covered by National Health Insurance. Eight cases were to apply western medicine technology as new health technology in Korean medicine area. The rest was 4 cases, which were totally not appropriate for the purpose of new health technology assessment system. According to the expert opinion, the obstacles of activation in new health technology assessment of Korean medicine were application of unstandardized technology, lack of understanding and experience, lack of clinical trial supporting system for Korean medicine, lack of committee members within the nHTA(new Health Technology Assessment) review board, ambiguous definition of medical practice and sharp conflict between western medicine and Korean medicine. Conclusions: Several suggestions were derived. First of all, to activate Korean medicine in the nHTA system, the existing system should be used sufficiently, and multifaceted efforts are needed to upgrade the system, if necessary. Also, self-help efforts, Korean medicine clinical trial supporting system and increasing R&D investment, establishing extra-committee for Korean medicine in nHTA could be needed. Finally, long-term strategy for improving collaboration between Korean medicine and western medicine should be considered.

• Journal of Korean Society of Health-System Pharmacists
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• v.35 no.4
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• pp.409-417
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• 2018

Background : Febrile neutropenia (FN) is one of the side effects in the patients treated with chemotherapy, and the patients who have FN generally need immediate treatment with extended-spectrum antibiotics and hospitalization. Pegfilgrastim and pegteograstim, which are used for the prevention of FN as a granulocyte-colony stimulating factor (G-CSF), have been granted insurance coverage in the Republic of Korea for certain breast cancer patients using doxorubicin and cyclophosphamide (AC) from September 2016. Methods : The data of the patients with breast cancer using AC regimen and G-CSF were collected retrospectively. This study involves cost-utility analysis of pegfilgrastim and pegteograstim. In this study, we constructed a simple decision tree model for short-term observation and calculated quality-adjusted life year (QALY) and the direct medical costs from the medical provider's perspective. Results : From September 2016 to May 2017, 15 patients were treated with pegfilgrastim and 15 patients were treated with pegteograstim. As a result of dividing the average cost by QALY for each treatment group, it was observed that pegfilgrastim and pegteograstim were consumed 24,923,384 won and 22,808,336 won per 1QALY, respectively. Consequently, incremental cost effectiveness ratio (ICER) showed 2,115,048 won more per pegfilgrastim than pegteograstim per 1QALY, and the cost per 1QALY of both the drugs was lower than 30,500,000 won; the Koreans were willing to pay this amount. Conclusions : This study suggests that pegfilgrastim and pegteograstim can be used to improve the quality of life of breast cancer patients undergoing AC therapy. Among the two drugs, pegteograstim seems to be more cost-effective. However, since this study was conducted as a retrospective observation method on a small scale, it is associated with many limitations. Therefore, a long-term prospective cohort study is needed to supplement the present findings.