• Journal of The Korean Society of Clinical Toxicology
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• v.4 no.2
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• pp.122-127
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• 2006

Purpose: It is not easy to detect carbon monoxide (CO) leakage, and CO-intoxicated patients do not show a specific set of symptoms. The aims of this study are to clinically evaluate patients with CO gas intoxication from a CO leak at an underground shopping center, and to discuss the establishment of a disaster prevention plan. Methods: A total of 51 patients intoxicated by CO gas exposure in a gas disaster at a underground shopping center in Seoul on September 8, 2006 were enrolled in this study, and the patients' medical records were retrospectively reviewed. Results: The mean patient age was $29.4{\pm}6.3$. The initial mean COHb level was $14.98{\pm}6.97%$. The number of patients with COHb greater than 25% was three, and six patients experienced a syncopal attack. Only one patient-was treated with hyperbaric oxygen therapy. However, none of the patients complained of severe neurologic or cardiovascular symptoms. Conclusion: The symptoms of CO intoxication are non-specific and difficult to define, and the detection of CO leak-age is difficult. Thus, workplaces should be equipped with leakage sensors and automatic alarm systems and should have develop disaster prevention plans.

• Journal of Preventive Medicine and Public Health
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• v.45 no.3
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• pp.127-136
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• 2012

The challenge facing the Korean National Health Insurance includes what to spend money on in order to elevate the 'value for money.' This article reviewed the changing issues associated with quality of care in the Korean health insurance system and envisioned a picture of an effective pay-for-performance (P4P) system in Korea taking into consideration quality of care and P4P systems in other countries. A review was made of existing systematic reviews and a recent Organization for Economic Cooperation and Development survey. An effective P4P in Korea was envisioned as containing three features: measures, basis for reward, and reward. The first priority is to develop proper measures for both efficiency and quality. For further improvement of quality indicators, an electronic system for patient history records should be built in the near future. A change in the level or the relative ranking seems more desirable than using absolute level alone for incentives. To stimulate medium- and small-scale hospitals to join the program in the next phase, it is suggested that the scope of application be expanded and the level of incentives adjusted. High-quality indicators of clinical care quality should be mapped out by combining information from medical claims and information from patient registries.

• Perspectives in Nursing Science
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• v.5 no.1
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• pp.1-15
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• 2008

Background: Recent changes in the medical environment have increased the need for the home health care nursing in Korea. Even though the number of home health care patients is increasing, the major nursing problems have not been identified due to lack of a standardized nursing diagnosis. Aim: An investigative study was conducted to determine the frequency and appropriateness of nursing problems in hospital-based home health care patients in Korea using two internationally standardized nursing diagnosis classification systems. Methods: Nursing records of 249 hospital-based home health care patients were reviewed and nursing problems were identified using the North American Nursing Diagnosis Association Nursing Diagnosis Taxonomy I (NANDA) and the Clinical Care Classification of Nursing Diagnoses (CCC). Findings: Out of 463 nursing problems. 403 nursing problems were described using the NANDA whereas 427 nursing problems were described using the CCC. Nursing diagnoses not captured by the NANDA classification include nausea/vomiting, anorexia, risk for nutrition deficit, decreased blood pressure, dying process, blood sugar impairment. infection unspecified, and disuse syndrome. Nursing diagnoses not captured by the CCC include nausea/vomiting and anorexia. Conclusions: In describing nursing problems of home health care patients, it was found that the CCC was able to represent more diagnoses than the NANDA.

• The KIPS Transactions:PartD
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• v.11D no.1
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• pp.229-240
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• 2004

The National Education Information System (NEIS), one of ERP systems developed by Ministry of Education & Human Resources Development, has been utilized in primary and secondary schools. In this paper, we considered the NEIS should be used not only for educational administration affairs, but also for a lifelong management of National Human Resource. The current School Information Management System (SIMS) is unsatisfactory due to the insufficiency of actual field suitability and user's conveniency. For solving such problems, the system rebuilding or revision should be accompanied by. As a guideline of revision and supplement of the SIMS, we suggest an application useful in both schools and clinics by the integrating healthcare management information of people. For this, we propose a lifelong healthcare information management by integrating Student Health Records of the NEIS with Electronic Medical Records of doctors' offices. The healthcare information is designed and represented in XML. We applied different XSL style-sheets to XML documents in order to offer a view suitable for demands of schools and clinics. The healthcare information can be managed and utilized efficiently by using the view. We ascertained that the lifelong Healthcare Information Management System is an improvement to overcome the inefficiency of healthcare information management and the connection inadequacy between schools and medical institutions, and is desirable for a lifelong management of the National Human Resource.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.21 no.4
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• pp.392-402
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• 2014

Purpose: This study was done to investigate the status of disinfection and sterilization in healthcare facilities. Method: A survey of 193 Korean healthcare facilities was conducted from February 8 to March 7, 2013. Data were analyzed using descriptive statistics, ${\chi}^2$ test, Fisher's exact test, one-way ANOVA, Scheffe with SPSS WIN 18.0. Results: Of the healthcare facilities 93.2% had specific guidelines for disinfection/sterilization, but only 47.9% had a committee on disinfection/sterilization for decision-making, less than half (42.7%) conducted regular monitoring of actual practices, while 83.9% had established procedures for recovery in case of problems with the disinfection process and 89.0% kept records and archives of disinfection practices. Cleaning process, selection of chemical disinfectants and process of disinfection and sterilization were found to be inadequate in some healthcare facilities. Perception score for adequacy of medical instruments was 8.10, environmental disinfection was 7.20, and sterilizer management was 8.45 out of a possible 10. Conclusion: Compared to larger institutions, smaller healthcare facilities had less effective disinfection and sterilization management systems, while some facilities showed inadequate practices for medical equipment and general sterilization. Better academic and state-level support is recommended for smaller facilities in order to establish a better system-wide management system.

• Journal of The Korean Society of Clinical Toxicology
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• v.9 no.2
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• pp.95-100
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• 2011

Purpose: Ingestion of puffer fish can be poisonous due to the presence of potent neurotoxins such as tetrodotoxin (TTX) found in its tissues. There are few clinical reports related to TTX. We performed this study to evaluate the clinical characteristics of TTX poisoning. Methods: We conducted a retrospective study of the 41 patients diagnosed with TTX poisoning who visited the Seoul Asan medical center from July 2004 and December 2010. A review of patients' electronic medical records and patient telephone interviews were conducted. Diagnosis of TTX poisoning was confirmed by observing the casual link between puffer fish consumption and the development of typical TTX intoxication symptoms. Results: The mean age of the patients included in the study was 46.6 years. The highest incidence of intoxication was observed in patients in their 50s (10 patients). Seasonal distribution of intoxication events included 10 in spring, 7 in summer, 10 in fall, and 14 in winter. In most cases, symptoms occurred within 1 hour of ingestion. A wide range of symptoms were associated with puffer fish ingestion affecting multiple body systems including neuromuscular (27 patients), gastrointestinal (19 patients), and cardiopulmonary/vascular (19 patients). All patients were treated with symptomatic and supportive therapy and recovered completely, without sequelae, within 48 hours. In three cases, ventilator support was required. Conclusion: TTX poisoning is not seasonally related, and patients admitted to the emergency room were observed with a wide range of symptoms. Where TTX poisoning is diagnosed, supportive therapy should be performed. Early intubation and ventilation is important, especially is cases of respiratory failure.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.21
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• pp.9529-9534
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• 2014

Background: Cancer staging enables planning for the best treatments, evaluation of prognosis, and predictions for survival. The Collaborative Stage (CS) system makes it possible to significantly reduce the proportion of patients labeled at an "unknown" stage as well as discrepancies among different staging systems. This study aims to analyze the factors that influence the accuracy and validity of CS data. Materials and Methods: Data were randomly selected (233 cases) from stomach cancer cases enrolled for CS survey at the Korea Central Cancer Registry. Two questionnaires were used to assess CS values for each case and to review the cancer registration environment for each hospital. Data were analyzed in terms of the relationships between the time spent for acquisition and registration of CS information, environments relating to cancer registration in the hospitals, and document sources of CS information for each item. Results: The time for extracting and registering data was found to be shorter when the hospitals had prior experience gained from participating in a CS pilot study and when they were equipped with full-time cancer registrars. Evaluation of the CS information according to medical record sources found that the percentage of items missing for Site Specific Factor (SSF) was 30% higher than for other CS variables. Errors in CS coding were found in variables such as "CS Extension," "CS Lymph Nodes," "CS Metastasis at Diagnosis," and "SSF25 Involvement of Cardia and Distance from Esophagogastric Junction (EGJ)." Conclusions: To build CS system data that are reliable for cancer registration and clinical research, the following components are required: 1) training programs for medical records administrators; 2) supporting materials to promote active participation; and 3) format development to improve registration validity.

• Journal of Korean Neurosurgical Society
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• v.57 no.6
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• pp.455-459
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• 2015

Objective : A cost comparison of the surgical clipping and endovascular coiling of unruptured intracranial aneurysms (UIAs), and the identification of the principal cost determinants of these treatments. Methods : This study conducted a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of UIAs between January 2011 and May 2014. The medical records, radiological data, and hospital cost data were all examined. Results : When comparing the total hospital costs for surgical clipping of a single UIA (n=188) and endovascular coiling of a single UIA (n=188), surgical treatment [$mean{\pm}$standard deviation (SD) : \$8,280,000{\pm}1,490,000$] resulted in significantly lower total hospital costs than endovascular treatment ($mean{\pm}SD$ : \$11,700,000{\pm}3,050,000$, p<0.001). In a multi regression analysis, the factors significantly associated with the total hospital costs for endovascular treatment were the aneurysm diameter (p<0.001) and patient age (p=0.014). For the endovascular group, a Pearson correlation analysis revealed a strong positive correlation (r=0.77) between the aneurysm diameter and the total hospital costs, while a simple linear regression provided the equation, y (\)=6,658,630+855,250x (mm), where y represents the total hospital costs and x is the aneurysm diameter. Conclusion : In South Korea, the total hospital costs for the surgical clipping of UIAs were found to be lower than those for endovascular coiling when the surgical results were favorable without significant complications. Plus, a strong positive correlation was noted between an increase in the aneurysm diameter and a dramatic increase in the costs of endovascular coiling.

• Korean Journal of Clinical Pharmacy
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• v.27 no.3
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• pp.143-149
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• 2017

Background: L-asparaginase (L-ASP) is a critical agent for the treatment of acute lymphoblastic leukemia and lymphoma, which is associated with serious toxicities including hypersensitivity, pancreatitis and thrombosis. Methods: To evaluate the toxicity of L-ASP in real clinical settings, we included the patients with L-ASP adverse drug reactions (ADRs) reported in a regional pharmacovigilance center of Seoul St. Mary's hospital from January 2014 to December 2015. Results: A total of 83 cases of L-ASP related ADRs were reported in 54 patients. Of these 83 cases, 65 cases (78.3%, 65/83) were spontaneously reported and 18 cases (21.7%, 18/83) were detected by further medical records review. Of the patients with ADRs, pediatric patients accounted for 83.3% of the cases (45/54) and median age was 9 years. The most common clinical manifestations of ADRs were hematology manifestations (31.3%, 26/83), followed by hepatobiliary manifestations (18.1%, 15/83). Thirty-four serious ADRs were reported in 19 patients. The sserious ADR group showed significantly longer hospitalization and higher rate of discontinuation of L-ASP than the non-serious ADR group (p = 0.005, 0.03). The most common clinical manifestations of serious ADRs were hepatobiliary manifestations (41.2%, 14/34). In total, 8 cases (9.6%, 8/83) of unlabeled ADRs were identified. They were serious ADRs. Conclusion: We identified unlabeled serious ADRs of L-ASP. Also, correlations were observed between serious ADRs and length of hospitalization, discontinuation rate respectively. Further investigations and developed spontaneous ADR reporting systems are needed to evaluate these correlations.

• Journal of the Korean Institute of Intelligent Systems
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• v.23 no.4
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• pp.292-297
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• 2013

In this paper, unusual waveform detection algorithm based on Refractory Period in arrhythmia ECG signal is proposed. Most of arrhythmia ECG signals consist of unusual waveforms with average 10% rate. Thus tremendous benefit can be obtained in terms of time and cost by providing unusual waveform samples reduced more than 90% to medical staffs who have to monitor and analyze for a long time. The proposed algorithm detects the R-peak using the features of R wave and variable refractory period. For the detected R-peak, unusual waveforms are found using means and standard deviation of electric potential and kurtosis of the R-peaks which are not included in unusual waveform. The proposed algorithm was applied to all records of the MIT-BIH arrhythmia database and showed more than average 90% of compression ratio.