• Journal of Hospice and Palliative Care
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• 제24권4호
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• pp.254-260
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• 2021

Continuous deep sedation (CDS) is an extreme form of palliative sedation to relieve refractory symptoms at the end of life. In this study, we shared our experiences with CDS and examined the clinical characteristics associated with survival in patients with terminal cancer who received CDS. We conducted a chart audit of 106 consecutive patients with terminal cancer who received CDS at a single hospice care unit between January 2014 and December 2016. Survival was defined as the first day of admission to the date of death. The associations between clinical characteristics and survival were presented as hazard ratios and 95% confidence intervals using a Cox proportional hazard model. The mean age of participants was 65.2 years, and 33.0% (n=35) were women. Diazepam was the most commonly administered drug, and haloperidol or lorazepam were also used if needed. One sedative was enough for a majority of the patients. Stepwise multivariate analysis identified poor functioning, a high Palliative Prognostic Index score, hyperbilirubinemia, high serum ferritin levels, and a low number of sedatives as independent poor prognostic factors. Our experiences and findings are expected to be helpful for shared decision-making and further research on palliative sedation.

• Journal of Yeungnam Medical Science
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• 제30권2호
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• pp.73-78
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• 2013

An institutional review board (IRB) should independently safeguard the right, safety, and well-being of all clinical trial subjects. It should consist of members who are qualified and experienced to review and evaluate the science, medical aspects, and ethics of the proposed trial. They have to pursue continuing efforts to improve the standards of review. The levels of review include the full board review, expedited review, continuing review, or exempt from review, while the levels of decision-making include approval, conditional approval, deferred approval, and disapproval. Investigators must follow the approved protocols and regulations honestly, and it is the IRB's mission to audit clinical trial sites as well.

• 대한방사성의약품학회지
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• 제1권2호
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• pp.98-103
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• 2015

Good manufacturing Practice (GMP) regulation for diagnostic and therapeutic radiopharmaceuticals was prepared at 2014. The mandatory GMP regulation becomes effective on $1^{st}$, July 2015,with two years of grace periods. Korean radiopharmaceuticals GMP regulation was consisted of quality management, personnel, premise and facility, documentation, production, quality control and self-audit and they have a very similar structure to European Union and PIC/S GMP regulation. Here, we describe detailed description of GMP regulation each part and application to radiopharmaceuticals production. And we also compare Korea, Japan and USA radiopharmaceuticals GMP regulation. GMP is a method to maintain quality of radiopharmaceuticals in daily production and it must be embedded on the manufacturing operation and management.

• 한국IT서비스학회지
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• 제21권4호
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• pp.63-74
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• 2022

Globally researchers at medical institutions are actively sharing COHORT data of patients to develop vaccines and treatments to overcome the COVID-19 crisis. OMOP-CDM, a common data model that efficiently shares medical data research independently operated by individual medical institutions has patient personal information (e.g. PII, PHI). Although PII and PHI are managed and shared indistinguishably through de-identification or anonymization in medical institutions they could not be guaranteed at 100% by complete de-identification and anonymization. For this reason the security of the OMOP-CDM database is important but there is no detailed and specific OMOP-CDM security inspection tool so risk mitigation measures are being taken with a general security inspection tool. This study intends to study and present a model for implementing a tool to check the security vulnerability of OMOP-CDM by analyzing the security guidelines for the US database and security controls of the personal information protection of the NIST. Additionally it intends to verify the implementation feasibility by real field demonstration in an actual 3 hospitals environment. As a result of checking the security status of the test server and the CDM database of the three hospitals in operation, most of the database audit and encryption functions were found to be insufficient. Based on these inspection results it was applied to the optimization study of the complex and time-consuming CDM CSF developed in the "Development of Security Framework Required for CDM-based Distributed Research" task of the Korea Health Industry Promotion Agency. According to several recent newspaper articles, Ramsomware attacks on financially large hospitals are intensifying. Organizations that are currently operating or will operate CDM databases need to install database audits(proofing) and encryption (data protection) that are not provided by the OMOP-CDM database template to prevent attackers from compromising.

• Asian Pacific Journal of Cancer Prevention
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• 제16권2호
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• pp.395-400
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• 2015

Both Japan and Korea provide population-based screening programs. However, screening rates are much higher in Korea than in Japan. To clarify the possible factors explaining the differences between these two countries, we analyzed the current status of the cancer screening and background healthcare systems. Population-based cancer screening in Korea is coordinated well with social health insurance under a unified insurer system. In Japan, there are over 3,000 insurers and coordinating a comprehensive strategy for cancer screening promotion has been very difficult. The public healthcare system also has influence over cancer screening. In Korea, public healthcare does not cover a wide range of services. Almost free cancer screening and subsidization for medical cost for cancers detected in population-screening provides high incentive to participation. In Japan, on the other hand, a larger coverage of medical services, low co-payment, and a lenient medical audit enables people to have cancer screening under public health insurance as well as the broad range of cancer screening. The implementation of evidence-based cancer screening programs may be largely dependent on the background healthcare system. It is important to understand the impacts of each healthcare system as a whole and to match the characteristics of a particular health system when designing an efficient cancer screening system.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제40권6호
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• pp.272-277
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• 2014

Objectives: Non-vascularized iliac crest bone graft (NVIBG) is a known treatment option in mandibular reconstruction following jaw resection, but no documented review of patients treated with NVIBG exists for northern Nigeria. The experience and technique from a Nigerian tertiary hospital may serve as baseline data for comparison and improvement of practice for other institutions. Materials and Methods: A retrospective review of medical records and patient case files from January 2012 to December 2013 was undertaken. All case files and other medical records of patients who had reconstruction with NVIBG for benign or malignant lesions with immediate or delayed reconstruction were selected for review. Results: Twenty patients had mandibular reconstruction with NVIBG during the study period. Two patients were excluded because of incomplete medical records. Eighteen patients' (male=14, female=4) records were reviewed. Their ages ranged from 13 to 62 years (mean $26.0{\pm}10.6years$). Indications for NVIBG included jaw tumors (n=16; 88.3%), jaw cyst (n=1; 5.6%) and gunshot injury (n=1; 5.6%). Jaw tumors seen were ameloblastoma (n=15; 83.3%) and osteosarcoma (n=1; 5.6%). Treatments done were mandibular resection with condylar resection (n=7; 38.9%), mandibular segmental resection (n=10; 55.6%) and subtotal mandibulectomy (n=1; 5.6%). Patients' postoperative reviews and radiographs revealed good facial profile and continued bone stability up to 1 year following NVIBG. Conclusion: NVIBGs provide an acceptable alternative to vascularized bone grafts, genetically engineered bone, and distraction osteogenesis for mandibular reconstruction in resource-limited centers.

• 한국병원경영학회지
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• 제25권4호
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• pp.38-47
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• 2020

Purposes: The problem in the recent immigration policy and social policy changes for foreigners is that the preliminary analysis or research on the actual impact of the influx of foreigners has not been done enough in Korea yet.. This study is to examine the impact of the Korean health insurance finances on the influx of foreigners. Approach: This study analyzed the health insurance statistics for foreigners and overseas Koreans of the Health Insurance Corporation from 2013 to 2017. The data is the "Status of Health Insurance Premiums for Nationals, Foreigners, and Overseas Koreans from 2013 to 2017" submitted by the National Health Insurance Service to the Health and Welfare Committee during the 2018 National Audit Period. Findings: To summarize the analysis, first, the proportion of foreigners was only 1% of all subscribers (1.7% at work, 1.9% in regions) until 2017. Second, employees at work have a lower pay-to-pay ratio, and local subscribers have a higher pay-to-pay rate, regardless of nationality. Third, as immigrants are mostly concentrated in younger ages, they are healthy and use of hospitals is relatively low. Fourth, in terms of gender distribution, there are many women of childbearing age due to marriage immigration among foreign local subscribers, and more men use hospitals than workers who have a high proportion of males due to childbirth. In conclusion, the impact of immigration on health insurance finances is not large, and has a positive effect on finances. Practical Implications: If we simply consider the financial aspect, encouraging foreigners to subscribe to health insurance has a positive effect on finances. In particular, the more foreign workers are enrolled, the greater the financial gain. In particular, increasing the employment of foreign women through language education, vocational training, and employment support will help finance health insurance. One of the reasons foreign subscribers have a positive impact on health insurance finance is the low medical utilization rate. It can be said that young and healthy foreigners use fewer hospitals and clinics, but another aspect means that foreigners have difficulty using health insurance for various reasons. Therefore, various supports must be accompanied so that foreign subscribers can use medical services when necessary.

• 보건의료산업학회지
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• 제9권1호
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• pp.157-168
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• 2015

A majority of menopausal women experience serious depressive symptom because they are disturbed by their menstruation stop and by multiple physiological symptoms. The purpose of this study is to analyze the related factors of depressive symptom of menopausal women in Korea. A multiple regression model was used to study in association with depressive symptom, controlling for socio-economic characteristics, health status and behavior characteristics, women's health, and family support characteristics. For the data, Menopausal women were 4,680 peoples were selected for this study. PASW 18.0 was used to study in association with affecting factors of depressive symptom in the menopausal women The study shows that Education level, Marital status, Income, Employment status, Activity limitations, Perceived health status, Perceived body Image recognition, Current smoking, AUDIT, Frequency of induced abortion, Frequency of eating out, Breakfast with family, Lunch with family were associated with depressive symptom of menopausal women in Korea.

• 한국보건간호학회지
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• 제32권2호
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• pp.304-318
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• 2018

Purpose: This study examined the characteristic of the Injury Severity Score (ISS) of Korean geriatric patients with a traumatic injury in a nationally representative sample to determine the optimal cutoff of ISS of mortality according to age. Methods: The subjects were 3,018 non-elderly patients and 1,584 elderly patients with an ISS and Korean Triage and Acuity Scale (KTAS) in 2016 from the data of the Health Insurance Review and Assessment Service. The traumatic characteristics of the elderly and non-elderly were compared by stratifying the ISS. Receiver Operating Characteristic (ROC) curve analysis was used to find the optimal cutoff of ISS of mortality according to age. Results: The elderly were more prone to severe trauma than the non-elderly were. The distribution of KTAS grades was lower, even though the severity of ISS was as high as that of the non-elderly. The optimal cutoff score of the ISS for mortality in the ROC curve was lower in elderly over 65 years than in the other age group. Conclusion: The elderly are more prone to severe trauma and death than non-elderly, even though their ISS is low. Therefore, a strategy to prevent elderly from experiencing serious trauma and managing their geriatric trauma actively is needed.

• 한국의료질향상학회지
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• 제1권1호
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• pp.66-94
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• 1994

Hospital Accreditation Programme(HAP) has been introduced in many countries in the world for these recent years. This article reviews the HAP in the aspects of the organization, survey and evaluation process, evaluation criteria, and its impact to the hospital quality improvement. The nations included in this study are USA, UK, Canada, Australia, and Korea. To carry out this comparative study, the authors have reviewed articles and accreditation manuals having been issued in many countries. An expert panel of medical doctor, nurse, pharmacist, administrator, and specialist in health facilities formulated a study framework. The results of this study enhance understanding about hospital accreditation activities according to each nation's health care system. In recent years, the Korean government has launched the plan to improve the quality of health services by strengthening the hospital accreditation programme. This study results can provide useful information in development and implementation of the national hospital accreditation programme in Korea.