• Journal of Korean Neurosurgical Society
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• v.59 no.2
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• pp.161-164
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• 2016

Few preoperative extrapontine myelinolysis (EPM) cases with pituitary adenoma have been reported. No such case had long follow-up to see the outcome of EPM. We reported a 38-year-old man complaining of nausea, malaise and transient loss of consciousness who was found to have severe hyponatremia. Neurologic deficits including altered mental status, behavioral disturbances, dysarthria and dysphagia developed despite slow correction of hyponatremia. Endocrine and imaging studies revealed hypopituitarism, nonfunctional pituitary macroadenoma and extrapontine myelinolysis. Transsphenoidal surgery was performed after three weeks of supportive therapy, when neurological symptoms improved significantly. The patient recovered function completely 3 months after surgery. Our case indicates that outcome of EPM can be good even with prolonged periods of severe neurologic impairment.

• Quality Improvement in Health Care
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• v.25 no.1
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• pp.11-28
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• 2019

Purpose: The purpose of this paper is to derive implication on the adoption of PROMs (Patient-Reported Outcome Measures) to improve quality of care in South Korea. With this purpose, the paper examines the status of PROMs in South Korea and other countries including OECD's PaRIS (Patient Reported Indicators Survey) initiative, and reviews policy cases that have adopted PROMs to improve performance of healthcare system. Methods: We conducted literature review on OECD reports on PaRIS, peer-reviewed journals, and information from the websites of relevant institutions such as ICHOM, NQF and OECD. Results: To identify healthcare services of best values and support patient-centered health system, OECD has initiated PaRIS which develops, collects and analyzes patient-reported indicators for cross-countries comparison. PaRIS is implemented on two work streams: 1) collect, validate and standardize PROMs in the areas where patient-reported indicators already exist such as breast cancers, hip and knee replacement, and mental conditions, 2) develop a new international survey on multiple chronic conditions. Countries like England, U.S., Sweden and Netherlands use PROMs for measuring performance of hospitals and performance evaluation at the national level, and provide the financial incentives for reporting PROMs. Conclusions: The use of PROMs can support the current policy agenda that is the patient-centered healthcare system which has been emphasized to reinforce the primary and the community-based care. For the use of PROMs, it is recommended to actively participate in PaRIS initiative by OECD, select appropriate instruments for PROMs, and continue on standardization of them. This will assure patients' involvement in improving health system performance, systemize information generated in the process of adopting PROMs, and develop a system to evaluate performance.

• Clinics in Shoulder and Elbow
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• v.22 no.4
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• pp.173-182
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• 2019

Background: Patient reported outcome measures assess clinical progress from the patient's perspective. This study explored the relationship between shoulder outcome measures (The Disability of the Arm, Shoulder and Hand [DASH], American Shoulder and Elbow Surgeons Standard Shoulder Assessment score [ASES], and Constant score) by comparing the best possible scores obtained in an asymptomatic population compared to overall perception of health, as measured by the SF-36 outcome measure. Methods: Volunteers (age range, 20-69 years) with asymptomatic shoulders and no history of shoulder pain, injury, surgery, imaging, or pathology (bilaterally) were included. The DASH and ASES measures were completed by 111 volunteers (72 female, 39 male), of which 92 completed the Constant score (56 female, 36 male). The SF-36 was completed by all volunteers (level of evidence: IV case series). Results: The mean (${\bar{x}}$) score for ASES measure on the right shoulder was higher for the left-hand dominant side (${\bar{x}}=100.00$ vs. 95.02, p-value<0.001); no other significant differences. Better SF-36 scores were associated with better DASH scores. Our prediction models suggest that perception of overall health affects the DASH scores. Sex affected all three shoulder measures scores. Conclusions: Comparing scores of shoulder outcome measures to the highest possible score is not the most informative way to interpret patient progress. Variables such as health status, sex, and hand dominance need to be considered. Furthermore, it is possible to use these variables to predict scores of outcome measures, which facilitates the healthcare provider to deliver individualized care to their patients.

• Journal of Sasang Constitutional Medicine
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• v.25 no.4
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• pp.442-453
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• 2013

Objectives This case study was about a Taeeumin patient with advanced Parkinson's disease diagnosed as Dry-heat symptomatic pattern. In this study, we reported significant improvement of motor and non-motor symptoms of this patient after Sasang constitutional medicine treatment. Methods The patient was diagnosed with Taeeumin Dry-heat symptomatic pattern and treated with Taeeumin's constitutional medications and acupuncture. The primary outcome measure for this study is Unified Parkinson Disease Rating Scale(UPDRS) to assess the overall function of patient. Secondary outcome assessments include Global Assessment Scale(GAS), change of patient's sleep, stool and urine. Results and Conclusions The patient treated with Taeeumin's constitutional medications and acupuncture had reduction in UPDRS (specifically Part II, Part III and Part IV) and GAS of motor symptoms. Furthermore, patient's sleep, stool and urine were reported to be normal after treatment. In conclusion, this study shows that Sasang constitutional medicine can be effective treatment for Taeeumin patient with Advanced Parkinson's disease diagnosed as Dry-heat symptomatic pattern.

• Journal of Korean Neurosurgical Society
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• v.53 no.1
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• pp.49-51
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• 2013

A case of traumatic spondyloptosis of the cervical spine at the C6-C7 level is reported. The patient was treated succesfully with a anterior-posterior combined approach and decompression. The patient had good neurological outcome after surgery. A-51-year-old female patient was transported to our hospital's emergency department after a vehicle accident. The patient was quadriparetic (Asia D, MRC power 4/5) with severe neck pain. Plain radiographs, computerize tomography and spinal magnetic resonance imaging (MRI) showed C6-7 spondyloptosis and C5, C6 posterior element fractures. Gardner-Wells skeleton traction was applied. Spinal alignment was reachived by traction and dislocation was decreased to a grade 1 spondylolisthesis. Then the patient was firstly operated by anterior approach. Anterior stabilization and fusion was firstly achieved. Seven days after first operation the patient was operated by a posterior approach. The posterior stabilization and fusion was achieved. Postoperative lateral X-rays and three-dimensional computed tomography showed the physiological realignment and the correct screw placements. The patient's quadriparesis was improved significantly. Subaxial cervical spondyloptosis is a relatively rare clinical entity. In this report we present a summary of the clinical presentation, the surgical technique and outcome of this rarely seen spinal disorder.

• Archives of Plastic Surgery
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• v.49 no.4
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• pp.488-493
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• 2022

Background Currently, the BREAST-Q can effectively measure patient's satisfaction on the quality of life from the patient's perspective in relation to different type of breast reconstruction. However, evaluation of patient satisfaction and cosmetic outcomes in breast reconstruction may have potential to led bias. Methods To maximize the benefits of using BREAST-Q to evaluate clinical outcome, we performed comparative study focused on the correlation between postoperative BREAST-Q and cosmetic outcomes assessed by medical professionals. For the current analysis, we used three postoperative BREAST-Q scales (satisfaction with breast, psychosocial well-being, and sexual well-being). The Ten-Point Scale by Visser et al was applied to provide reproducible grading of the postoperative cosmetic outcomes of the breast. The system includes six subscales that measured overall aesthetic outcome, volume, shape, symmetry, scarring, and nipple-areolar complex. The photographic assessments were made by five medical professionals who were shown photographs on a computer screen in a random order. Obtained data were stored in Excel and evaluated by Spearman's correlations using SPSS Statistics. Results We enrolled 92 women in this study, 10 did not respond to all scales of postoperative BREAST-Q, the remaining 82 women had undergone breast reconstruction. The correlation between BREAST-Q score and aesthetic score measured by Ten-Point Scale for the three BREAST-Q scales all show positive values in Spearman's correlation coefficient. Conclusion A significant correlation without any bias observed was found between the patient's satisfaction measured by BREAST-Q after breast reconstruction and the medical expert's aesthetic evaluation.

• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.970-975
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• 2001

Objective : By conducing a review of clinical outcomes for patients with aneurysm treated using current microneurosurgical techniques and intensive care unit management, we speculated that grading systems based only on clinical condition or CT finding after admission failed to provide a significant stratification of outcome between individual grades of patients, because these systems did not include the factor for postoperative vasospasm. We hypothesized that postoperative blood flow velocity could have a significant impact on outcome prediction for patients surgically treated for intracranial aneurysms. Methods : We conducted a analysis on patient- and lesion-specific factors that might have been associated with outcome in a series of 55 aneurysm operations performed with measurements of blood-flow velocity with transcranial Doppler ultrasonography(TCD). In the new scale(NS) score system, 1 point is assigned additionally for the case with Hunt and Hess(H-H)/World Federation of Neurological Surgeons(WFNS) Grade IV or V, Fisher Scale(FS) score 3 or 4, aneurysm size greater than 10mm, patient age older than 60 years, blood-flow velocity higher than 120cm/sec, and posterior circulation lesion. By adding the total points, a 6-point scale score(score 0-6) is obtained. Results : Age of patient, size of aneurysm, clinical condition(H-H grade and WFNS), FS score, and blood flow velocity(TCD 1day after operation) were independently and strongly associated with long-term outcome. When NS scores were applied to 55 patients with at least 6 months follow-up, the correlation of individual scores with outcome was strongly validated the retrospective findings. Conclusion : It was speculated that TCD could be used to assess postoperative vasospasm and to monitor noninvasively the patients with aneurysmal SAH. This NS score system is easy to apply, divide patients into groups with different outcome, and is comprehensive, allowing for more accurate prediction of surgical outcome.

• Journal of Sasang Constitutional Medicine
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• v.26 no.2
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• pp.194-204
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• 2014

Objectives The aim of this study was to examine significant improvement of gait ataxia, vertigo and tremor after treatment with Sipyimigwanjung-tang, Hyangsayangwi-tang in a Soeumin Greater Yin Symptomatology patient Diagnosed as Cerebellar ataxia. Methods The patient was diagnosed with Soeumin Greater Yin Symptomatology and treated with Soeumin's constitutional medications and acupuncture. The primary outcome measures for this study were the Unified Multiple System Atrophy Rating Scale(UMSARS) and Cerebellar function test to assess the overall function of patient. Secondary outcome assessment included Global Assessment Scale(GAS), change of patient's sleep, stool and digestion. Results The symptoms of gait ataxia, vertigo and tremor decreased from GAS 100 to GAS 0~40 after treatment, and the UMSARS score decreased in Part I, II. Conclusions This case showed that Sasang Constitutional medicine treatment can be effective treatment method for cerebellar ataxia. We consider that consistent treatment can contribute to improve the patient's quality of life.

• Health Policy and Management
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• v.25 no.1
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• pp.31-39
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• 2015

Background: The purpose of this study is comparison of the results between regression and multi-level analysis to find out factors influencing outcome indicators (in-hospital death, length of stay, and medical charges) of stroke patients. Methods: By using patient sample data of Health Insurance Review & Assessment Service, patients admitted with stroke were selected as survey target and 15,864 patients and 762 hospitals were surveyed. Results: For the results of existing regression analysis and multi-level analysis, models were assessed through model suitability index value and as a result, the value of results of multi-level analysis decreased compared to the results of regression, showing it is a better model. Conclusion: Factors influencing in-hospital death of stroke patients were analyzed and as a result, intra-class correlation (ICC) was 13.6%. In factors influencing length of stay, ICC was 11.4%, and medical charges, ICC was 17.7%. It was found that factors influencing the outcome indicators of stroke patients may vary in every hospital. This study could carry out more accurate analysis than existing research findings through analysis of reflecting structure at patient level and hospital level factors and analysis on random effect.

• Korean Journal of Bronchoesophagology
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• v.4 no.2
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• pp.193-196
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• 1998

Gastroesophageal reflux (GER) has been considered one of major causes in patient with globus symptom. Diagnostic methods for GER are gastroesophagoscopy, acid perfusion test esophagogram, esophageal manometry, 24-hour double probe pH-metry, and so on. According to the literature, positive rate of GER on esophagogram was reported variably from 4.7% to 45.9% and the outcome of classical treatment with antacid and prokinetic agent was reported from 70% to 84%. We reviewed the medical records of 81 patients with globus symptom. Each patient had been performed esophagogram and treated with antacid and prokinetic agent. Positive rate of GER on esophagogram was 46.9%. Complete resolution and improvement of globus symptom was 79% overally, 92% in positive group of GER rut esophgogram, and 72% in negative group. Considering aspects of time-cost and compliance of patient esophagogram is one of the screening methods of GER in patients with globus symptom. Antacid and prokinetic agent is recommended in treatment of patients with globus symptom.