• Korean Journal of Head & Neck Oncology
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• v.36 no.1
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• pp.1-8
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• 2020

It is well established that cancer patients are more susceptible to infection because of the immunosuppressive status caused by both disease itself and anticancer treatment, including surgery and chemoradiation. Head and neck cancer (HNC) patients are generally at high-risk for coronavirus disease 2019 (COVID-19) infection and serious adverse outcomes. Although there is an urgent need for guidance in the delivery of safe, quality oncologic care, no international consented recommendation addressed the management of HNC patients in COVID-19 due to limited data. In this review, we summarized the consideration for head and neck oncologic care in the context of the COVID-19 pandemic, based on the data and the very recent recommendations from the Korean Cancer Association and National Cancer Center. COVID-19 should be taken into consideration in the comprehensive management of HNC patients, and multidisciplinary evaluation of multilevel surgical-risks, discussion of optimized strategy, and shared-decision-making with the patient are needed to maximize both the safety from infectious pandemic and outcome of surgical and oncologic care.

• Korean Journal of Biological Psychiatry
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• v.5 no.2
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• pp.166-174
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• 1998

While the therapeutic efficacy of antipsychotic drugs is not in doubt, a variety of undesirable side effects are common. They can be a disincentive to good compliance with treatment, resulting in increased possibilities for relapse and hospitalization. They can be distressing and disabling and thus interfering with patient safety and quality of life. Furthermore, they may be counter-therapeutic by exacerbating the condition that the drug was prescribed for. In this article, we will provide an overview of management of antipsychotic- induced side effects, with a particular emphasis on the most common side effects as well as less common but serious side effects. In addition, some practical issues regarding the management of side effects will be discussed.

• Journal of The Korean Dental Society of Anesthesiology
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• v.13 no.3
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• pp.103-110
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• 2013

Background: Recently the use of sedation by pediatric dentists in Korea is increased. This study describes training programs about sedation practices in Korean pediatric dentistry residency program. Methods: A questionnaire was filled in by participants of Korean Academy of Pediatric Dentistry on 17th-18th August, 2008. Also the data about sedation practices of the training institution is collected by phone call. Results: Seventy two percent of respondents used sedation. Most of them used sedation with agents under 25% of their patients. Distribution of ages in patients sedated with agents was 3 years, 4-5 years, under 2 years, 6-10 years, and more than 10 years. Determinative factors of using sedation were behavior management, number of visiting, amount of treatment and general condition, and oral route was the most favorable route. Sixty six percent of them have failed on sedation, and thity percent of them have rarely failed on sedation. Only fifty percent of dentists using sedation completed the cardiopulmonary resuscitation course. Conclusions: For safety, dentists using sedation need to be educated about emergency equipment and management. Especially medication dose, use frequency and the detail related to treatment procedure should be discussed carefully. Also putting a patient under general anesthesia and taking emergency measures should be discussed with Korean Dental Society of Anesthesiology.

• Health Policy and Management
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• v.25 no.3
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• pp.229-239
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• 2015

Background: The hospital accreditation program in Korea has been conducted since 2011 in order to improve patient safety and healthcare service quality. This study was conducted to find factors associated with satisfaction as surveyor and reliability of surveyors in hospital accreditation program. Methods: This study was performed targeting 217 responded to the survey among 412 surveyors who had participated in the accreditation survey for acute care hospitals from December 2010 to February 2014. Results: The average number of survey per surveyor is 2.35. We divided surveyors into those who participated in the survey more than 3 times and less than 3 times in order to judge the professionalism of surveyors according to the number of survey participation. Those factors that have an influence on the satisfaction as surveyors include: activity period as surveyor, role in the survey team, experience of survey in other fields, experience as consultant and the useful education and proper composition of survey team (p<0.05). Those factors that have an influence on the reliability for fellow surveyors include: number of beds of hospitals they belong, experience of survey in other fields, useful education, proper composition of survey team and difficulty in leadership interview (p<0.05). Conclusion: It is important to provide useful education and proper composition of survey team to increase the satisfaction as surveyors and the reliability for fellow surveyors.

• Journal of Yeungnam Medical Science
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• v.40 no.3
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• pp.276-282
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• 2023

Background: Bleeding and thrombosis are major complications associated with high mortality in extracorporeal membrane oxygenation (ECMO) management. Anticoagulant therapy should be adequate to reduce thrombosis. However, related studies are limited. Methods: We retrospectively reviewed all patients supported with ECMO at a single institution between January 2014 and July 2022 and included those on all types of ECMO using the Permanent Life Support System. Patients were classified into two groups according to their measured mean activated partial thromboplastin time (aPTT) during ECMO management: a high-anticoagulation (AC) group (aPTT, ≥55 seconds; n=52) and a low-AC group (aPTT, <55 seconds; n=79). The primary outcome was thrombotic or bleeding events during ECMO. Results: We identified 10 patients with bleeding; significantly more of these patients were in the high-AC group (n=8) than in the low-AC group (15.4% vs. 2.5%, p=0.01). However, thrombus events and oxygenator change-free times were not significantly different between the two groups. Four patients in the high-AC group died of bleeding complications (brain hemorrhage, two; hemopericardium, one; and gastrointestinal bleeding, one). One patient in the low-AC group developed a thrombus and died of ECMO dysfunction due to circuit thrombosis. Conclusion: Heparin did not significantly improve thrombotic outcomes. However, maintaining an aPTT of ≥55 seconds was a significant risk factor for bleeding events, especially those associated with mortality.

• Clinical Endoscopy
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• v.56 no.4
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• pp.423-432
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• 2023

Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.

• Journal of the Korea Safety Management & Science
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• v.17 no.1
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• pp.111-117
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• 2015

When scanning PET/CT, dose not unwrinkle gastric folds can be difficult to diagnose gastric cancer. In this study, we use an blowing agent to evaluate the extension the stomach and usefulness of it. The study enrolled 30 patients who patient with uptake in stomach between January and February 2013. Stomach extension was described as the vertical length of the Water drink group was $61.7{\pm}9.7mm$, horizontal length was $102.5{\pm}17.6mm$ and the vertical length of the Blowing agent group was $74.1{\pm}10.7mm$, horizontal length was $101.5{\pm}14.8mm$ in transverse section. Stomach extension was described as the vertical length of the Water drink group was $109.3{\pm}18.8mm$, horizontal length was $62.7{\pm}18.4mm$ and the vertical length of the Blowing agent group was $123.1{\pm}23.1mm$, horizontal length was $87.6{\pm}14.9mm$ in coronal section. Water drink group SUV decreased 35% and Blowing agent group SUV decreased 56%. Blowing agent group extension was similar or superior than water drink group. Therefore, when using a blowing agent will be able to help clinical.

• Journal of The Korea Institute of Healthcare Architecture
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• v.22 no.3
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• pp.7-15
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• 2016

Purpose: As medicare services have gotten spreaded, clinical laboratory has been dominant position. So, it has been acted for quality control and clinical pathology accreditation. But there has been quite deficient information to evaluate working space and technical standards of medical laboratory for accreditation. This study goals to figure out accreditation standard and design guideline for clinical laboratory, and to give safe and efficient design information. Methods: This study has been searched by literature for accreditation standards and design guidelines of clinical pathology in USA, UK, and Germany. Results: Three countries have accredited based on working lab space, staff space, storage space, patient space and health and safety equipment. Design guidelines of three countries commonly have focused on worktable layout, worktable distance and module, and specific laboratory biosafety level. And USA guidelines stress on the architectural design such as design process and passage distance for escape, UK stress on the efficiency as functional work flow and construction cost, lastly Germany design guidelines stress on the operator's safety distance and workstation. Three countries have not only accreditation standards but also design guidelines for more specific quality management, separating from accrediting institute. Implications: In korea, it has been needed to make clinical laboratory design guideline for the safe and efficient environment and reliable and competitive medical service.

• Health Policy and Management
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• v.25 no.2
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• pp.67-70
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• 2015

To establish an appropriate policy for robotic surgery in Korea, the National Evidence-based Collaborating Agency (NECA) and the Korean Society of Health Policy and Administration held a round-table conference (RTC) to gather opinions through a comprehensive discussion of scientific information in gastric cancer. The NECA RTC is a public discussion forum wherein experts from diverse fields and members of the lay public conduct in-depth discussions on a selected social issue in the health and medical field. For this study, representatives from the medical field, patient groups, industry, the press, and policy makers participated in a discussion focused on the medical and scientific evidence for the use of robotic surgery in gastric cancer. According to the RTC results, robotic surgery showed more favorable results in safety and efficacy than open surgery and it is similar to laparoscopy. When the cost-effectiveness of robotic surgery and laparoscopy is compared, robotic surgery costs are higher but there was no difference between the two of them in terms of effectiveness (pain, quality of life, complications, etc.). In order to resolve the high cost issue of the robotic surgery, a proper policy should be implemented to facilitate the development of a cost-effective model of the robotic surgery equipment. The higher cost of robotic surgery require more evidence of its safety and efficacy as well as the cost-effectiveness issues of this method. Discussions on the national insurance coverage of robotic surgery seems to be necessary in the near future.

• Journal of The Korean Society of Clinical Toxicology
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• v.12 no.2
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• pp.39-45
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• 2014

Purpose: The purpose of this study is to review the evidence comparing the efficacy and safety between L-carnitine and extracorporeal elimination therapy in the management of acute valproic acid L-carnitine vs Extracorporeal Elimination for Acute Valproic acid Intoxication Methods: PubMed, Embase, Cochrane library, Web of Science, KoreaMed, KMbase, and KISS were searched, using the terms carnitine and valproic acid. All studies, regardless of design, reporting efficacy or safety endpoints were included. Reference citations from identified publications were reviewed. Both English and Korean languages were included. Two authors extracted primary data elements including poisoning severity, presenting features, clinical management, and outcomes. Results: Thirty two articles including 33 cases were identified. Poisoning severity was classified as 3 mild, 11 moderate, and 19 severe cases. Nine cases were treated with L-carnitine while 24 cases received extracorporeal therapy without L-carnitine. All patients except one expired patient treated with hemodialysis recovered clinically and no adverse effects were noted. A case report comparing two patients who ingested the same amount of valproic acid showed increased ICU stay (3 vs 11 days) in case of delayed extracorporeal therapy. Conclusion: Published evidence comparing L-carnitine with extracorporeal therapy is limited. Based on the available evidence, it is reasonable to consider L-carnitine for patients with acute valproic acid overdose. In case of severe poisoning, extracorporeal therapy would also be considered in the early phase of treatment.