• Nutrition Research and Practice
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• 제8권1호
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• pp.103-111
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• 2014

This study aims to determine the effect of a trained dedicated dietitian on clinical outcomes among Lebanese hemodialysis (HD) patients: and thus demonstrate a viable developing country model. This paper describes the study protocol and baseline data. The study was a multicenter randomized controlled trial with parallel-group design involving 12 HD units: assigned to cluster A (n = 6) or B (n = 6). A total of 570 patients met the inclusion criteria. Patients in cluster A were randomly assigned as per dialysis shift to the following: Dedicated Dietitian (DD) (n = 133) and Existing Practice (EP) (n = 138) protocols. Cluster B patients (n = 299) received Trained Hospital Dietitian (THD) protocol. Dietitians of the DD and THD groups were trained by the research team on Kidney Disease Outcomes Quality Initiative nutrition guidelines. DD protocol included: individualized nutrition education for 2 hours/month/HD patient for 6 months focusing on renal osteodystrophy and using the Trans-theoretical theory for behavioral change. EP protocol included nutrition education given to patients by hospital dietitians who were blinded to the study. The THD protocol included nutrition education to patients given by hospital dietitian as per the training received but within hospital responsibilities, with no set educational protocol or tools. Baseline data revealed that 40% of patients were hyperphosphatemics (> 5.5 mg/dl) with low dietary adherence and knowledge of dietary P restriction in addition to inadequate daily protein intake ($58.86%{\pm}33.87%$ of needs) yet adequate dietary P intake ($795.52{\pm}366.94$ mg/day). Quality of life (QOL) ranged from 48-75% of full health. Baseline differences between the 3 groups revealed significant differences in serum P, malnutrition status, adherence to diet and P chelators and in 2 factors of the QOL: physical and social functioning. The data show room for improvement in the nutritional status of the patients. The NEMO trial may be able to demonstrate a better nutritional management of HD patients.

• Journal of Genetic Medicine
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• 제13권2호
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• pp.72-77
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• 2016

Purpose: Gaucher disease (GD) is the most common lysosomal storage disease caused by beta-glucocerebrosidase (GBA) deficiency. Oral substrate reduction therapy with miglustat ($Zavesca^{(R)}$) was approved for the treatment of adults with GD type 1, for whom enzyme replacement therapy (ERT) is unsuitable or not a therapeutic option. In this study, we report the effect of miglustat ($Zavesca^{(R)}$) in three Korean GD patients. Materials and Methods: Clinical findings comprising age at diagnosis, presenting signs, laboratory findings at diagnosis, GBA activity and mutations, and clinical courses of the three patients were reviewed. Results: Miglustat was administered to three patients who reported allergic reactions during intravenous imiglucerase infusions. One patient withdrew after 15 months of miglustat administration owing to continuous elevation of disease biomarker levels (chitotriosidase, acid phosphatase, and angiotensin-converting enzyme). Poor adherence to medication was suspected but was denied by the patient. In the other two patients, platelet count and levels of hemoglobin and other biomarkers remained stable during miglustat administration. However, they suffered from severe diarrhea and weight loss, which led to miglustat discontinuation after 1 and 12 months of administration. Conclusion: Our study shows that although miglustat is suggested to GD patients as an alternative treatment to ERT, significant adverse reactions may lead to discontinuation of miglustat. In addition, it is difficult to monitor the drug adherence.

• 한국임상약학회지
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• 제28권4호
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• pp.308-319
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• 2018

Background: Some mental illnesses such as depression are known to be one of the risk factors of suicide and proper antidepressant therapy can reduce suicidal behavior. Objectives: This study aimed to analyze regional variations in antidepressant consumption and adherence, suicide rate, prevalence of suicide related mental disorders, and access to relevant healthcare services. Methods: Cross-sectional analyses were conducted using National Patients Sample data compiled by the Health Insurance Review and Assessment Service between 2014 and 2016. We included patients who had a diagnosis record of suicide related mental disorders during the study period. Cause of death statistics and National health and medical statistics were used to identify suicide rate and distribution of healthcare service. We conducted visual analyses, chi-squared tests, independent t-tests and correlation analyses to demonstrate regional variations. Results: Between 2014 and 2016, the average prevalence of suicide related mental disorders was 5.4 per cent. Suicide rate and prevalence of suicide related mental disorders were higher in Gangwon, Chungcheong, and Jeolla (p < 0.001), and lower in Seoul (p < 0.001) than the national average. Unexpectedly, regional variations in antidepressant consumption were seen in the limited area including Daejeon, Chungnam and Gyeongnam (p < 0.05). The number of mild patient-centered clinics was associated positively with antidepressant consumption (p < 0.01) and associated negatively with suicide rate (p < 0.01). Conclusion: There were some regional variations in prevalence of suicide related mental disorders, antidepressant adherence and suicide rate. The higher level of antidepressant therapy and the lower level of suicide rates were seen in regions with easy access to mild patient-centered clinics.

• 근관절건강학회지
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• 제22권3호
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• pp.245-257
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• 2015

Purpose: The purpose of this study was to apply intervention mapping (IM) to develop a community-based disease self-management support program for patients with osteoarthritis. Methods: IM was applied as follows: i) a needs assessment has been carried out by a literature review, survey and interview with osteoarthritis patients; ii) on the basis of the needs assessment, identification of expected outcomes and change objectives for the target population; iii) selection of theory-based methods and practical applications to influence self-management and the determinants of behavior; iv) design of the intervention by developing activities and materials such as osteoarthritis self-management guide and smart patient pocket book. The activities were integrated into an existing healthcare activities; v) implementation and evaluation plan has been developed. Results: The program is aimed at improving health status through activating patients by a patient-centered and tailored intervention for patients with osteoarthritis; consists of 8 sessions with coaching and cognitive emotional psychological skills; includes smart patient, communication, osteoarthritis, medication adherence, pain control, depressive mood control, physical activity and healthy diet. Conclusion: The IM is a systematic and feasible method for developing the program. The next step is to evaluate the impact of the intervention on activation, and health status.

• Journal of Korean Neurosurgical Society
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• 제51권4호
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• pp.219-221
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• 2012

A 20-month-old boy presented with a intraparenchymal mass in the right frontoparietal area manifesting as complex partial seizure, secondary generalization and left hemiparesis. Magnetic resonance images (MRI) of the brain showed inhomogeneously enhancing mass in the right frontoparietal area which has irregular margin and perilesional edema. Based on the radiological findings, a preoperative diagnosis was an intraaxial tumor, such as pilocytic astrocytoma or dysembryoplastic neuroepithelial tumor. The patient underwent a surgery including frontal craniotomy. The tumor had a partially extreme adherence to the surrounding brain tissue but it showed no dural attachment. Gross-total resection of the tumor was achieved. Postoperative follow-up computed tomography scans showed no residual tumor. The pathological findings confirmed the tumor as a WHO grade I meningioma, transitional type. Nine months after the surgery, follow-up brain MRI showed no recurrence of the tumor, porencephaly in site where the tumor was resected; the patient's symptoms had fully recovered. We report the case of a meningioma in a 20-month-old boy.

• 한국콘텐츠학회논문지
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• 제17권6호
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• pp.415-423
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• 2017

환자가 의사를 신뢰한다는 의미를 살펴보는 것은 의료서비스를 바탕으로 이루어지는 환자-의사 관계관리 뿐만 아니라 진료만족도, 병원재방문 등 마케팅 측면에서도 중요하다. 이 연구에서는 의사-환자 관계에서 신뢰의 의미가 무엇인지를 병원방문경험이 6개월 이내인 20대 이상 성인들을 대상으로 설문조사한 328명의 응답결과를 분석자료로 활용하여 살펴보았다. 연구결과, 환자가 의사를 신뢰한다는 의미는 한마디로 정의하기는 힘들지만 적어도 네 가지 의미를 담고 있음을 알 수 있었다. 환자가 신뢰하는 의사는 첫째, 환자의 이야기를 주의깊게 경청하며 관심을 표현하는 대화 분위기를 형성하는 커뮤니케이션 행위를 보여야 한다. 둘째, 환자의 건강을 먼저 생각하고 환자를 이해하려고 하며 공감할 수 있도록 해야 한다. 셋째, 기술적인 능력뿐만 아니라, 치료와 관련한 검사와 절차에 있어서 솔직하여야 한다. 마지막으로 환자와 협력을 자아내고자 노력해야 한다.

• 보건행정학회지
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• 제33권1호
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• pp.3-18
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• 2023

Background: A chronic disease management program including patient education, recall and remind service, and reduction of out-of-pocket payment was implemented in Korea through a chronic care model. This study aimed to assess the effect of a community-based intervention program for improving medication adherence of patients with diabetes mellitus in rural areas of Korea. Methods: We applied a non-equivalent control group design using Korean National Health Insurance Big Data. Hongcheon County has been continuously adopting this program since 2012 as an intervention region. Hoengseong County did not adopt such program. It was used as a control region. Subjects were a cohort of patients with diabetes mellitus aged more than 65 years but less than 85 years among residents for 11 years from 2010 to 2020. After 1:1 matching, there were 368 subjects in the intervention region and 368 in the control region. Indirect indicators were analyzed using the difference-in-difference regression according to Andersen's medical use model. Results: The increasing percent point of diabetic patients who continuously received insurance benefits for more than 240 days from 2010 to 2014 and from 2010 to 2020 were 2.6%p and 2.7%p in the intervention region and 3.0%p and 3.9%p in the control region, respectively. The number of dispensations per prescription of diabetic patient in the intervention region increased by approximately 4.61% by month compared to that in the control region. Conclusion: The intervention program encouraged older people with diabetes mellitus to receive continuous care for overcoming the rule of halves in the community. More research is needed to determine whether further improvement in the continuity of comprehensive care can prevent the progression of cardiovascular diseases.

• 산업융합연구
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• 제22권3호
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• pp.91-100
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• 2024

허혈성 심장질환은 재발의 위험이 높고, 재발 시 사망률이 더욱 증가하므로, 재발 예방을 위해서 운동과 식이요법 등 건강행위의 실천이 중요하다. 관상동맥질환자의 규칙적인 운동에 대한 동기를 유발하기 위해서는 의료인의 건강행위 권고가 필요하다고 알려져 있으나, 의료인의 권고가 대상자들의 운동이행에 어떠한 영향을 미치는 지에 대한 연구는 드물다. 이에 의료인의 식이 및 운동 권고가 규칙적인 운동이행에 미치는 영향을 파악하고자, 2018년 7월 4일부터 2019년 7월 30일까지 서울 소재 2개 대학병원 순환기내과에 관상동맥조영술을 위해 입원한 환자 219명을 대상으로 서술적 조사 연구를 실시하였다. 연구 결과, 의료인으로부터 운동이행 권고를 받은 경우(OR 3.52, p=.036), 식이이행 권고를 받은 경우(OR 6.48, p=.022), 운동자기효능감이 높은 경우(OR 1.36, p=.001), 경제 상태가 좋은 경우(OR 7.59, p=.007), 주관적인 건강 상태가 좋은 경우(OR 0.31, p=.047), 규칙적인 운동이행에 긍정적인 영향을 주었다. 따라서 의료인은 규칙적인 운동과 건강한 식이에 대해 환자 맞춤형 권고를 강화할 필요가 있고, 운동자기효능감 증진 프로그램을 개발하여 참여를 유도할 필요가 있다. 향후 의료인 권고의 정도나 방법에 따라 관상동맥질환자들의 자기 관리 실천에 미치는 영향을 파악하는 연구를 제언한다.

• 대한치과의사협회지
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• 제52권3호
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• pp.153-163
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• 2014

3-dimensional information for anatomic stucture plays a role as integral part in clinical aspect of dental practice. CBCT(cone beam computed tomography) has been accepted as useful diagnostic tool offering Volume data and images for evaluating teeth and jaws in lower radiation dose than conventional CT. CBCT equipment is essential for the quality assurance of it to ensure continued satisfactory performance and result of adequate images. Dental practitioner and oral and maxillofacial radiologist should have a responsibility and critical thinking to deliver this technology to patients in a responsible way, so that diaganostic value is maximised and radiation doses kept as low as resonably achievable. CBCT imaging modality should be used only after a review of the patient's health and imaging history and the completion of a thorough clinical examination. Clinical guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances Dental practitioners should prescribe CBCT imaging only when they expect that the diagnostic yield will benefit patient care, enhance patient safety or improve clinical outcomes significantly. Knowledge of patient dose is essential for clinicians who are making the decision regarding the justification of the exposure. There are some limitation in the measurement of patient dose in CBCT for the approval and adaptation of conventinal methodolgy in CT. It is also important to ensure that doses are optimised and in line with any national and international guidelines. The higher radiation doses of CBCT compared with conventional radiography, mean that high standards must be maintained. The Quality Assurance(QA) programme should entail surveys and checks that are performed according to a regular timetable. QA programme should be maintained by staff to ensure adherence to the programme and to raise its importance among staff.

• 한국임상약학회지
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• 제19권2호
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• pp.110-119
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• 2009

Medication compliance is essential to improve person's health status through pharmacotherapy. Since separation of dispensing and prescription has been implemented, the importance of pharmacist's role on medication counseling have been emphasized, especially among outpatients. The objective of this study is to investigate the effect of patient's satisfaction with pharmacist's medication counseling on medication compliance among outpatients. We used the 2005 Korea National Health and Nutrition Survey data to examine medication compliance of persons who visited pharmacy. Ordered logistic regression analysis was conducted to assess whether patient's satisfaction with pharmacist's medication counseling was associated with medication compliance. Overall, 86.17% of study subjects(5,494) reported to take the prescribed medicines correctly and 80.54% of respondents were satisfied with pharmacist's medication counseling. Logistic regression analysis presents patient's satisfaction with pharmacist's counseling is significantly associated with medication compliance after controlling patient's characteristics(proxy-measured by age, family income, educational attainments, comorbid conditions). Interestingly, even patients who are dissatisfied with pharmacist's counseling have slightly higher odds of better compliance to medication therapy than those without pharmacist's counseling. In addition, higher educational attainments and older age groups are associated with better medication compliance. In conclusion, pharmacist's medication counseling appears to be effective in improving medication compliance. Further research that assess medication counseling in detail needs to develop strategies to improve medication adherence.