• Journal of the Korean Data and Information Science Society
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• v.28 no.5
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• pp.1027-1041
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• 2017

Hyperlipidemia, the status of blood with high level of low-density lipoprotein cholesterol (LDL-C), is known as a main cause of coronary artery diseases such as myocardiac infarction or brain infarct. Statin is the representative prescription to hyperlipidemia and the effects of it depend on the patient's individual conditions such as health-caring habits or adherence to medication. The main effect of statin is reducing LDL-C, which should reach the target range based on National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) guideline. In this research, the reduction of LDL-C and attainment to patient's target range are considered effects of statin. The association between factors - individual conditions and adherence to medication of patients - and the effects of statin is analyzed with National Health Insurance Service-National Sample Cohort (NHIS-NSC).

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.6
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• pp.2523-2527
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• 2014

Background: Serum thyroglobulin detection plays an essential role during the follow-up of thyroid cancer patients treated with total/near total thyroidectomy and radioiodine ablation. The aim of this retrospective study was to evaluate the relationship between stimulated serum thyroglobulin (Tg) level at the time of high dose $^{131}I$ ablation and risk of recurrence, using a three-level classification in patients with differentiated thyroid cancer (DTC) according to the ATA guidelines. Also we investigated the relationship between postoperative stimulated Tg at the time of ablation and DxWBS results at 8-10 months thereafter. Materials and Methods: Patients with radioiodine accumulation were regarded as scan positive (scan+). If there was no relevant pathological radioiodine accumulation or minimal local accumulation in the thyroid bed region, this were regarded as scan negative (scan-) at the time of DxWBS. We classified patients in 3 groups as low, intermediate and high risk group for assessment of risk of recurrence according to the revised ATA guidelines. Also, we divided patients into 3 groups based on the stimulated serum Tg levels at the time of $^{131}I$ ablation therapy. Groups 1-3 consisted of patients who had Tg levels of ${\leq}2ng/ml$, 2-10 ng/ml, and ${\geq}10ng/ml$, respectively. Results: A total of 221 consecutive patients were included. In the high risk group according to the ATA guideline, while 45.5% of demonstrated Scan(+) Tg(+), 27.3% of patients demonstrated Scan(-) Tg(-); in the intermediate group, the figures were 2.3% and 90.0% while in the low risk group, they were 0.6% and 96.4%. In 9 of 11 patients with metastases (81.8%), stimulated serum Tg level at the time of radioiodine ablation therapy was over 10, however in 1 patient (9.1%) it was <2ng/mL and in one patient it was 2-10ng/mL (p=0.005). Aggressive subtypes of DTC were found in 8 of 221 patients and serum Tg levels were ${\leq}2ng/ml$ in 4 of these 8. Conclusions: We conclude that TSH-stimulated serum thyroglobulin level at the time of ablation may not determine risk of recurrence. Therefore, DxWBS should be performed at 8-12 months after ablation therapy.

• Journal of radiological science and technology
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• v.39 no.4
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• pp.483-491
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• 2016

The conditions after exposure to digital mammography and digital breast tomosynthesis were analyzed. The examinations for the ACR phantom were done using manual exposure, not auto exposure, to examine image discrimination and patient dose. As a result, the following results were derived: In the CC exposure, the kVp was 2kVp higher while mAs decreased to 58.6% for the 3D tomography. Such result showed an approximate decrease of 60mAs. At that time, the patients' Average Glandular Dose (AGD) was 1.65mGy in 2D and 1.87mGy in 3D; thus, AGD of 3D was shown to have about 1.13times higher. The result of the manual exposure revealed a reduced mAs of up to 80%; there was no effect in the assessment standard in terms of image discrimination, resulting in more than 10 points. When mAs was reduced to 80% in the manual exposure for ACR phantom, AGD was decreased to 0.66mGy. The diagnostic values of images were maintained and patients dose was reduced in the manual exposure in the AEC condition for 3D. Since the use of 3D has recently increased, using the manual exposure has been recommended in this study to improve the diagnostic value, while, simultaneously reducing patients dose.

• Journal of Radiation Protection and Research
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• v.36 no.3
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• pp.140-147
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• 2011

Our purpose is to specify behavior and environmental factors aimed at reducing the exposed dosage caused by PET-CT and to develop radiation safety management guidelines adequate for domestic circumstances. We have used a multistep-multimethod as the methodological approach to design and to carry out the research both in quality and quantity, including an analysis on previous studies, professional consultations and a survey. The survey includes responses from 139 practitioners in charged of 109 PET-CTs installed throughout Korea(reported by the Korean Society of Nuclear Medicine, 2010). The research use 156 questions using Cronbach's ${\alpha}$ (alpha) coefficients which were: 0.818 for "the necessity of setting and installing the radiation protective environment"; 0.916 for "the necessity of radiation protection", "setting and installing the radiation protective environment"; and 0.885 for "radiation protection". The check list, derived from the radiation safety management guidelines focused on behavior and environment, was composed of 20 items for the radiation protective environment: including 5 items for the patient; 4 items for the guardian; 3 items for the radiologist; and 8 items applied to everyone involved; for a total of 26 items for the radiation protective behavior including: 12 items for the patient; 1 item for the guardian, 7 items for the radiologist; and 6 items applied to everyone involved. The specific check list is shown in(Table 5-6). Since our country has no safety management guidelines of its own to reduce the exposed dosage caused by PET-CTs, we believe the guidelines developed through this study means great deal to the field as it is not only appropriate for domestic circumstances, but also contains specific check lists for each target who may be exposed to radiation in regards to behavior and environment.

• The Korean Society of Law and Medicine
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• v.13 no.1
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• pp.359-395
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• 2012

In a broad term, health and medical data means all patient information that has been generated or circulated in government health and medical policies, such as medical research and public health, and all sorts of health and medical fields as well as patients' personal data, referred as medical data (filled out as medical record forms) by medical institutions. The kinds of health and medical data in medical records are prescribed by Articles on required medical data and the terms of recordkeeping in the Enforcement Decree of the Medical Service Act. As EMR, OCS, LIS, telemedicine and u-health emerges, sharing and protecting digital health and medical data is at issue in these days. At medical institutions, health and medical data, such as medical records, is classified as "sensitive information" and thus is protected strictly. However, due to the circulative property of information, health and medical data can be public as well as being private. The legal grounds of health and medical data as such are based on the right to informational self-determination, which is one of the fundamental rights derived from the Constitution. In there, patients' rights to refuse the collection of information, to control recordkeeping (to demand access, correction or deletion) and to control using and sharing of information are rooted. In any processing of health and medical data, such as generating, recording, storing, using or disposing, privacy can be violated in many ways, including the leakage, forgery, falsification or abuse of information. That is why laws, such as the Medical Service Act and the Personal Data Protection Law, and the Guideline for Protection of Personal Data at Medical Institutions (by the Ministry of Health and Welfare) provide for technical, physical, administrative and legal safeguards on those who handle personal data (health and medical information-processing personnel and medical institutions). The Personal Data Protection Law provides for the collection, use and sharing of personal data, and the regulation thereon, the disposal of information, the means of receiving consent, and the regulation of processing of personal data. On the contrary, health and medical data can be inspected or delivered of the copies, based on the principle of restriction on fundamental rights prescribed by the Constitution. For instance, Article 21(Access to Record) of the Medical Service Act, and the Personal Data Protection Law prescribe self-disclosure, the release of information by family members or by laws, the exchange of medical data due to patient transfer, the secondary use of medical data, such as medical research, and the release of information and the release of information required by the Personal Data Protection Law.

• Journal of the Korean Society of Radiology
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• v.10 no.3
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• pp.161-169
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• 2016

In this study, the proposal to seek ways to reduce the amount of radiation is drawn by comparing and analyzing CT Dose Index(CTDI) on the pediatric head CT which was performed at the busan regional hospitals, to the national diagnostic reference levels. As a result, it was appeared to exceed the amount of the dose recommendation in order of hospital, general hospital and senior general hospital in the hospital-specific classification and from 2 to 5 year, from 1 month to 1 year and from 6 to 10 year in the age-specific classification. In addition, the amount of the dose recommendation was exceed in order of helical, axial and volume in the scan-specific classification. As the results of the scan range reset to match the diagnostic reference level, the dose reduction showed 11.68%, 15.79% and 20.66% in senior general hospital, general hospital and hospital respectively. In the results of analysing patient average scan ranges which does not deviate from the guideline of patient dose recommendation, there was age of 1 month to 1 year, 2 to 5 year and 6 to 10 year of $03.2{\pm}11.8mm$, $110.5{\pm}14.5mm$, and $117.8{\pm}17.2mm$ respectively.

• Korean Journal of Psychosomatic Medicine
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• v.29 no.2
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• pp.77-85
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• 2021

Breast cancer is the most prevalent oncological disease among women. Various psychosocial distress is common at the diagnosis, treatment, and posttreatment phase of breast cancer. For the treatment of breast cancer, not only medical treatment but also psychosomatic integrative care will be needed. Patients with breast cancer may lead to increased vulnerability to stress, adjustment disorder, anxiety disorder, and depressive disorder, and these psychiatric diseases and conditions are associated with recurrence or exacerbation of breast cancer. Psychosocial treatment of anxiety and depression could increase the quality of life of patients and decrease the recurrence and progression of breast cancer. In this article, we reviewed 5 clinical breast cancer survivorship guidelines focused on psychosomatic integrative care including psychosocial treatment and alternative treatment for psychosocial distress. Because 5 treatment guidelines were using various definitions of evidence, we confirmed evidence of various psychosocial treatments for patients with breast cancer based on the definition of evidence by the US Preventive Service Task Force (USPSTF) guideline. We also reviewed the effect size of psychosocial treatment for anxiety, depression, mood, and quality of life in patients with breast cancer. This article discusses the barrier to the delivery of psychosomatic integrative care and suggests integrative care planning for breast cancer. Multi-disciplinary teams, patient's needs assessment, information technology support, patient and caregiver engagement, planned periodic monitoring of psychosocial distress by a psychosomatic specialist or consultation-liaison psychiatrist are recommended as key features of a psychosomatic integrated care plan.

• 한국노년학
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• v.40 no.2
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• pp.227-237
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• 2020

The purpose of this study is to understand using of antithrombotic agents in clinical settings. The number of patients receiving antithrombotic therapy is increasing in the long term due to the increased prevalence of cardiovascular disease in the elderly. There is a guideline for discontinuation of antithrombotic treatment before dental treatment, but the present study shows that there is a difference from the actual clinical situation. We used an online survey methodology to involve 1000 participants. The questionnaires were asked about general items and Clinical experience such as history of antithrombotic history, experience of complications due to antithrombotics, discontinuation of use, reasons for discontinuing use. The result is as follows. The incidence of delayed bleeding was found to be 55.1%, and discontinuation of antithrombotic therapy before withdrawal was 87.8%. Among respondents 98.3% responded that they stopped antithrombotics because of delayed bleeding and 57.4% responded that they would stop for three to five days. Korean dentists maybe cope with delayed bleeding considering the emotional problem of the patient, the relationship with the patient's physician, and the additional socioeconomic problems.

• The Korean Society of Law and Medicine
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• v.19 no.2
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• pp.235-261
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• 2018

The Medical law stipulates regulations about the physician's duty to inform to contribute to patient's self-determination. This law was most recently revised on December 20, 2016, and came into effect on June 21, 2017. There has been much controversy about this, and it has been questioned whether or not it will be effective for physicians to comply with the duty to inform. Therefore, this study investigated perceptions of physicians of whether they observed the duty to inform and their legal judgment about that duty, and analyzed how the revision of the medical law may have affected the legal cognition of physician's duty to inform. This study was conducted through an online questionnaire survey involving 109 physicians over 2 weeks from March 29 to April 12, 2018, and 108 of the collected data were used for analysis. The questionnaire was developed by revising and supplementing the previous research (Lee, 2004). It consisted of 41 items, including 26 items related to the experience of and legal judgment about the duty to inform, 6 items related to awareness of revised medical law, and 9 items on general characteristics. The data were analyzed using SAS 9.4 program and descriptive statistics, Chi-square test, Fisher's exact test and Binary logistic regression were performed. The results are as follows. • Out of eight situations, the median number of situations that did not fulfill the duty to inform was 5 (IQR, 4-6). In addition, 12 respondents (11%) answered that they did not fulfill the duty to inform in all eight cases, while only one (1%) responded that he/she performed explanation obligations in all cases. • The median number of the legal judgment score on the duty to inform was 8 out of 13 (IQR, 7-9), and the scores ranged from a minimum of 4 (4 respondents) to a maximum of 11 (3 respondents). • More than half of the respondents (n=26, 52%) were unaware of the revision of the medical law, 27 (25%) were aware of the fact that the medical law had been revised, 20(18%) had a rough knowledge of the contents of the law, and only 5(5%) said they knew the contents of the law in detail. The level of awareness of the revised medical law was statistically significant difference according to respondents' sex (p<.49), age (p<.0001), career (p<.0001), working type (p<.024), and department (p<.049). • There was no statistically significant relationship between the level of awareness of the revised medical law and the level of legal judgment on the duty to inform. These results suggest that efforts to improve the implementation and cognition of physician's duty to inform are needed, and it is difficult to expect a direct positive effect from the legal regulations per se. Considering the distinct characteristics of medical institutions and hierarchical organizational culture of physicians, it is necessary to develop a credible guideline on the duty to inform within the medical system, and to strengthen the education of physicians about their duty to inform and its purpose.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.310-316
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• 2006

Background: We study the QOL (quality of life) & functional improvement in patients underwent esophageal surgery for cancer by the viewpoint of the patient and would like make the guideline of recovery course. Material and Method: Between Dec. 1996$\sim$Aug. 2002, 250 patients were operated and 57 patients was enable interview, didn't have evidence of recurrence & survived more than 1 year postoperatively at Asan Medical Center. Questionnaire made by direct or telephone interview & include diet habitus, change of body weight, G-E (gastroesophageal) reflux, dumping symptom, change of daily life. Result: There were 53 men (93%), 4 women (7%) with mean age of $62.05{\pm}8.7$ (range: $37{\sim}94$). Operation method was Ivor Lewis operation in 43 case (75.4%), Esophagocolojejunostomy 4 case (7.1%), Mckeown operation 10 case (17.5%). In Diet habitus, 55 patients (96.5%) ate more than three times in a day with mean diet frequency was 3.5 times/day, 51 patients (89.5%) have been ate solid, regular diet, 5 patients (8.8%) enable to eat liquid diet. To compare with preoperative state, 32 patients (56.9%) had a diet speed more than 80%, 28 patients (39.1%) had a diet amount more than 80%. 32 patients (56.9%) had a little change of body weight within a 10%, 25 patients (43%) had a improvement rather than preoperative state. In G-E reflux, 4 patients (7%) had a reflux after every diet, 27 patients (47.4%) had a little reflux after diet. In dumping symptom. 7 patients (12.3%) had a diarrhea after meal. 38 patients (66.6%) had a normal activity 19 patients (33.3%) had a decreased activity. At present state, majority (53 patient-93%) of patient were satisfactory to the operation result, in spite of discomfort from time to time. In the emotional status, 50 patients (88%) had a well sleeping without disturbance. 65% of patients were comfortable in the psychology state. 39% of patients had a libido. Compare with their median age (63 y), it's a normal varient. Conclusion: QOL in patients underwent esophageal surgery for esophageal cancer nearly recovery to preoperative state.