• Tuberculosis and Respiratory Diseases
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• v.82 no.1
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• pp.53-61
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• 2019

Background: Antiphospholipid antibody syndrome (APS), an important cause of acquired thrombophilia, is diagnosed when vascular thrombosis or pregnancy morbidity occurs with persistently positive antiphospholipid antibodies (aPL). APS is a risk factor for unprovoked recurrence of pulmonary embolism (PE). Performing laboratory testing for aPL after a first unprovoked acute PE is controversial. We investigated if a specific phenotype existed in patients with unprovoked with acute PE, suggesting the need to evaluate them for APS. Methods: We retrospectively reviewed patients with PE and APS (n=24) and those with unprovoked PE with aPL negative (n=44), evaluated 2006-2016 at the Asan Medical Center. We compared patient demographics, clinical manifestations, laboratory findings, and radiological findings between the groups. Results: On multivariate logistic regression analysis, two models of independent risk factors for APS-PE were suggested. Model I included hemoptysis (odds ratio [OR], 12.897; 95% confidence interval [CI], 1.025-162.343), low PE severity index (OR, 0.948; 95% CI, 0.917-0.979), and activated partial thromboplastin time (aPTT; OR, 1.166; 95% CI, 1.040-1.307). Model II included age (OR, 0.930; 95% CI, 0.893-0.969) and aPTT (OR, 1.104; 95% CI, 1.000-1.217). Conclusion: We conclude that patients with first unprovoked PE with hemoptysis and are age <40; have a low pulmonary embolism severity index, especially in risk class I-II; and/or prolonged aPTT (above 75th percentile of the reference interval), should be suspected of having APS, and undergo laboratory testing for aPL.

• Journal of Information Technology Services
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• v.21 no.4
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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.

• Imaging Science in Dentistry
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• v.53 no.1
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• pp.21-26
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• 2023

Purpose: A fully digital approach to oral prosthodontic rehabilitation requires the possibility of combining (i.e., registering) digital documentation from different sources. This becomes more complex in an edentulous jaw, as fixed dental markers to perform reliable registration are lacking. This validation study aimed to evaluate the reproducibility of 1) intraoral scanning and 2) soft tissue-based registration of an intraoral scan with a cone-beam computed tomography (CBCT) scan for a fully edentulous upper jaw. Materials and Methods: Two observers independently performed intraoral scans of the upper jaw in 14 fully edentulous patients. The palatal vault of both surface models was aligned, and the inter-observer variability was assessed by calculating the mean inter-surface distance at the level of the alveolar crest. Additionally, a CBCT scan of all patients was obtained and a soft tissue surface model was generated using patient-specific gray values. This CBCT soft tissue model was registered with the intraoral scans of both observers, and the intraclass correlation coefficient(ICC) was calculated to evaluate the reproducibility of the registration method. Results: The mean inter-observer deviation when performing an intraoral scan of the fully edentulous upper jaw was 0.10±0.09 mm. The inter-observer agreement for the soft tissue-based registration method was excellent(ICC=0.94; 95% confidence interval, 0.81-0.98). Conclusion: Even when teeth are lacking, intraoral scanning of the jaw and soft tissue-based registration of an intraoral scan with a CBCT scan can be performed with a high degree of precision.

• Child Health Nursing Research
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• v.30 no.1
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• pp.54-66
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• 2024

Purpose: This study investigated participation in and perceptions of antibiotic stewardship among nurses at a children's hospital. Methods: This descriptive study included 125 nurses working in the inpatient ward, intensive care unit and emergency room of a single tertiary children's hospital. The study measured 14 factors influencing antibiotic stewardship behaviors using the theoretical domains framework. Each factor was analyzed by categorizing it into components (capability, opportunity, and motivation) that have been proposed as influencing factors in the COM-B model of behavior. One-way analysis of variance and Pearson correlation coefficients were used to explore differences in antibiotic stewardship behaviors and influencing factors according to general characteristics and the correlation between antibiotic stewardship behaviors and COM-B components. Results: No statistically significant difference in antibiotic stewardship behaviors was found based on the experience of antibiotic stewardship education or the nursing department. However, significant differences were observed in the perception levels of factors related to antibiotic stewardship behaviors according to the experience of antibiotic stewardship education in skill (physical) (p=.042), knowledge (p=.027), intentions (p=.028), and social influences (p=.010). Additionally, significant differences were observed in perception levels according to the sub-components of the COM-B model, specifically physical capability (p=.042), psychological capability (p=.027), and social opportunity (p=.010). Conclusion: To expand nurses' involvement and roles in antibiotic stewardship, nurses should acknowledge the significance of appropriate antibiotic use, aiming to enhance the quality of medical care and ensure patient safety. In pursuit of this objective, tailored education aligning with the specific needs and practices of nurses is essential.

• Journal of the Korea Institute of Information and Communication Engineering
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• v.18 no.1
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• pp.149-154
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• 2014

Quality is the value that can be measured by observing the characteristics of the service quantity or quality. QoS is predictable service traffic to a minimum requirements what passed in network. In the course of Smart Medical Information System Development there exist some functional requirements to satisfy quality objectives. The functional smart domains of healthcare information systems consists of Patient Module, a smart sensing and communication domain, RFID Tag Readers and the behavior domain, Homecare Station Domain, Clinical Station. This study is performed on evaluation methodology of u-health service satisfaction quality of each domain. In this paper QoS metrics and the quality of medical information requirements, functional requirements are separated by. Quality parameters consists of six items and the functional requirements and quality requirements 20 details the five items and consist of 20 detailed items. On this study the quality evaluation methodology of Korean smart health information quality assessment matrix 2 - factor evaluation method is proposed. The overall framework of this paper is organizing the specific criteria of quality of medical information system and modeling quality evaluation process under all smart environment.

• Health Policy and Management
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• v.12 no.2
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• pp.23-42
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• 2002

The purpose of this study was to analyze the results of 133 studies related to patient compliance published between 1980 and 2001 and to assess the effectiveness of intervention on compliance by using meta-analysis. We collected the existing literatures by using web and manual search 'patient compliance', 'sick role behavior', 'major clinical disease', and 'intervention' as key words and by reviewing content of journals related to medicine, nursing and public health. The compliance interventions were classified by theoretical focus into educational, behavioral, and affective categories within which specific intervention strategies were further distinguished. The compliance indicators broadly represent five classes of compliance-related assessments: (1) health outcomes (eg, blood pressure and hospitalization), (2) direct indicators (eg, urine and blood tracers and weight change), (3) indirect indicators (eg, pill count and refill records), (4) subjective report (eg, patients' or others' reports), (5) utilization (appointment making and keeping, use of preventive services). Quantitative meta-analysis was performed by MetaKorea program which was developed for meta-analysis in Korea. Among the 133 articles, 10 studies were selected through the qualitative meta-analysis process, and then only 6 studies were selected for the quantitative meta-analysis finally. The interventions produced significant effects for all the compliance indicators with the magnitude of common effect size (4.1192) than the non-intervention group in a random effect model. The largest effects were each study for patient of hypertension using health outcome such as blood pressure (0.4679) and diabetes mellitus using direct indicator such as glucose level in blood and urine (0.7753). These results suggest that strategic interventions showed clear advantage for improvement of patient compliance compared with non-intervention group.

• The Journal of the Korea Contents Association
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• v.18 no.5
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• pp.432-445
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• 2018

For health care professionals(HCPs) who have relatively higher possibility of exposing tuberculosis(Tb), it is important for them to equip with proper levels of knowledge and prevention activities. In terms of establishment of Tb education model for junior HCPs, therefore, literature review was done alongside 129 junior HCPs and 14 HCPs were asked to answer questionnaires and telephone survey. The results are follows.; Firstly, six educational themes such as epidermiology of Tb, Tb transmission and patho-physiology, test and diagnosis, latent Tb, Tb treatment, and Tb prevention were identified, based on the literature review. Secondly, the junior HCPs showed lower levels of knowledge regarding epidermiology, transmission and patho-physiology and latent Tb, compared to the other themes. When education courses are planned, longer period of time should be given to the lower level of knowledge areas. Thirdly, the HCPs emphasized that definition and type of Tb should be well integrated into the education in particular epidermiology education. They also responded that hospital infection and infection cycle of Tb need to be addressed during educational session about transmission and patho-physiology. in addition, they said that specific and detailed contents about diagnosis and group examination should be carefully delivered during the education, along with diagnosis, test and application of personal protective devices during education of latent Tb. They also answered that patient education and adverse effect of Tb medication should be taught during Tb treatment session, as well as self activities of health promotion for junior HCPs and systematic TB education as key way of Tb prevention. As the findings were from limited numbers of respondents and contained the sampling bias, the result has to be carefully interpretated prior to generalization. Therefore, further survey with larger study population is required in terms of development of Tb education model.

• Journal of radiological science and technology
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• v.40 no.3
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• pp.469-484
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• 2017

Radiological Technologists deals with the life of a person which means professional competency is essential for the job. Nevertheless, there have been no studies in Korea that identified the job competence of radiologists. In order to define the core job competencies of Korean radiologists and to present the factor models, 147 questionnaires on job competency of radiology were analyzed using 'PASW Statistics Version 18.0' and 'AMOS Version 18.0'. The valid model consisted of five core job competencies ('Patient management', 'Health and safety', 'Operation of equipment', 'Procedures and management') and 17 sub - competencies. As a result of the factor analysis, the RMSEA value was 0.1 and the CFI, and TLI values were close to 0.9 in the measurement model of the five core job competencies. The validity analysis showed that the mean variance extraction was 0.5 or more and the conceptual reliability value was 0.7 or more, And there was a high correlation between subordinate competencies included in each subordinate competencies. The results of this study are expected to provide specific information necessary for the training and management of human resources centered on competence by clearly showing the job competence required for radiologists in Korea's health environment.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.4.1-4.4
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• 2018

Background: Along with the advances in technology of three-dimensional (3D) printer, it became a possible to make more precise patient-specific 3D model in the various fields including oral and maxillofacial surgery. When creating 3D models of the mandible and maxilla, it is easier to make a single unit with a fused temporomandibular joint, though this results in poor operability of the model. However, while models created with a separate mandible and maxilla have operability, it can be difficult to fully restore the position of the condylar after simulation. The purpose of this study is to introduce and asses the novel condylar repositioning method in 3D model preoperational simulation. Methods: Our novel condylar repositioning method is simple to apply two irregularities in 3D models. Three oral surgeons measured and evaluated one linear distance and two angles in 3D models. Results: This study included two patients who underwent sagittal split ramus osteotomy (SSRO) and two benign tumor patients who underwent segmental mandibulectomy and immediate reconstruction. For each SSRO case, the mandibular condyles were designed to be convex and the glenoid cavities were designed to be concave. For the benign tumor cases, the margins on the resection side, including the joint portions, were designed to be convex, and the resection margin was designed to be concave. The distance from the mandibular ramus to the tip of the maxillary canine, the angle created by joining the inferior edge of the orbit to the tip of the maxillary canine and the ramus, the angle created by the lines from the base of the mentum to the endpoint of the condyle, and the angle between the most lateral point of the condyle and the most medial point of the condyle were measured before and after simulations. Near-complete matches were observed for all items measured before and after model simulations of surgery in all jaw deformity and reconstruction cases. Conclusions: We demonstrated that 3D models manufactured using our method can be applied to simulations and fully restore the position of the condyle without the need for special devices.

• Journal of Preventive Medicine and Public Health
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• v.47 no.4
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• pp.206-215
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• 2014

Objectives: The hospital standardized mortality ratio (HSMR) has been widely used because it allows for robust risk adjustment using administrative data and is important for improving the quality of patient care. Methods: All inpatients discharged from hospitals with more than 700 beds (66 hospitals) in 2008 were eligible for inclusion. Using the claims data, 29 most responsible diagnosis (MRDx), accounting for 80% of all inpatient deaths among these hospitals, were identified, and inpatients with those MRDx were selected. The final study population included 703 571 inpatients including 27 718 (3.9% of all inpatients) in-hospital deaths. Using logistic regression, risk-adjusted models for predicting in-hospital mortality were created for each MRDx. The HSMR of individual hospitals was calculated for each MRDx using the model coefficients. The models included age, gender, income level, urgency of admission, diagnosis codes, disease-specific risk factors, and comorbidities. The Elixhauser comorbidity index was used to adjust for comorbidities. Results: For 26 out of 29 MRDx, the c-statistics of these mortality prediction models were higher than 0.8 indicating excellent discriminative power. The HSMR greatly varied across hospitals and disease groups. The academic status of the hospital was the only factor significantly associated with the HSMR. Conclusions: We found a large variation in HSMR among hospitals; therefore, efforts to reduce these variations including continuous monitoring and regular disclosure of the HSMR are required.