The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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v.27
no.1
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pp.91-98
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2014
Objective : This study aimed to assessment for concordance rate in pattern analysis between pattern diagnosis of KiFDA on allergic rhinitis in 2008 and doctor of Korean medicine. Methods : Data were obtained from 35 patients with allergic rhinitis(AR). They were asked to perform the questionnaires and had been interviewed by specialist of Korean Medicine. For correlation analysis, we used Cohen's Kappa. Results : The pattern diagnosis was done only 15 patients(42.9%). Correlation between pattern diagnosis of questionnaires and specialist showed 0.2105 in Kappa and 0.1993 in weighed Kappa. Conclusions : The result may provide the basis of modification in Pattern Diagnosis of KiFDA on allergic rhinitis in 2008.
This research was carried out to determine the performance rate of health related practices, to measure the agreement between morbidity by doctor's diagnosis and morbidity by subject' self-reported and the degree of association between health related practices and morbidity rate by doctor's diagnosis, to identify their effects on morbidity among rural area populations. The data were gathered by volunteer residents (over the age of 20) of Haman Myeon, Haman Gun, Kyeongsangnam Do in Korea, from June 10, 1993 to June 12, 1993 (369 male and 516 female). Face to face interview, lab, chest P-A, EKG and physical examination were completed. Descriptive statistics, agreement analysis and multiple logistic regression procedures were employed for analyses. The results of the study were summarized as follows : 1) Age adjusted morbidity rates by doctor's diagnosis and self-reported were 38.5% (male:37.3%, female:36.5%), 26.4% (male:33.3%, female:27.5%), respectively. Kappa coefficient between morbidity by doctor's diagnosis and morbidity by self-reported was 0.21 (male:0.21, female:0.22). 2) The frequency of disease by doctor's diagnosis was as follows: hypertension(15.3%), gastritis (9.6%), diabetes mellitus (8.5%), live. disease (8.1%), and degenerative arthritis (6.2%) in the study population. 3) Order of health practice performance rate was as follows: Males-normal body weight (62.1%), non-heavy alcohol consumption (57.5%), 7-8 hours of sleeping (50.1%), non-smoking (21.7%), and exercise (19.8%). Females- non-heavy alcohol consumption (97.3%), non-smoking (84.7%), normal body weight (57.8%), 7-8 hours of sleeping (45.0%), and exercise (9.9%). 4) There was no significant relationship between health related practice and morbidity except exercise among health related practices. 5) Health related practice index which was recategorized by high, medium, and low had effects on the probability of developing morbidity.
Objective : This study was aimed to reassess the scope of practice for medical personnel based on laws. Method : The law specifying the scope of practice for medical personnel has been selected searching Korean Law Information Center(https://www.law.gov.kr). The result was categorized as 'examination, diagnosis, treatment, procedure, prescription, and others'. Results : The laws related to medical procedures were divided into three categories: diagnosis, treatments, and public health and others. In the field of diagnosis, traditional Korean medicine practitioners are generally allowed to play a role. However, some laws specify that only medical doctors can be the primary authorities for diagnosing infectious diseases. In the area of treatments, particularly in emergency medical situations, only medical doctors or nurses are typically mentioned. There are debates in the field of public health and other areas concerning issues such as vaccination, disability diagnosis, and the qualifications for health center directors. A reevaluation is also needed for the Occupational Safety and Health Act, where only medical doctors are set as the personnel standard for workers' health examinations. Conclusion : To safeguard and promote the health of the citizens, there is a need for a clear definition of the licensure and scope of practice for healthcare professionals. Consistent interpretation of conflicting provisions among various laws and clear criteria for the term 'physician' in legal contexts are essential.
Objective : This study aimed to analyze the utilization of Korean Medicine clinics, and high-frequent diseases by sex, age, and region of outpatients and inpatients Methods : The data for this study were "Report on Usage Patterns of Korean Medicine Clinics" issued by the Ministry of Health and Welfare in 2008. Descriptive analysis and correspondence analysis were used to find the patterns of patient's utilization by sex, age and region Results : Diagnosis and examination methods mostly consisted of the pulse for diagnosis. Treatment methods consisted of acupuncture, medical herbs in package, and insurance extract powder. Fee for consultation was paid by Korean Medicine insurance. Usage increased when people's age was over 20 and climaxed among people who were in their 40s and 50s and decreased gradually afterwards. Also, there were differences between the sexes. There were differences in high-frequent diseases by regions, and in usage of Korean Medicine clinics according to sex and age. Conclusion : It was found that there were differences in usage and patterns of Korean Medicine Clinics according to sex, age, and region.
In Korea there is no specific method of age adjustment in noise induced hearing loss(NIHL). We attempted the age adjustment to understand the effects of age on the diagnosis of NIHL. We used the International Standard Organization 1999 as an age adjustment method. We used the 1, 617 otologically normal person's hearing data from a health examination center, and 206 workers diagnosed as NIHL. We concluded as follows; 1. The ISO 7029 function used for age specific hearing loss is not suited to Korean people. 2. The mean of age specific hearing loss is 11.0 6.2dB and the older of age, the more decrease on hearing loss, especially in 4000Hz. 3. The difference of NIHL between before age adjustment and after age adjustment in the 3rd decade is 5.4dB, in the 4th decade is 6.7dB, in the 5th decade is 8.5dB, in the 6th decade is 10.4dB, and in the 7th decade is 12.9dB. The older, the more is the difference. 4. After age adjustment, the number of workers diagnosed as NIHL decreases to 60% of unadjusted.
Seo, Sun Won;Kim, Kwang Hwan;Pu, Yoo Kyung;Suh, Jin Sook;Seo, Jeong-Don;Park, Woo-Sung;Yoon, Seok Jun;Lee, Young Sung;Lee, Moo-Sik;Chung, Hee-Ung
Quality Improvement in Health Care
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v.9
no.1
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pp.52-64
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2002
Background : Coding of principal diagnosis is essential component for producing reliable health statistics. We performed this study to evaluate the current practice of principal diagnoses determination and coding, and to give some basic data to improve coding of principal diagnosis. Method : Nineteen medical record administrators (MRAs) of 3 university hospitals participated in coding principal Dx. from August 1, 2001 to August 31, 2001. From each hospital, 10 medical records of patients with high frequency disease were selected randomly. Each 10 medical records were grouped into three (A. B, C). Then, these 30 medical records were given to each MRAs for coding. At the same time questionnaire was given to each of them. Questions were to prove how they decide and code the principal diagnosis among many current diagnoses; how they decide and code the principal diagnosis when they see irrelevant diagnosis recorded as the principal diagnosis in medical record, when only tentative diagnoses were recorded without final diagnosis, and when different diagnoses were recorded in different sheets of same record. Agreement of coding among 3 hospitals were compared and survey results were analysed with SAS 6.12. Results : Agreement of coding was found in medical records 5-6 of each 10 medical records. Causes of disagreement were as follows. Difference of clinician's opinion from each hospital; mixed use of guideline from KCD-3 and guideline from DRG; difference in 4th digit classification according to the absence of pathology report in the medical record; difference of abbreviations among hospitals. 57.9% of MRAs selected the principal diagnosis recorded by physician, 42.1% of MRAs decided principal diagnosis after consulting to KCD-3 guideline. When there were difficulties in determining the principal diagnosis, 42.1% of MRAs decided principal diagnosis after discussion with the physician, 26.3% after discussion with fellow MRAs. Conclusion : There were differences in codings among hospitals. To minimize the difference, we suggest the development of disease-specific guidelines for coding in addition to the current general guideline such as KCD-3. To do this, Coding Clinic which can produce guidelines is needed.
Objectives: Previous observations propose that risk-taking behaviors such as cigarette smoking are prevailing among young people with chronic conditions including diabetes. The purpose of this study was to examine whether cigarette smoking is more prevalent among diabetics than non-diabetics and whether it differs by age at the time of diagnosis with diabetes from young adulthood (YAH) to adulthood (AH). Methods: We used US panel data from the National Longitudinal Study of Adolescent Health (Add Health Study) during the years 2001 to 2002 (Wave III, YAH) and 2007 to 2008 (Wave IV, AH). Multivariate logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of cigarette use behaviors according to age at the time of diagnosis with diabetes, after adjusting for demographic and selected behavioral factors. Results: Of 12 175 study participants, 2.6% reported having been diagnosed with diabetes up to AH. Early-onset diabetics (age at diagnosis <13 years) were more likely than non-diabetics to report frequent cigarette smoking (smoking on ${\geq}20$ days during the previous 30 days) in YAH (OR, 3.34; 95% CI, 1.27 to 8.79). On the other hand, late-onset diabetics (age at diagnosis ${\geq}13$ years) were more likely than non-diabetics to report heavy cigarette smoking (smoking ${\geq}10$ cigarettes per day during the previous 30 days) in AH (OR, 1.54; 95% CI, 1.03 to 2.30). Conclusions: The current study indicated that diabetics are more likely than non-diabetics to smoke cigarettes frequently and heavily in YAH and AH. Effective smoking prevention and cessation programs uniquely focused on diabetics need to be designed and implemented.
Objectives : We presented the results of reliability study in advance, and analyzed agreement between Korean medicine doctors(KMDs)' diagnosis and cold-heat pattern identification questionnaire(CHPI)'s diagnosis. Methods : This survey was conducted from May 16 to 17, 2015. The subjects were 93 adults living in rural society. Diagnosis of CHPI was performed by 2 KMDs who have clinical experience more than 5 years. The KMDs' diagnosis was set as a reference index, and then we compare 23 items(cold pattern 11 items and heat pattern 12 items) of CHPI questionnaire and 15 items(cold pattern 8 items and heat pattern 7 items) that were brief form of it. We had cut-off value by standard of KMDs' diagnosis using receiver operating characteristic-curve(ROC-curve), with which we calculated agreement including kappa value. Correlation analysis between CHPI evaluation score by KMDs and by the questionnaire was fulfilled as well. Results : Agreement about 11 and 8 cold pattern items showed 87.1% together, and the value of kappa each recorded 0.742 and 0.741. Agreement about 12 and 7 heat pattern items suggested 81.7% and 78.5%, and the value of kappa showed 0.634 and 0.570. Correlation coefficients were 0.803 of 11 items and 0.761 of 8 items about cold pattern. In addition, correlation coefficients were 0.789 of 12 items and 0.767 of 7 items about heat pattern. The significant probability (p-value) was under 0.001. Conclusions : We have developed CHPI questionnaire involving reliability and agreement based on usual symptoms, and hope additional complements so that Korean medicine diagnostics and Korean preventive medicine would be improved.
Objectives: The lung injuries by exposure to the humidifier disinfectants (HDs) were reported in 2011, Korea. For the HD victims, environmental exposure level and clinical diagnosis were conducted to determine the levels of damage by HDs. Methods: The exposure assessment to the HDs from 1st to 4th questionnaire surveys were carried out for 5,245 victims. And the affecting factors of exposure levels were analyzed by characterizing exposure and demographic information. By using of exposure concentration and cumulative time, exposure levels were classified and compared by percentage of clinical diagnosis classes. The high exposure and low clinical diagnosis rating groups, and low exposure and high clinical diagnosis rating groups were analyzed to overcome the limitation of past exposure assessment such as recall bias. Results: Among the all applicants damaged by the humidifier disinfectants, survivors were 4,028 and the dead were 1,217. And male and female were 2,675, and 2,547, respectively. In case of occurrence age of lung disease, under 10 years was majority age group (1,536) and followed by thirties (917). Pregnant women and fetuses were 339 and 439, respectively. And the damages by exposure to the HDs were concentrated on these susceptible populations in groups with low exposure and high clinical diagnosis rating. On the other hand, the groups classified by high exposure and low clinical diagnosis rating were shown different characterization. Conclusions: The questionnaire survey on past exposure may be uncertain due to recall bias. However, the relationship between classified exposure levels and clinical diagnosis ratings might be shown positive correlation if the exposure assessment errors were analyzed and controlled.
In this paper, we describe the developed learning tool of expert system for preventive diagnosis of substation power equipments. The expert system was programmed by using the diagnosis methods as like gas analysis in oil and partial discharge, hottest temperature, the current of OLTC driving meter, the current of fan and pump in MTr and driving coil current in GCB and leakage current in LA. The learning tool is composed of the expert system and the explanation of diagnosed examples and the applied rules and it well worked according to the rule.
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