• The Korean Journal of Pain
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• 제25권4호
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• pp.254-257
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• 2012

Background: Elderly patients visiting pain clinic may be at greater risk of misunderstanding the explanation because of age-related cognitive decline. Video instruction may provide a consistent from of teaching in a visual and realistic manner. We evaluated the effect of educational video on the patient understanding and satisfaction in a group of geriatric patients visiting pain clinic. Methods: Ninety two patients aged more than 60 years old who were scheduled for transforaminal epidural block were recruited. After exposure to either video or paper instruction process, each patient was asked 5-item comprehension questions, overall satisfaction and preference question. During follow-up period, number of outpatient referral-line call for further explanation was counted. Results: We observed significantly better comprehension in the video education compared with paper instruction (P < 0.001). Patient satisfaction was also higher in the video group (P = 0.015), and patients visiting pain clinic were more preferred video instruction (P < 0.001). Proportion of referral-line call for further explanation were similar (P = 0.302). Conclusions: Video approach to instruction process before consent improves treatment comprehension in geriatric patient visiting pain clinic.

• Clinical and Experimental Pediatrics
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• 제59권2호
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• pp.59-64
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• 2016

Purpose: Infantile Marfan syndrome (MFS) is a rare congenital inheritable connective tissue disorder with poor prognosis. This study aimed to evaluate the cardiovascular manifestations and overall prognosis of infantile MFS diagnosed in a tertiary referral center in Korea. Methods: Eight patients diagnosed with infantile MFS between 2004 and 2014 were retrospectively evaluated. Results: Their median age at the time of diagnosis was 2.5 months (range, 0-20 months). The median follow-up period was 25.5 months (range, 0-94 months). The median length at birth was 50.0 cm (range, 48-53 cm); however, height became more prominent over time, and the patients were taller than the 97th percentile at the time of the study. None of the patients had any relevant family history. Four of the 5 patients who underwent DNA sequencing had a fibrillin 1 gene mutation. All the patients with echocardiographic data of the aortic root had a z score of >2. All had mitral and tricuspid valve prolapse, and various degrees of mitral and tricuspid regurgitation. Five patients underwent open-heart surgery, including mitral valve replacement, of whom two required multiple operations. The median age at mitral valve replacement was 28.5 months (range, 5-69 months). Seven patients showed congestive heart failure before surgery or during follow-up, and required multiple anti-heart failure medications. Four patients died of heart failure at a median age of 12 months. Conclusion: The prognosis of infantile MFS is poor; thus, early diagnosis and timely cautious treatment are essential to prevent further morbidity and mortality.

• Asia pacific journal of information systems
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• 제23권1호
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• pp.45-63
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• 2013

The purpose of this research is on the identification of the effects of perceived interactivity formed by the electronic collaborative referral system on the organizational loyalty. Two channels through which the effects proceeded were investigated. One is the "system channel" which consists of "interactivity of the inter-organizational system ${\rightarrow}$ intention of using the system ${\rightarrow}$ organization loyalty" (hypothesis 1, 2), that is the channel which anticipates that a better understanding on the interactivity of the inter-organizational system makes the intention of the using the system strong, and this strong intention results the higher organization loyalty. The other is "organization channel" which consists of "interactivity of the inter-organizational system ${\rightarrow}$ perceived interactivity on the counterpart ${\rightarrow}$ perceived relation benefits with the counterpart ${\rightarrow}$ organization loyalty" (hypothesis 3, 4, 5). The channel means that as the perceived interactivity of users on the inter-organizational system becomes greater, the perceived interactivity with the counterpart is increasing. And this makes the users feel that more benefits can be obtained by the relationship with system providing organization, and finally makes the organization loyalty that is the intention to maintain the relationship greater. The corroborative evidence data confirm the two channels are obtained by questing on the electronic referral system of Samsung Medical Center to the doctors of the first and second collaborated hospitals or clinics, and by analyzing statistically. The verification result for the "system channel" showed that as the perception on the interactivity of inter-organizational system was increasing, the intention for consistent using increased(support hypothesis 1), and then the organization loyalty that is the relationship maintaining indication by using the referral system also increased(support hypothesis 2). And the confirmation result for the "organization channel" indicated that the perceptive interactivity on the counterpart increased as the understanding on the interactivity of inter-organizational system increased(support hypothesis 3), consecutively, with the intuitive relation benefits increase with the counterpart(support hypothesis 4) the organization loyalty means the intention to maintain the relationship was confirmed to increase(support hypothesis 5). These results demonstrate that when the perceived interactivity in using many systems at the collaboration between organizations is increasing, the positive image on the systems creates the consistent system using intention, and the positive image increases the wants for preserving the relationship with counter organization. In addition, the perceived interactivity of inter-organizational system users affects directly on the perceived interactivity of the counter organization, so the important role of inter-organizational system in promoting the interactivity between cooperative counterparts was recognized. And the perceived interactivity on the counter organization become greater, the influence on the perceived benefits from cooperation is positive. Therefore, the perceived interactivity by using inter-organizational system was confirmed as a prerequisite for the continuous relationship.

• 대한응급의학회지
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• 제29권5호
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• pp.465-473
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• 2018

Objective: We evaluated the clinical characteristics and prognoses of patients with septic shock who transferred to the emergency department (ED) in a tertiary referral center. Methods: This study was performed using a prospective, multi-center registry of septic shock, with the participation of 11 tertiary referral centers in the Korean Shock Society between October 2015 and February 2017. We classified the patients as a transferred group who transferred from other hospitals after meeting the inclusion criteria upon ED arrival and a non-transferred group who presented directly to the ED. Primary outcome was hospital mortality. We conducted multiple logistic regression analysis to assess variables related to in-hospital mortality. Results: A total of 2,098 patients were included, and we assigned 717 patients to the transferred group and 1,381 patients to the non-transferred group. The initial Sequential Organ Failure Assessment score was higher in the transferred group than the non-transferred group (6; interquartile range [IQR], 4-9 vs. 6; IQR, 4-8; P<0.001). Mechanical ventilator (29% vs. 21%, P<0.001) and renal replacement therapy (12% vs. 9%, P=0.034) within 24 hours after ED arrival were more frequently applied in the transferred group than the non-transferred group. Overall hospital mortality was 22% and there was no significant difference between transferred and non-transferred groups (23% vs. 22%, P=0.820). Multivariable analysis showed an odds ratio for in-hospital mortality of 1.00 (95% confidence interval, 0.78-1.28; P=0.999) for the transferred group compared with the non-transferred group. Conclusion: The transferred group showed higher severity and needed more organ support procedures than the non-transferred group. However, inter-hospital transfer did not affect in-hospital mortality.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제20권3호
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• pp.129-139
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• 2009

Objectives : This study evaluated the effectiveness of school-based mental health screening and treatment linkage programs, focusing on attention-deficit hyperactivity disorder (ADHD) and adolescent depression. Methods : All 11,158 children and adolescents aged 8-14 years in Seoul received a school-based mental health screening, consisting of the Korean versions of the ADHD rating scale and the Child Behavior Checklist (CBCL), for ADHD, and the Center for Epidemiological Studies Depression Scale (CES-DS) and the Suicidal Ideation Questionnaire-Junior (SIQ-JR), for depression. The high-risk children's and adolescents' diagnoses were confirmed using the Diagnostic Interview Schedule for Children-IV (DISC-IV). Treatment linkage programs were managed by the Seoul Metropolitan Community Mental Health Center (Program 1), the Seoul Metropolitan Office of Education (Program 2), or the Dongjak District Office of Education (Program 3). We estimated and compared the referral rates of the three programs. Results : Program 1 screened and referred 22.9% of ADHD youths to mental health services, Program 2, 68.8%, and Program 3, 40.0%. Program 1 screened and referred 22.8% of depressed youths to mental health services, Program 2, 53.8%, and Program 3, 88.9%. Key elements for successful screening and referral programs were an effective school/community mental health center/Office of Education network, the parents' financial support and perception of their child's mental health status as being problematic, and the teachers' active engagement. Conclusion : This is the first study investigating the effectiveness of school-based mental health screenings' linkage to treatment for primary and middle school students in Korea. An effective network for community mental health and improvements in parents' and teachers' perceptions regarding mental health are needed for more successful treatment linkage.

• Journal of mucopolysaccharidosis and rare diseases
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• 제4권1호
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• pp.11-13
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• 2018

In Malaysia, diagnosis and treatment of patients with mucopolysaccharidoses (MPS) is mainly localized at Hospital Kuala Lumpur, which is the national referral center for rare diseases. To date there are 83 patients diagnosed with MPS in our center, with MPS II being the commonest. The Malaysian National Medicines Policy second edition has a specific section on the orphan drugs which includes recombinant human enzyme for enzyme replacement therapy (ERT) in MPS. So far, National Pharmaceutical Regulatory Agency Malaysia has approved recombinant human enzyme for MPS types I (Loranidase), II (idursulfase), IVA (elosulfase alfa), and VI (Galsufase). Access to Idursulfase beta (another recombinant human enzyme for MPS II) and vestronidase alfa-vjbk (MPS VII) required special authorization on named patient basic. Currently there are 25 patients receiving ERT, 70% of the funding are from Ministry of Health (MOH), the remaining 30% are from various charitable funds and humanitarian programs. Thirteen newly diagnosed patients have to queue for an additional fund. Four patients have been treated with Hematopoietic stem cell transplant. MOH has also published guidelines regarding the patient selection criteria for ERT and treatment monitoring schedule.

• Archives of Plastic Surgery
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• 제45권4호
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• pp.384-387
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• 2018

Blepharoplasty is one of the most commonly performed aesthetic procedures. Surgical complications are rare, but can have severe consequences, such as permanent vision loss. In this report, we describe a patient who developed primary angle-closure glaucoma (ACG) with associated vision loss after a oculoplastic procedure using local anesthesia. So far, six similar cases have been described in the literature. It is believed that acute ACG is triggered by the surgical procedure in patients with predisposing risk factors such as a cataract. Surgical triggering factors include the use of buffered lidocaine/xylocaine with adrenaline/epinephrine, stress, and coverage of the eyes postoperatively. Due to postoperative analgesic use, the clinical presentation can be mild and atypical, leading to a significant diagnostic delay. Acute ACG should therefore be excluded in each patient with postoperative complaints by assessing pupillary reactions. If a fixed mid-wide pupil is observed in an ophthalmologic examination, an immediate ophthalmology referral is warranted. Surgeons should be aware of this rare complication in order to offer treatment at an early stage and to minimize the chance of irreversible vision loss.

• Diabetes and Metabolism Journal
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• 제42권6호
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• pp.538-543
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• 2018

Globally, diabetic retinopathy (DR) is one of the leading causes of blindness, that diminishes quality of life. This study aimed to describe the prevalence of DR, and its associated risk factors. This cross-sectional study was carried out among 478 diabetic patients in a referral center in Fars province, Iran. The mean${\pm}$standard deviation age of the participants was $56.64{\pm}12.45$ years old and DR prevalence was 32.8%. In multivariable analysis, lower education levels (adjusted odds ratio [aOR], 0.43; 95% confidence interval [CI], 0.24 to 0.76), being overweight (aOR, 1.70; 95% CI, 1.02 to 2.83) or obese (aOR, 1.88; 95% CI, 1.09 to 3.26), diabetes duration of 10 to 20 years (aOR, 2.35; 95% CI, 1.48 to 3.73) and over 20 years (aOR, 5.63; 95% CI, 2.97 to 10.68), receiving insulin (aOR, 1.99; 95% CI, 1.27 to 3.10), and having chronic diseases (aOR, 1.71; 95% CI, 1.02 to 2.85) were significantly associated with DR. In conclusion, longer diabetes duration and obesity or having chronic diseases are strongly associated with DR suggesting that control of these risk factors may reduce both the prevalence and impact of retinopathy in Iran.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제16권1호
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• pp.72-78
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• 2005

목 적 : 종합병원에서의 소아청소년을 대상으로 한 정신과 자문의 임상적 특징을 알아보고자 하였다. 방 법 : 4년 동안 한 종합병원에서 소아정신과에 의뢰된 302명의 환자의 병원기록을 조사 분석하였다. 결 과 : 학령기 아동과 청소년의 소아정신과 자문비율은 $2.15\%$였다. 중, 고등학생에서는 여자에서 더 많이 자문이 의뢰되었으나 학령전기 아동에서는 남자에서 더 많이 의뢰되었다. 자문의 $50\%$가 내과와 소아과로부터 의뢰되었다. 자문의뢰의 주된 이유는 정신과적 평가$(31.1\%)$, 우울$(11.6\%)$, 그리고 불안$(11.3\%)$이었다. 가장 자주 행해진 치료 목적의 정신과적 처치는 정신과적 교육과 지지적 정신치료였다$(21.2\%)$. 결 론 : 정신과 자문 의뢰의 임상적 양상은 성인과 소아청소년 사이에 차이가 있다. 소아 및 청소년을 위한 자문서비스를 강화시키기 위하여 더 많은 연구가 필요하다.

• 대한영상의학회지
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• 제79권5호
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• pp.247-253
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• 2018

이 연구의 목적은 영상정보교류의 효용성을 높이기 위한 영상 품질 기준 연구에서 영상정보교류의 실태를 파악하고 영상정보교류에 대한 의사들의 의견을 수렴하기 위해 시행한 설문조사의 결과를 정리하는 것이다. 설문조사는 개별 접촉 또는 소셜 네트워크 서비스를 통해 홍보하였고, 자발적으로 참여한 의사가 설문조사의 대상이다. 설문조사는 기본 정보 및 영상정보교류에 대한 11개의 문항으로 구성되었다. 총 30개 진료과의 전문의 160명이 설문조사에 참여하였고, 95.6%의 응답자가 상급종합병원 또는 종합병원에 근무하는 상태였다. 외부 병원에서 영상검사를 시행한 후 의뢰되는 환자가 빈번하였다. 하지만 판독소견서가 함께 교류되는 경우는 드물었고, 의뢰받은 의료기관의 영상의학과 전문의에 의한 재판독을 통해 이차적인 의견을 구하고자 하는 요구가 많았다. 결론적으로, 외부 판독소견서가 누락되는 경우가 많으므로 판독소견서가 영상정보와 함께 교류될 수 있도록 하는 방안의 마련이 필요하다. 또한 외부 판독이 있더라도 재판독이 필요하다는 의견이 많은 점을 고려할 때 판독소견서에 반드시 포함되어야 할 기본적인 판독소견서의 요소 및 외부 검사의 재판독에 대한 가이드라인이 필요할 것으로 생각된다.