• Journal of Preventive Medicine and Public Health
• /
• v.53 no.2
• /
• pp.82-88
• /
• 2020

Objectives: The objective of this study was to identify individual and institutional factors associated with the prescription of systemic steroids in patients with acute respiratory infections and to investigate the role of a policy measure aimed to reduce inappropriate prescriptions. Methods: We used data from the National Health Insurance Service-National Sample Cohort from 2006 to 2015 and focused on episodes of acute respiratory infection. Descriptive analysis and multiple logistic regression analysis were performed to identify individual-level and institution-level factors associated with the prescription of systemic steroids. In addition, steroid prescription rates were compared with antibiotic prescription rates to assess their serial trends in relation to Health Insurance Review and Assessment Service (HIRA) Prescription Appropriateness Evaluation policy. Results: Among a total of 9 460 552 episodes of respiratory infection, the steroid prescription rate was 6.8%. Defined daily doses/1000 persons/d of steroid increased gradually until 2009, but rose sharply since 2010. The steroid prescription rate was higher among ear, nose and throat specialties (13.0%) than other specialties, and in hospitals (8.0%) than in tertiary hospitals (3.0%) and other types of institutions. Following a prolonged reduction in the steroid prescription rate, this rate increased since the HIRA Prescription Appropriateness Evaluation dropped steroids from its list of evaluation items in 2009. Such a trend reversal was not observed for the prescription rate of antibiotics, which continue to be on the HIRA Prescription Appropriateness Evaluation list. Conclusions: Specialty and type of institution are important correlates of steroid prescriptions in cases of acute respiratory infection. Steroid prescriptions can also be influenced by policy measures, such as the HIRA Prescription Appropriateness Evaluation policy.

• Tuberculosis and Respiratory Diseases
• /
• v.75 no.1
• /
• pp.1-8
• /
• 2013

Several papers on respiratory and critical care published from March 2012 to February 2013 were reviewed. From these, this study selected and summarized ten articles, in which the findings were notable, new, and interesting: effects of high-frequency oscillation ventilation on acute respiratory distress syndrome (ARDS); safety and efficacy of hydroxyethyl starch as a resuscitation fluid; long-term psychological impairments after ARDS; safety and efficacy of dexmedetomidine for sedation; B-type natriuretic peptide-guided fluid management during weaning from mechanical ventilation; adding of daily sedation interruptions to protocolized sedations for mechanical ventilation; unassisted tracheostomy collar of weaning from prolonged mechanical ventilations; and effects of nighttime intensivist staffing on the hospital mortality rates.

• Korean Journal of Clinical Pharmacy
• /
• v.27 no.3
• /
• pp.186-194
• /
• 2017

Objectives: A significant concern has been raised about the emerging resistance that is largely caused by the excessive or inappropriate use of antibacterial agents for viral respiratory infections. This study investigated the trend of respiratory tract infections (RTIs) and the use of antibiotics. Methods: Utilizing the national level health insurance claims data from 2005 to 2008, we examined encounter days, antibiotic use, and the prescription rate for respiratory tract infections including upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs), and otitis media in outpatient settings. The antibiotic use was measured as defined daily dose per 1,000 patients per day (DDD/1,000 patients/day). Results: The visit for URTI increased from 141,693,465 in 2005 to 120,717,966 in 2008 and the visit for LRTI decreased from 61,778,718 to 66,930,122. For RTIs, prescription rates of antibiotics decreased from 65.2% to 58.5% for URTIs and 76.9% to 68.3% for LRTIs from 2005 to 2008. The antibiotic use decreased to 20.85 DDD/1,000 patients/day after a significant increase of 22.01 DDD/1,000 patients/day in 2006. Among antibiotics, J01CR had the highest use- 7.93 DDD/1,000 patients/day followed by J01DC of 3.71 DDD/1,000 patients/day and J01FA of 3.2 DDD/1,000 patients/day. One notable trend is that J01FA presented a continuous increase in antibiotic use from 2.3 in 2005 to 3.26 DDD/1,000 patients/day in 2008. Conclusion: The use of antibiotics had poor compliance to guidelines for RTIs. Despite decrease in the use of antibiotics, prescription rates for URTIs were still about 50% indicating that the delayed prescribing antibiotics (or wait-and-see) were not observed.

• Journal of Veterinary Clinics
• /
• v.20 no.3
• /
• pp.312-316
• /
• 2003

This study was performed to investigate the reverse effects of Jen Chung(Ren Thong, Shui Gou, GV-26) electroacupuncture after tiletamime-zolazepam administration in dogs. Seven healthy dogs ranging in weigh from 3.5 to 6.5 kg were used in this experiment. The treatment group was electrostimulated to Jen Chung(+) and Su Liao(Shan Gen, GV-25, -) for 20 minutes after 10 minutes of anesthesia. The control group I was anesthetized with tiletamine-zolazepam. The control group II was electrostimulated to nonacupuncture point for 20 minutes after 10 minutes of anesthesia. Various parameters were evaluated including the onset and recovery time of anesthesia, heart rates, body temperature, respiratory rates and electrocardiogram. The recovery time of the treatment group was shorter than that of the control group I and the control group II(p < 0.05). The treatment group had an increase in the heart rate from 20 minutes to 30 minutes after administration of tiletamime-zolazepam compared to the control group I and control group II(p < 0.05). The decrease in the body temperature was observed in all groups, but the body temperature of the treatment group was higher than the body temperature of the other groups. Respiratory rates gradually increased in all groups, but the treatment group had an increase in the respiratory rates from 20 minutes to 30 minutes after administration of tiletamime-zolazepam compared to the other groups. In the three groups, there was no specific finding on the electrocardiogram. In the result, the electroacupuncture on Jen Chung in dogs was effective for the reversed effects the tiletamine-zolazepam anesthesia 20 minutes after induction.

• The Korean Journal of Health Service Management
• /
• v.14 no.1
• /
• pp.93-102
• /
• 2020

Objectives: This study analyzed the prescription characteristics of medication for acute respiratory diseases before and after pay-for-performance to provide basic data on effective medical quality management policies. Methods: The research data were collected from the 2013-2014 sample cohort of the National Health Insurance Corporation, from Internal Medicine, Pediatrics, Otorhinolaryngology, Family Medicine and General practitioner clinics (classification of disease codes: J00-J06, J20-J22, J40 outpatients). Results: The antibiotics prescription rates decreased from 43.9% in 2013 to 43.5% in 2014 when the major diagnosis was for upper respiratory infections and increased from 62.0% in 2013 to 62.5% in 2014 when the major diagnosis was for lower respiratory infections. Conclusions: There is a need to identify the correct antibiotic prescription method by expanding the current assessment standards. Such standards must include acute lower respiratory infections and minor diagnoses as the current evaluation techniques focus only on the major diagnosis of acute upper respiratory infections.

• Acute and Critical Care
• /
• v.33 no.4
• /
• pp.238-245
• /
• 2018

Background: Infection by multidrug-resistant (MDR) pathogens leads to poor patient outcomes in intensive care units (ICUs). Contact precautions are necessary to reduce the transmission of MDR pathogens. However, the importance of the surrounding environment is not well known. We studied the effects of ICU relocation on MDR respiratory pathogen detection rates and patient outcomes. Methods: Patients admitted to the ICU before and after the relocation were retrospectively analyzed. Baseline patient characteristics, types of respiratory pathogens detected, antibiotics used, and patient outcomes were measured. Results: A total of 463 adult patients admitted to the ICU, 4 months before and after the relocation, were included. Of them, 234 were admitted to the ICU before the relocation and 229 afterward. Baseline characteristics, including age, sex, and underlying comorbidities, did not differ between the two groups. After the relocation, the incidence rate of MDR respiratory pathogen detection decreased from 90.0 to 68.8 cases per 1,000 patient-days, but that difference was statistically insignificant. The use of colistin was significantly reduced from 53.5 days (95% confidence interval [CI], 20.3 to 86.7 days) to 18.7 days (95% CI, 5.6 to 31.7 days). Furthermore, the duration of hospital stay was significantly reduced from a median of 29 days (interquartile range [IQR], 14 to 50 days) to 21 days (IQR, 11 to 39 days). Conclusions: Incidence rates of MDR respiratory pathogen detection were not significantly different before and after ICU relocation. However, ICU relocation could be helpful in reducing the use of antibiotics against MDR pathogens and improving patient outcomes.

• Clinical and Experimental Pediatrics
• /
• v.54 no.5
• /
• pp.192-196
• /
• 2011

Respiratory syncytial virus (RSV) is a main cause of hospitalization for bronchiolitis and pneumonia in infants worldwide. Children with hemodynamically significant congenital heart disease (HS-CHD), as well as premature infants are at high risk for severe RSV diseases. Mortality rates for CHD patients hospitalized with RSV have been reported as about 24 times higher compared with those without RSV infection. Recently with advances in intensive care, mortality rates in CHD patients combined with RSV have decreased below 2%. The requirements of intensive care and mechanical ventilation for CHD patients with RSV infection were still higher than those without RSV infection or with non-CHD children. RSV infection has frequently threatened CHD infants with congestive heart failure, cyanosis, or with pulmonary hypertension. As a progressive RSV pneumonitis in those infants develops, the impairment of oxygen uptake, the breathing workload gradually increases and eventually causes to significant pulmonary hypertension, even after the operation. Preventing RSV infection as much as possible is very important, especially in infants with HS-CHD. A humanized monoclonal antibody, palivizumab, has effective in preventing severe RSV disease in high-risk infants, and progressive advances in supportive care including pulmonary vasodilator have dramatically decreased the mortality (<1%). Depending on the global trend, Korean Health Insurance guidelines have approved the use of palivizumab in children <1 year of age with HS-CHD since 2009. Korean data are collected for RSV prophylaxis in infants with CHD.

• Journal of fish pathology
• /
• v.16 no.2
• /
• pp.91-102
• /
• 2003

The present study was investigated the effects of chlorine dioxide ($CIO_2$) on the rcspimtory metabolism of olive flounder (Parolichlhys olivaceus) imtermittently exposed to seawater chlorinated by $CIO_2$:. Oxygen consumption of flounder before and after once or twice $CIO_2$-treatment with 12 hr- or/and 24 hr-interval were serially measured with automatic intenniteent-flow respirometer system (AIRS). The oxygen consumption rates of flowKier exposed to 0.10 and 0.20 ppm$CIO_2$, were not different from the control fish prior to the once or twice chlorinations . On the other hand, the respiratory metabolic rates of flounder exposed to 0.30 ppm$CIO_2$ were significantly increased 15% and 22 - 23% after the once and twice chlorinations compared to the control fish. respectively. The flounder exposed In 0.40 and 0.50 ppm$CIO_2$: died within 4 hr and I hr. respectively. The elevation( respiratory metabolism in flounder exposed toO.30 ppm$CIO_2$ and above is considered due to physiological stress caused by $CIO_2$ exposure.

• Tuberculosis and Respiratory Diseases
• /
• v.80 no.3
• /
• pp.241-246
• /
• 2017

Chronic obstructive pulmonary disease (COPD) is an ambulatory care-sensitive condition, and effective treatment of outpatients can prevent worsening of the illness and hospitalization. Current COPD guidelines provide appropriate guidance for the diagnosis and treatment of patients with COPD. In fact, it has been shown that when appropriate guidance and treatment are performed, the morbidity and mortality rates of COPD patients are reduced. However, there is a gap between the clinical guidelines and the actual clinical treatment. Therefore, the Health Insurance Review and Assessment Service (HIRA) conducted an evaluation of the adequacy of COPD diagnosis and treatment using the Claims Database of HIRA. This review provides a summary of the COPD adequacy assessment results reported by the HIRA and some brief comments on the results.

• Journal of Veterinary Clinics
• /
• v.35 no.6
• /
• pp.273-275
• /
• 2018

A 6-month-old male cat was presented for investigation of depression, loss of appetite, dehydration, pale conjunctival mucous membrane, weight loss, fast heart and respiratory rates, nasal discharge and cough. Nasal swabs collected from the studied cat. As the results of bacterial culture with nasal swabs, it was suspected with Mycoplasma spp. Also, Mycoplasma species was detected by the PCR reaction with Mycoplasma genus primers. At species PCR assay, the specimens evaluated for the presence of M. felis, M. arginini, M. gateae, and Acholeplasma laidlawii and the result was visualization of bands from 238 bp in agarose gel 1.5% showing M. felis amplicons in samples. In conclusion, we detected M. felis in a cat with respiratory disease. PCR was able to detect successfully M. felis infection in cats.