• Health Policy and Management
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• v.20 no.4
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• pp.45-57
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• 2010

Background : If different cost efficiency indexes were informed to the same clinic depending on the inclusion or exclusion of pharmacy cost, it may impair the reliability of provider-profiling system. This study aimed to investigate whether the omission of pharmacy cost affects cost-efficiency rankings in medical clinics. Methods : Data for ambulatory care cost at 23,112 medical clinics were collected from the claims database, which was constructed after review by the Health Insurance Review and Assessment Service (HIRA) of Korea in April 2007. We calculated two types of cost efficiency indexes by inclusion or exclusion of pharmacy cost for a medical clinic. The agreement between the decile rankings of the two indexes was also assessed using the weighted kappa statistic of Landis and Koch. Results : When the cost efficiency index for total cost including pharmacy cost was compared with the index for total cost excluding it, the agreement between the two indexes was only 55%. The agreements between the two indexes were relatively low within specialties which have larger pharmacy volume of total cost and lower correlation between total cost with or without pharmacy cost included than the average level of all the specialties. Conclusion : These results suggest that the omission of pharmacy cost may result in contradictory outcomes that may be confusing to a medical institution and may impair the reliability of provider-profiling systems. It is very important to standardize profiling criteria for the reliability of provider profiling system.

• The Journal of Internal Korean Medicine
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• v.27 no.4
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• pp.822-826
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• 2006

Objectives : Essential hyperhidrosis is a socially and occupationally disabling disorder. There are many suggestions that hyperhidrosis is associated with the autonomic nervous system, especiallythe sympathetic system. This study was designed to investigate the autonomic nerve system in patients with essential hyperhidrosis and healthy controls by the frequency domain analysis of heart rate variability (HRV). Methods : 17 head-hyperhidrosis patients in the ambulatory care were investigated. All were inspected at the first medical examination. using the PSA of HRV. HRV was measured for minutes after 5 minutes bed rest. We checked the frequency domain analysis of HRV (i.e. TP, VLF, LF, HF) which were transformed into natural logarithm of patients against the standard measures of the HRV components. Then we compared the values of patients with means of normal Korean subjects. Results : The values of natural logarithmic measure of HRV (LnTP, LnHF, LnLF, LnVLF) of patients With head-hyperhidrosis we examined were $6.85{\pm}1.61$, $4.93{\pm}$2.00, $5.40{\pm}1.83$, and $6.13{\pm}1.37$, respectively. None of these values were higher than means of normal subjects. Conclusions : This study suggests that the function of the autonomic nervous system does not increase in patients with head-hyperhidrosis.

• The Journal of Internal Korean Medicine
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• v.29 no.1
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• pp.1-11
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• 2008

Objectives : Essential hyperhidrosis is a socially and occupationally disabling disorder. There are many suggestions that hyperhidrosis is associated with the autonomic nervous system. This study was designed to investigate the autonomic nerve system the patients with hyperhidrosis. Methods : 348 palmar and plantar hyperhidrosis patients and 20 systemic hyperhidrosis patients in the ambulatory care were investigated. All patients were inspected at the first medical examination, using the PSA of HRV. HRV was measured for 5 minutes after 5 minutes' bed rest. We checked the frequency domain analysis of HRV (i.e. TP, VLF, LF, HF and LF/HF) which were transformed into natural logarithm of patients against the standard measures of the HRV components. Then, we compared the means of patients with means and highest values of in the normal range of Koreans 1) between the patients with palmar and plantar hyperhidrosis and the healthy controls and 2) between the patients with the systemic hyperhidrosis and healthy controls, by the frequency domain analysis of heart rate variability (HRV), respectively. We then compared the results between 1) and 2). Results : The values of natural logarithmic measures of LF/HF ratio in the patients with palmar and plantar hyperhidrosis we examined were significantly higher than the values of healthy controls, but those in the patients with systemic hyperhidrosis were not higher. Conclusion : This study suggests that the autonomic nervous function did not simply increase but that the balance between sympathetic and parasympathetic nervous function did matter in patients with palmar and plantar hyperhidrosis. This balance included that the sympathetic nervous function aggravated comparatively with parasympathetic nervous function. On the other hand, we couldn't find any significance of the patients with the systemic hyperhidrosis as for the autonomic nervous function.

• Health Policy and Management
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• v.5 no.1
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• Physical Therapy Korea
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• v.25 no.2
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• pp.53-61
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• 2018

Background: Stroke patients show abnormal walking patterns due to brain injury. In order to have the desired walking pattern, appropriate stimulation is required to activate the central pattern generator. For this reason, our study performed treadmill ambulatory training with rhythmic auditory stimulation. However we did not consider the influence of visual feedback. Objects: The purpose of this study was to compare the gait abilities in chronic stroke patients following either treadmill walking training with rhythmic auditory stimulation and visual feedback (TRASVF) or treadmill walking training with rhythmic auditory stimulation (TRAS) alone. Methods: Twenty-one stroke patients were divided into two groups: A TRASVF group (10 subjects) and a TRAS group (11 subjects). They received 30 minutes of neuro-developmental therapy (NDT) and walking training for 30 minutes, five times a week for three weeks. Temporal and spatial gait parameters were measured before and after the training period. The Biodex gait trainer treadmill system measured gait parameters. Results: After the training periods, the TRASVF group showed a significant improvement in walking speed, the step length of the affected limb, and time on each foot of the affected limb when compared to the TRAS group (p<.05). Conclusion: The results of this study showed that the treadmill walking training with rhythmic auditory stimulation and visual feedback improved individual gait ability more than the treadmill walking training with rhythmic auditory stimulation alone. Therefore, visual feedback should be considered along with rhythmic auditory stimulation training.

• Korean Journal of Community Nutrition
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• v.5 no.1
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• pp.109-119
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• 2000

The purpose of this study was to measure serum lipids concentrations by gender and age, and to investigated the relation of serum lipids levels to cigarette smoking alcohol intake exercise and menopausal status in Korean adults. The subjects consisted of 463 healthy adult(29- men and 173 women) volunteers who were visiting the health Promotion Center in the Asan Medical Center from July 1, 1994 to July 22, 1994 Subjects were ambulatory free-living people and aged 20- 80 years, Anthropometric measurement was performed and serum triglyceride(TG), HDL-cholesterol and total cholesterol(TChol) concentrations were measure by automatic system(Hitachi 736-40). Data on life styles were obtained using structured questionnaires issued by a trained interviewer, All data were statistically analyzed by PC-SAS(Version 6.04) Serum concentrations of triglyceride and total cholesterol was higher(p<0.05) in men than in women, and serum HDL-cholesterol was lower(p<0.05) in men than in women. The prevalence of hyperlipidemia(TG>170 mg/dL and TChol>220 mg /dL) was 12.5% in men and 4.1% in women. The levels of serum triglyceride, total cholesterol and BMI increased with age in women. The distribution curves of serum triglyceride, total cholesterol and LDL-cholesterol of women were located in lower increased more rapidly with aging than in men, The distribution curves of BMI of women increased with aging after the thirties, The BMI of women was located in higher levels than of men in their sixties. The serum concentration of triglyceride and total cholesterol of male current-smokers and non- smokers were significantly(p<0.05) higher than those of ex-smokers. The concentrations triglyceride the male current0drinkers were higher(p<0.05) than those of male non-drinkers. In non-smokers and non- drinkers, serum TG concentration were lower (p<0.05) than those of current-smokers and current-drinkers. In exercisers, the serum triglyceride concentration was significantly(p<0.05) lower than in non- exercisers. In postmenopausal woman BMI and serum concentrations of TChol, TG and LDL-Chol were significantly by age and gender and smoking alcohol drinking, exercise and menopausal staus might be a better indicator to predict serum lipids in both genders.

• The Journal of the Korea institute of electronic communication sciences
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• v.12 no.4
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• pp.533-538
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• 2017

In this thesis, the ambulatory aid mechanism was implemented so that blind people could be safer at risk of walking outdoors. Using ultrasonic sensors, the obstacles can be detected when the distance between the obstacle is within 50 cm of the obstacle. If the light sensor becomes less than 25 lux, the LED will automatically turn on and help the safety of the visually impaired and the security of sight of the peripheral walkers. Color recognition sensors increase the rate of recognition of yellow color by the detection distance is 1cm, it vibrated when yellow light was detected. Using GPS with 7.3 m of error range, the guardian was able to check the location of the visually impaired.

• Korean Journal of Clinical Pharmacy
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• v.20 no.3
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• pp.213-220
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• 2010

Therapeutic duplication (TD) is a serious problem that frequently occurring primarily in the ambulatory setting in Korea. Implementation of concurrent drug utilization review (DUR) is a promising way to reduce inappropriate prescription and dispensing, and improve patient safety. This study was aimed to develop the process of DUR module of TD. Sixty-five drug ingredients classified into the drug category of the antipyretic, analgesic, and anti-inflammatory drug approved in Korea (The KFDA-dess nated classification codes of 114 or 264) were reviewed for this purpose. The drug ingredients (and products) were reclassified based on WHO's Anatomical, Therapeutic and Chemical (ATC) classification system. The clinical practice guidelines, textbooks and product labels on therapeutic uses of these drugs in Korea and several fores n countries were reviewed. If the drugs were categorized into the same therapeutically duplicable class, they were defined not to be used concurrently because the concurrent use was "therapeutically duplicated (unnecessary or even harmful)". Among the studied drug products, the following 5 drug classes were considto beas "therapeutic duplication": (1), on-t tooid DURnti-inflammatory drugs (NSAIDs, including s Dicylates), (2),Anilidts, (3),Opioids, (4) Ergot Dk Doids and (5) 5-$HT_1$ receptor agonot s. Therefore, concurrent prescribing or dispensing of more than 2 drug ingredients any in the above same classes should be considered as TD and needed to be warrant for careful review by pharmacists before dispensing.

• Journal of Biomedical Engineering Research
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• v.35 no.3
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• pp.55-61
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• 2014

In sleep monitoring system, polysomnography (PSG) is the gold-standard but previous studies revealed that attaching numerous amount of sensors disturb sleep during the test which is the fundamental disadvantage of PSG. We suggest an unconstrained rapid-eye-movement (REM) sleep monitoring method measured with polyvinylidene (PVDF) film-based sensor for the normal and the obstructive sleep apnea (OSA) patients. Nine normal subjects and seventeen OSA patients have participated in the study. During REM sleep, rate and variability of respiration are known to be greater than in other sleep stages. Based on this phenomena, respiratory signals of participants were unconstrainedly measured using the PVDF-based sensor with the PSG and REM sleep were extracted from the average rate and variability of respiration. In epoch-by-epoch REM sleep detection, proposed method classified REM sleep with an average sensitivity of 72.3%, specificity of 92.5%, accuracy of 88.9%, and kappa statistic of 0.60 compared to the results of PSG. Student's t-test showed no significant difference between the results of normal and OSA group. This method is potentially applicable to REM sleep detection in homing environment or ambulatory monitoring.

• Journal of the Ergonomics Society of Korea
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• v.35 no.6
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• pp.493-501
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• 2016

Objective: This study analyzes the effect of angle conditions of rehabilitation equipment used for supporting hemiplegic patients on their rehabilitation training for standing action. The study was performed by adjusting the rear angle of seat inclination through a motion analysis. Background: Owing to a loss of muscle rigidity and degradation of muscle control ability, hemiplegic stroke patients suffer from asymmetrical posture, abnormal body balance, and degraded balance abilities due to poor weight-shifting capacity. The ability to shift and maintain one's weight is extremely essential for mobility, which plays an important role in our daily life. Thus, to improve patients' ability to maintain weight evenly and move normally, they need to undergo orthostatic and ambulatory training. Method: Using a motion analysis system, knee movements on both hemiplegic side and non-hemiplegic side were measured and analyzed in five angles ($0^{\circ}$, $10^{\circ}$, $30^{\circ}$, $50^{\circ}$, $70^{\circ}$) while supported by the sit-to-stand rehabilitation equipment. Results: The knee movements on both sides increased as the angle increased in angle support interval to support a hemiplegic patient's standing up position. In standing up interval, a hemiplegic patient's knee movement deviations on both sides decreased, and the movement differences between hemiplegic and non-hemiplegic legs also decreased as the angle increased. Conclusion: The results of this study showed that the rehabilitation effectiveness increases as the angle increases, leading to a balanced standing posture through the decrease of movement difference between hemiplegic and non-hemiplegic sides and an improved standing up ability through the increase of knee movement on both sides. However, angles higher than $50^{\circ}$ didn't provide a significant effect. Therefore, a support angle under $50^{\circ}$ was proposed in this study. Application: The results of this study are expected to be applicable to the design of sit-to-stand support equipment to improve the effectiveness of the rehabilitation process of hemiplegic patients.