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Analysis of 'Sleep Disease' Medical Service Delivery system Through In-Depth Interview

  • Yu, Tae Gyu
    • International Journal of Advanced Culture Technology
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    • v.8 no.2
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    • pp.1-5
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    • 2020
  • As the world gradually advances to an aging society, the quality of human life is valued. Among them, 'quality of sleep' is very closely related to quality of life. Recently, Korea expanded health insurance coverage for "sleep disorders". Particularly, as the number of sleep multiple tests and prescriptions for sleep aids has increased rapidly, much attention has been focused on the related medical service environment. Therefore, this study looked at an in-depth interview of 11 hospitals to see what treatment delivery system is being established when the government applies health insurance for 'sleep disorders'. In conclusion, the organizations with the most average number of sleep polyp tests per day were found to have more sleep polyp labs (hardware) and more full-time specialists. Also, the polysomnography lab (hardware) and the specialist's full-time status (software) did not necessarily result in a "positive pressure regulator prescription" that can solve "sleep apnea" caused by "sleep ailments". Rather, it was found that the number of days of sleep multiple laboratories (hardware), the number of full-time specialists (software) or the specialty majors (software) had a greater impact. In particular, the higher the specialist's full-time personnel (software) index (=6.000), the higher the sleep-inducing agent prescription rate(=1.000), and the lower the specialist's full-time personnel (software) index (=1.000), the higher the sleep-inducer's prescription rate(= 0.010) Was low. In addition, even if the professional full-time personnel(software) index was the same (=1.000), the hospital type was lower as it was closer to the public hospital(=0.067) and higher at the specialized hospital (= 0.933). In the case of university hospitals, when the full-time specialists (software) are in the same condition (= 1.000), the frequency of use of the sleep laboratory (=1.000) and the sleep test rate (= 1.000) were all the same.

Medication Use and Drug Expenditure in Inflammatory Bowel Disease: based on Korean National Health Insurance Claims Data (2010-2014) (국내 염증성장질환의 약물치료 및 약제비 현황: 2010-2014 국민건강보험자료 활용 연구)

  • Ha, Jung Eun;Jang, Eun Jin;Im, Seul Gi;Sohn, Hyun Soon
    • Korean Journal of Clinical Pharmacy
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    • v.29 no.2
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    • pp.79-88
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    • 2019
  • Backgrounds: Inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn's disease (CD) increased prevalence and economic burden. Objectives: This study aimed to investigate drug use pattern in IBD patients in a real world. Methods: National Health Insurance claim data from 2010 to 2014 were used in this population-based study. All IBD patients diagnosed during study period were enrolled. IBD medications included 5-aminosalicylic acid (ASA), glucocorticoid, immunomodulator and anti-tumor necrosis factor-${\alpha}$ agent(anti TNF-${\alpha}$). Growth rate of IBD prevalence, prescribed drug classes, duration of drug therapy and medication cost were analyzed. Number and percentage of patients for categorical variables, and mean and median for continuous variables were presented. Results: Total numbers of patients were 131,158 and 57,286 during 5 years, and their annual growth rate were 3.2 and 5.7% for UC and CD. UC and CD were prevalent in the 40-50 (41.2%) and 20-30 age groups (36.0%). About 60% of IBD patients was prescribed any of medications. 5-ASA was the most frequently prescribed, followed by corticosteroid and immunomodulator. Anti TNF-${\alpha}$ use was the lowest, but 5 times higher than UC in CD. Combination therapies with different class of drugs were in 29% for UC and 62% for CD. Mean prescription days per patient per year were 306 and 378, and the median medication cost per patient per year was KRW 420,000 (USD 383) and KRW 830,000 (USD755), for UC and CD, respectively. Conclusions: Increasing prevalence of IBD requires further studies to contribute to achieve better clinical outcomes of drug therapy.

Effects of rhBMP-2 with various carriers on bone regeneration in rat calvarial defect (백서 두개골 결손에서 rhBMP-2와 다양한 carrier의 골재생 유도효과)

  • Lee, Seo-Kyoung;Kim, Ji-Sun;Kang, Eun-Jung;Eum, Tae-Kwan;Kim, Chang-Sung;Cho, Kyoo-Sung;Chai, Jung-Kiu;Kim, Chong-Kwan;Choi, Seong-Ho
    • Journal of Periodontal and Implant Science
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    • v.38 no.2
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    • pp.125-134
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    • 2008
  • Purpose: Bone morphogenetic protein (BMP) is a potent differentiating agent for cells of the osteoblastic lineage. It has been used in the oral cavity under a variety of indications and with different carriers. However, the optimal carrier for each indication is not known. This study evaluated the bone regenerative effect of rhBMP-2 delivered with different carrier systems. Materials and Methods: 8 mm critical-sized rat calvarial defects were used in 60 male Sprague-Dawley rats. The animals were divided into 6 groups containing 10 animals each. Two groups were controls that had no treatment and absorbable collagen membrane only. 4 groups were experimentals that contained rhBMP-2 only and applied with absorbable collagen sponge($Collatape^{(R)}$), $MBCP^{(R)}$, Bio-$Oss^{(R)}$ each. The histological and histometric parameters were used to evaluate the defects after 2- or 8-week healing period. The shape and total augmented area were stable in all groups over the healing time. Results: New bone formation was significantly greater in the rhBMP-2 with carrier group than control group. rhBMP-2/ACS was the highest in bone density but gained less new bone area than rhBMP-2/$MBCP^{(R)}$ and rhBMP-2/Bio-$Oss^{(R)}$. The bone density after 8 weeks was greater than that after 2 weeks in all groups. However, rhBMP-2 alone failed to show the statistically significant difference in new bone area and bone density compared to control group. Also $MBCP^{(R)}$ and Bio-$Oss^{(R)}$ particles remained after 8 weeks healing period. Conclusion: These results suggest that rhBMP-2 with carrier system is an excellent inductive agent for bone formation and we can use it as the predictable bone tissue engieering technique. Future study will likely focus on the kinetics of BMP release and development of carriers that is ideal for it.

Drug Utilization Review of Antiulcerative Agents in Korean Elderly Inpatients (노인 입원환자에 대한 항궤양약물 처방양상 분석)

  • Lee, Won-Sik;Lee, Seung-Mi;Koo, Hye-Won;Park, Byung-Joo
    • Journal of Preventive Medicine and Public Health
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    • v.35 no.1
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    • pp.41-48
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    • 2002
  • Objectives : To review the drug prescription pattern of antiulcerative agents for elderly inpatients, Methods : The study population comprised inpatients of community hospitals who were members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, beneficiaries of the Korea Medical Insurance Corporation (KMIC) and residing in Busan city in 1993. The drug prescription information was collected from the claims data of hospitals where the cohort members received medical care between January 1993 and December 1594. The information included personal identification, age, gender, diagnosis, drug dosage, date of hospital admission and name of medical institutions where the study subjects received drug prescriptions. The data analysis produced outcomes in terms of distribution of antiulcerative agents by class and by medical institution and trend of relative prescription, Analysis was also performed in terms of combined prescriptions of antiulceratives and drugs that could induce risk from drug interaction with antiulceratives. Results : The number of patients prescribed antiulcerative agents was 1,059 (64,9%) male and 1,724 (65.5%) female among the total inpatients. An antacid and composite agent was the most frequently prescribed antiulcerative agent (70.8%), followed by $H_2$ antagonist (16.0%), Among the potential drugs that could induce risk from drug interaction with the antiulcerative agents, diazepam was the most frequently prescribed. The proportion of diazepam co-prescription was 22.5% of the total cimetidine prescriptions and 14.5% of the fetal omeprazole prescriptions. Conclusions : Antiulcerative drugs were frequently prescribed in the elderly inpatients. The adverse drug reaction could possibly be due to drug interaction. The study results could be used as fundamental data for further drug utilization review of antiulceratiye agents.

A Study on the Prescription Patterns of Gastrointestinal Protective Agent with Non-Steroidal Anti-Inflammatory Drugs in Korean Elderly Patients with Osteoarthritis (골관절염을 진단받고 비스테로이드성 항염제 복용 중인 65세 이상 환자의 위장관보호제 처방양상 연구)

  • Chun, Seongmin;Choi, Yoonhee
    • Journal of The Korean Society of Integrative Medicine
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    • v.8 no.4
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    • pp.79-92
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    • 2020
  • Purpose : The purpose of this study was to evaluate the prescription pattern of NSAIDs and GPAs in the arthritis patients over 65 years old to prevent the GI adverse events. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used agents to treat arthritis, can cause gastrointestinal (GI) adverse effects. Recent guidelines recommend that moderate risk patients who have one or two risk factors, should be prescribed either combination of non-selective NSAID (nsNSAIDs) and gastroprotective agent (GPAs) or selective NSAID alone. Methods : Study population was National Patient Sample of 2011. Number of drugs used were 138 for NSAIDs and 21 for GPAs. Chi-square test was used to compare prescribing patterns. Results : The appropriate prescription rate follows the guideline was 11.2%: co-prescription with nsNSAID and proton pump inhibitor (PPI) or misoprostol was 1.6% and selective NSAID alone was 9.6%. Inappropriate prescription rates were as follows: co-prescription with nsNSAID and Histamine-2 receptor antagonist (H2RA) or antiacid was 53.8% and nsNSAID alone was 35.0%. The appropriate prescription rate among the types of medical institute was 54.4% in tertiary hospital, 31.2% in secondary hospital, and 6.0% in primary hospital. The appropriate prescription rate among the regions was 19.4%, highest in Seoul and 4.2%, lowest in Jeju. The appropriate prescription rate among the medical departments was as follow: 12.2% in orthopaedic surgery, 11.0% in internal medicine, and 7.7% in other departments. Conclusion : This finding suggests the needs to revise the national medical insurance imbursement policy, provide continuing medical education about the guideline of medical doctors.

A Case of Non-traumatic Rhabdomyolysis after Doxylamine Overdose (Doxylamine 중독 후 합병한 비 외상성 횡문근융해증 1례)

  • Hwang, Sung Woog;No, Hyeung Kyeung;Kim, Kee Hyuck
    • Clinical and Experimental Pediatrics
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    • v.45 no.8
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    • pp.1033-1037
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    • 2002
  • Doxylamine is an antihistamine of the ethanolamine class. It is used primarily as a sleep-inducing agent. Clinicians should be aware of the complications in rhabdomyolysis patients who ingest doxylamine succinate and over-the-counter antihistamines. The easy availability of these substances increases the potential not only of intentional overdose by adults but also of inadvertent ingestion by children. Prompt intervention and careful assessment of renal function, urinary output, and serum creatine kinase levels may represent the difference between an uncomplicated and acute renal failure. Recognition of the potential for rhabdomyolysis and institution of vigorous treatment may prevent acute renal failure in patients who have taken an overdose of the drug. A 14-year-old male was found to have hematuria and oliguria. Evaluation of the patient revealed myoglobinuria, and a creatine kinase(CK) level of 117,563 IU/L. He was recovered by massive fluid administration, urine alkalization and mannitol infusion. We report a case of a suicide attempt in a child where ingestion of the doxylamine complicated by non-traumatic rhabdomyolysis with brief review related literatures.

Factors Associated with Poor Glycemic Control among Patients with Type 2 Diabetes Mellitus: The Fifth Korea National Health and Nutrition Examination Survey (2010-2012) (제2형 당뇨병 환자의 혈당 비조절 관련 요인분석: 국민건강영양조사(2010-2012) 자료이용)

  • Park, Jinhyun;Lim, Seungji;Yim, Eunshil;Kim, Youngdae;Chung, Woojin
    • Health Policy and Management
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    • v.26 no.2
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    • pp.125-134
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    • 2016
  • Background: Glycemic control is an effective way to reduce the cardiovascular complications of diabetes, but more than half of the adults with diabetes in Korea are improperly controlling their glycemic levels. The purpose of this study is to identify the factors associated with poor glycemic control in type 2 diabetes patients. Methods: This study analyzed 1,261 subjects ${\geq}30years$ old diagnosed with type 2 diabetes who participated in the fifth Korean National Health and Nutrition Examination Survey (2010-2012). Poor glycemic control rates were defined as hemoglobin A1c (HbA1c) level ${\geq}7%$. To shed light on the causes of poor glycemic control, socio-demographics, diabetes severity, health status, and health behavior factors were adjusted and logistic regression was done. Results: Of the total 1,261 patients, 53.0% of patients with type 2 diabetes had HbA1c ${\geq}7%$. After running a logistic regression model, the odds ratio of poor glycemic control was higher in high school graduates than elementary school graduates; in people living in Chungcheong and Jeolla/Jeju than those living in Seoul; in the group with diabetes for over 5 years had diabetes less than 5 years; in a group with insulin and oral hypoglycemic agent treatment than non-treatment; in a group with hypertriglyceridemia than without hypertriglyceridemia; and in the group with slept less than 6 hours slept 7-8 hours. Conclusion: We need a comprehensive public health policy to reduce the poor glycemic control rates in type 2 diabetes patients. We should recognize the education levels, duration of diabetes, diabetes treatment, hypertriglyceridemia, and sleep duration were associated with poor glycemic control.

The moderating effects of converging smart work and supervisor's support in the study of turnover on job satisfaction in call centers (콜 센터에서 이직요인이 직무만족에 미치는 영향에 있어 스마트워크와 상사지원 융복합 서비스의 조절효과에 관한 연구)

  • Kim, Kye-Chul;Cheong, Ki-Ju
    • Journal of Digital Convergence
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    • v.13 no.4
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    • pp.101-114
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    • 2015
  • The purpose of this study is first to understand agent's turnover from both academic and perspectives. Then we suggest convergence of smart work paradigm and supervisor's support as the relieving factors of turnover, The research model of this study is based upon reviews of turnover literature, the smart work and supervisor's support as moderating variables from which research hypotheses were derived. The data came from the survey from financial sector agents such as banking, insurance, and others. The analyses has been done by SPSS 20.0, We used multiple regressions to test the effects of the tested variables on the dependent variable, job satisfaction. The results of this study find significant relations of smart work and supervisor's supports in relations to personal and job-related turnover. The implication is smart work and supervisor's supports play significant role in increasing job satisfactions. Major finding is too much supervisor's supports ignoring agent's situations may bring reverse effects on relieving turnover.

Development of an SWRL-based Backward Chaining Inference Engine SMART-B for the Next Generation Web (차세대 웹을 위한 SWRL 기반 역방향 추론엔진 SMART-B의 개발)

  • Song Yong-Uk;Hong June-Seok;Kim Woo-Ju;Lee Sung-Kyu;Youn Suk-Hee
    • Journal of Intelligence and Information Systems
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    • v.12 no.2
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    • pp.67-81
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    • 2006
  • While the existing Web focuses on the interface with human users based on HTML, the next generation Web will focus on the interaction among software agents by using XML and XML-based standards and technologies. The inference engine, which will serve as brains of software agents in the next generation Web, should thoroughly understand the Semantic Web, the standard language of the next generation Web. As abasis for the service, the W3C (World Wide Web Consortium) has recommended SWRL (Semantic Web Rule Language) which had been made by compounding OWL (Web Ontology Language) and RuleML (Rule Markup Language). In this research, we develop a backward chaining inference engine SMART-B (SeMantic web Agent Reasoning Tools -Backward chaining inference engine), which uses SWRL and OWL to represent rules and facts respectively. We analyze the requirements for the SWRL-based backward chaining inference and design analgorithm for the backward chaining inference which reflects the traditional backward chaining inference algorithm and the requirements of the next generation Semantic Web. We also implement the backward chaining inference engine and the administrative tools for fact and rule bases into Java components to insure the independence and portability among different platforms under the environment of Ubiquitous Computing.

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The Roofing System of High wind-Resistant Performance using Thermoplastic polyolefin and Electromagnetic Induction Technology (TPO 시트재와 유도가열공법을 적용한 고내풍성 지붕마감 공법)

  • Choi, Hee-Bok;Shin, Yoon-Seok;Choi, Jin-Cheol;Lee, Bo-Hyeong;Kang, Kyung-In
    • Journal of the Korea Institute of Building Construction
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    • v.9 no.1
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    • pp.103-109
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    • 2009
  • Strong winds according to global warming cause the increase of the frequency and the repair cost of damaged roofs. In the United States, Factory Mutual Insurance Company(FMIC) promotes the roofing design that resists heavy wind-load, as the means of strict criteria. This fact reveals that more durable roofing system will be also required in Korea. Therefore, this study aims at developing such a system with high wind-resistance performance using Thermoplastic polyolefin(TPO) and Electromagnetic induction technology(EIT) than the previous systems. The system presented in this study consists of 4 main devices as follow; 1) a disc to fix sheets for TPO & EIT method, which can conduct structural design according to site condition, such as region, building height, and wind load. 2) a nail to have about 30% stronger lifting-up capacity than that of the previous nail. 3) a disc to fix sheets, which has triangle protuberance not to damage sheets in the repeatable wind load, and 4) a electromagnetic induction device to combine a disc and a sheet by heating uniformly and quickly adhesive agent on the disc. The results of mock-up test illustrate that the system provides wind-resistant performance to achieve satisfactorily the structural design criteria of FMIC. In addition, the system is faster, chipper, and easier than the existing system, and is expected that this roofing system can be applied to the rehabilitations of an existing as well as a new building.