• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.31 no.2
• /
• pp.56-60
• /
• 2020

Vocal fold injections are usually performed with a patient wake in an office under local anesthesia. For comfortable and safe office-based procedures, thorough anesthesia and premedication should be provided to the following three regions; nasal cavity, oropharynx, and larynx. Topical lidocaine is most widely used anesthetics on office based procedure. Lidocaine has a low to intermediate potency, 45 minutes to 60 minutes' duration of action, and onset of sufficient anesthesia within 90 seconds of topical administration. Tetracaine, prilocaine, ropivacaine, and bupivacaine also have been used in the office-based procedures. Nasal decongestant, oxymetazoline, is also used for widening nasal cavity by constriction of nasal mucosa. The amount of topical and local anesthetics used in vocal fold injection rarely exceeds toxic doses. The physician should know proper anesthesia techniques and must be familiar with the safe dose and complication of all anesthetics used.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.20 no.1
• /
• pp.17-20
• /
• 2009

Office based injection laryngoplasty for voice and swallow disorders is increasing steadily. In recent years, the application of injection laryngoplasty is extended to inject medicine, such as cidofovir or botox. The reason why office based injection laryngoplasty is increasing in popularity is several potential advantages when compared with other procedures. It can avoid surgical scar and is easily performed with local anesthesia. However, injection can be performed in a variety of settings, depending on several factors, including the goal of the procedure, patient comfort and anatomy, and physician skill. In this article, we describe indication of injection laryngoplasty and discuss about various techniques for procedure.

• Quality Improvement in Health Care
• /
• v.4 no.1
• /
• pp.36-49
• /
• 1997

Background : Hypertension is one of the most important risk factors of the cerebrovascular accident and coronary artery disease which are the major causes of mortality in Korea. In Korea, the quality of care provided by office-based physicians has not been evaluated formally. The purpose of this study is to assess the quality of hypertension management of office-based physicians. Method : Self-administered questionnaires were mailed to the office-based physicians with the speciality of internal medicine, general surgery, family medicine, and general practitioners. Among 2,045 physicians, 981 doctors(48.0%) replied the questionnaires. Contents of questionnaires were based on the recommendation from the JNC-V report(the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure), and included the criteria of diagnosis, treatment, follow-up interval, and other characteristics of physicians(age, sex, type of speciality, and location of practice). Results : Eighty four percent of the office-based physicians made diagnosis of hypertension with less than 3 times of blood pressure measurements. The performance rate of required examination for hypertensives was very low in most items. Rate of fundoscopic examination is the lowest one among them(5.9%). The performance rate of laboratory examination was also low in most items. Internists tended to order more frequent laboratory examinations than any other type of physicians. Only 11.4% of the physicians did appropriate treatments for the mild hypertension case. The antihypertensives selected by the physicians as a first line drug were in the order of beta blocker(26.4%), calcium channel blocker(23.4%), diuretics(23.1%), ACE inhibitors(14.3%). The visit interval for established hypertensives was very short. Proportion of physicians with follow-up interval longer than 4 weeks was only 4.3%. Conclusions : The overall quality of hypertension management of office-based physicians in Korea is very problematic in many aspects. So further investigations to find out the reasons of low quality arid quality of care should be initiated.

• Health Policy and Management
• /
• v.3 no.2
• /
• pp.100-129
• /
• 1993

This study is designed to find out some intra-clinic factors affecting the content of practice provided by primary care physicians in Korea, and proposed factors in this study are characteristcs of each private clinc --- physician-related variables(age, sex, specialty), bfed-related variables for inpatient care, laboratory-related variables for precise diagnosis. We have tried to estimate the difference of disease entities cared by each primary care physician according to above factors by analyzin gdisease data claimed during one month(April, 1992) to National Federation of Medical Insurance. The diagnosis codes by ICD-9 in the research disease data were reclassified to 'diagnosis clusters' by virtue of clinical similarities for effective analyses. We have converted frequent-tsing ICD-9 codes to 86 diagnosis clusters, which incorporated 97.4 percents of all ambulatory visits to private clinics. This result means proposed diagnosis-cluster method is effective tool for analysis of the content of ambulatory medical care carried out by primary care physicians. Comparisons and analyses of multiple diagnosis-clusters made on the basis of presented factors were done and the results were as follows; - Major factors affecting the difference between diagnosis-cluster pattern by each variables were phyusician's age, sex, specialty and bed counts of each private clinic for inpatient care and the size of laboratories of each clinic. - Middle aged(30th to 40th) group physicians are providing more comprehensive care than 20th or above 50th aged groups. Male physicians are more adequate for comprehensive care than female physicians, because woman-doctors are providing narrow-spectrum care. The content of practice of obstetricians and gynecologists shows much difference from primary medical practice, and they cannot be included in primary care physician, this study suggested. Pediatricians are also providing short-spectum acre, and nearly all visits to pediatricians were incorporated only 2-3 diagnosis-clusters. General surgeons' practices are very similar to general practioners' or family physicians' practices, the means they are providing primary care rather than special surgical care. And small number of beds(under 5 beds) and only basic(2-3 sorts of)diagnostic apparatuses are sufficient for primary physicians' clinic to carry out primary care. In conclusion, to reinforce primary care department in Korea, there must be support with health policy to expand office-based primary care practice-- with small number of beds for inpatient care and only basic laboratories-- provided by general practitioner of family physician.

• The Korean Society of Law and Medicine
• /
• v.9 no.1
• /
• pp.505-534
• /
• 2008

Aesthetic plastic surgery rarely has the lifesaving, the medical necessity, and the emergency, because it was executed in order to acquire personal satisfaction in the external features. In addition, aesthetic plastic surgery has the strong commerciality in that it is based on the attraction of a client through medical advertisement and the range of uninsurance. These characteristics cause whether aesthetic plastic surgery is included in medical procedure and the legal contract between physician and client is controversial issue. Also, attention and explanation in aesthetic plastic surgery are more emphasized than those in general medical procedure. According, this document presents the various characteristics of aesthetic plastic surgery, which differs from that of general medical procedure.

• Journal of Preventive Medicine and Public Health
• /
• v.46 no.5
• /
• pp.237-248
• /
• 2013

Objectives: The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea. Methods: We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners. Results: The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010. Conclusions: We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

• Biomedical Science Letters
• /
• v.24 no.4
• /
• pp.418-425
• /
• 2018

Amyloid brain positron emission tomography (PET) images are visually and subjectively analyzed by the physician with a lot of time and effort to determine the ${\beta}$-Amyloid ($A{\beta}$) deposition. We designed a convolutional neural network (CNN) model that predicts the $A{\beta}$-positive and $A{\beta}$-negative status. We performed 18F-florbetaben (FBB) brain PET on controls and patients (n=176) with mild cognitive impairment and Alzheimer's Disease (AD). We classified brain PET images visually as per the on the brain amyloid plaque load score. We designed the visual geometry group (VGG16) model for the visual assessment of slice-based samples. To evaluate only the gray matter and not the white matter, gray matter masking (GMM) was applied to the slice-based standard samples. All the performance metrics were higher with GMM than without GMM (accuracy 92.39 vs. 89.60, sensitivity 87.93 vs. 85.76, and specificity 98.94 vs. 95.32). For the patient-based standard, all the performance metrics were almost the same (accuracy 89.78 vs. 89.21), lower (sensitivity 93.97 vs. 99.14), and higher (specificity 81.67 vs. 70.00). The area under curve with the VGG16 model that observed the gray matter region only was slightly higher than the model that observed the whole brain for both slice-based and patient-based decision processes. Amyloid brain PET images can be appropriately analyzed using the CNN model for predicting the $A{\beta}$-positive and $A{\beta}$-negative status.

• Nutrition Research and Practice
• /
• v.9 no.4
• /
• pp.400-403
• /
• 2015

BACKGROUND/OBJECTIVES: By the year 2050, thirty-eight percent of the Korean population will be over the age of 65. Health care costs for Koreans over age 65 reached 15.4 trillion Korean won in 2011, accounting for a third of the total health care costs for the population. Chronic degenerative diseases, including coronary heart disease (CHD), drive long-term health care costs at an alarming annual rate. In the elderly population, loss of independence is one of the main reasons for this increase in health care costs. Korean heath policies place a high priority on the prevention of CHD because it is a major cause of morbidity and mortality. SUBJECTS/METHODS: This evidence-based study aims to the estimate potential health care cost savings resulting from the daily intake of omega-3 fatty acid supplementation. Potential cost savings associated with a reduced risk of CHD and the medical costs potentially avoided through risk reduction, including hospitalizations and physician services, were estimated using a Congressional Budget Office cost accounting methodology. RESULTS: The estimate of the seven-year (2005-2011) net savings in medical costs resulting from a reduction in the incidence of CHD among the elderly population through the daily use of omega-3 fatty acids was approximately 210 billion Korean won. Approximately 92,997 hospitalizations due to CHD could be avoided over the seven years. CONCLUSIONS: Our findings suggest that omega-3 supplementation in older individuals may yield substantial cost-savings by reducing the risk of CHD. It should be noted that additional health and cost benefits need to be revisited and re-evaluated as more is known about possible data sources or as new data become available.

• Korean Journal of Adult Nursing
• /
• v.18 no.1
• /
• pp.146-156
• /
• 2006

Purpose: 1) to construct cohorts according to risk scores calculated with the Gail Breast Cancer Risk Assessment Tool (Gail et al., 1989) (Gail) and the Breast Cancer Risk Appraisal (Lee et al,. 2003) (Lee) 2) to identify the distribution of risk factors and preventive behavior stages between the cohorts 3) to identify abnormal breast conditions in risk cohort. Method: Using convenience sampling, 775 rural women were selected. Risk appraisal was scored using Gail and Lee. Preventive behavior stages for BSE (Breast self examination) and mammography were measured using 4 stages of the Transtheoretical Model (Prochaska & DiClemente, 1983). Results: 1) The risk cohort according to Gail was 12.3% (n=95), and Lee, 3.1% (n=24). 2) There were significant differences in the distribution of risk factors (age, family history, age at 1st live birth, age at menarche, number of breast biopsy, history of breast disease, and breast-feeding) between cohorts. 3) There was a significant difference in the distribution of the stage of BSE according to Lee. 4) Six women in the risk group detected masses or nodules and physician consultation and ultrasonography were recommended. Conclusion: On the basis of the constructed cohorts, further longitudinal studies of cohorts are recommended with interventions according to characteristics of cohorts.