• Health Policy and Management
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• v.23 no.3
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• pp.266-280
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• 2013

Background: Information asymmetry between physicians and patients is one of the most unique characteristics of health care. But as consumerism spreads in health care sector, health care consumers are searching comparative information about quality and cost of providers from many information sources. Providing comparative information to health care consumers not only makes consumers choose hospital rationally, but also invigorates the health care market by providers' competition. However there are few studies regarding information searching behavior of health care consumers, then this study is carried out. Methods: The purpose of this study is to understand the information searching behavior of health care consumers based on their characteristics and the types of medical institutions. For this purpose, 313 spinal patients' data of 11 medical institutions (university hospital, spine specialized hospital, clinic) located in Seoul were collected by self-administered surveys. Results: The results of this study are as follows: 1) t-test/analysis of variance analysis showed that according to various characteristics of health care consumers and the types of medical institutions, the level of information searching of each source and the amount of information searching and searching outcomes are statistically different. 2) Regression analysis showed that influence on searching outcomes are statistically different according to the level of information searching of each source and searching content and the amount of information searching has positive effects on searching outcomes. Conclusion: The significance of this study is to provide empirical basis for establishment of health care policy reflecting information needs and preference of health care consumers.

• Tuberculosis and Respiratory Diseases
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• v.39 no.4
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• pp.355-360
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• 1992

Nocardiosis is an acute, subacute or chronic infection, which usually introduced through the respiratory tract resulting pneumonia, and may develop a disseminated infection, especially subcutaneous abscess and/or CNS infection. It is usually affects the immunocompromized host and may be fatal unless early diagnosis and adequate treatment are performed. There have been only several case reports of nocardial infection in Korea. Nocardiosis is so unfamiliar to many physicians that may be misdiagnosed as pneumonia, tuberculosis, or neoplasm. We have experienced a case of nocardiosis from a patient who had been treated as pneumonia and tuberculosis at first. The 57-year-old male patient had fever, chill, dyspnea and blood tinged purulent sputum for 20 days. Under the impression of bacterial pneumonia, broad spectrum antibiotics were administered for more than 3 weeks without clinical improvement. Although antituberculous drugs began to be administered after acid fast bacilli were found in bronchial aspirate by bronchoscopy, the nocardial infection was suspected due to no clinical response toward antituberculous therapy and the occurrence of multiple subcutaneous abscesses on scalp. The diagnosis was made by modified Ziehl-Neelson stain and culture of the sputum and pus. Nocardia asteroides was identified. After 25 days of trimethoprim-sulfamethoxazole treatment, the patient was much improved and discharged.

• Safety and Health at Work
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• v.9 no.3
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• pp.339-346
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• 2018

Background: Workplace bulling is a pervasive phenomenon with negative consequences for the health of victims and the productivity of organizations. The aim of this study was to measure the prevalence and forms of workplace bullying among employees working at the public health-care sector of Cyprus using the Greek version of Leymann Inventory of Psychological Terror (LIPT) instrument. Methods: A translation process was followed from the French to the Greek version of LIPT questionnaire. Test-retest reliability expressed by Pearson's correlation coefficient was 0.98 indicating excellent reproducibility. Internal consistency reliability assessed by Cronbach ${\alpha}$ coefficient was 0.87 suggesting high reliability. LIPT instrument was distributed among 403 employees working at the primary health-care setting and at the largest public hospital of Cyprus with response rate of 73.4%. Results: Women comprised the majority of participants (71.4%). Mean age was 43.3 years. Prevalence of workplace bulling according to Leymann's definition was 5.9%. Most common forms of bullying were "Being continuously interrupted" (17.2%) and "continuously being given new work assignments" (13.5%). Women were significantly more often exposed to at least one mobbing behavior than men within the previous year (49% vs. 35.7%, p = 0.038), whereas nurses were significantly exposed to at least one mobbing behavior as compared to physicians (53.3% vs. 31.4%, p = 0.004). Conclusion: This was the first study that examined the prevalence of workplace bullying in the public health-care sector by elaborating the Greek version of LIPT instrument. Results showed that workplace bullying is a common and complex phenomenon among health-care organizations.

• Journal of Gastric Cancer
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• v.3 no.3
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• pp.139-144
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• 2003

Purpose: Because of an improving gastric cancer detection program and treatment methods, we can expect improved survival of patients with gastric cancer. Given the longer survival times, the chance of an occurrence of multiple primary malignant tumors other than stomach is increased in the same patients. The purpose of this study is to analyze the clinical characteristrics and the survival of patients with gastric cancer and other malignancies. Materials and Methods: A retrospective study of 3669 patients with gastric cancer observed at our department between January 1994 to December 2002 was conducted. Associated tumors were diagnosed using the Warren and Gates criteria, and included tumors that were not considered to be a metastasis, invasion, or recurrence of the gastric cancer. Results: Of all 3669 patients, $2.07\%$ (n=76) had primary tumors other than gastric cancer, $63\%$ of which were synchronous (n=48) and $37\%$ metachronous (n=28). The mean age of the study group was 64.9 (65.5 in males, 61.8 in females), and the male-to-female ratio was 4.8 : 1. The most common cancer associated with gastric cancer was a hepatocellular carcinoma ($23.7\%$), followed by colorectal cancer ($17.1\%$), esophageal cancer ($10.5\%$), breast cancer ($6.6\%$). Of the 45 patients who had undergone a resection, 14 were in stage I, 12 in stage II, 13 in stage III, and 6 in stage IV. No statistically significant differences were found between the synchronous and the metachronous groups with regard to age, sex ratio, differentiation, and stage. The 5-year survival rates of the metachronous and the resected patients were significantly higher than those of the synchronous and the non resected patients, respectively. Conclusion: Due to increasing length of the follow-up period for patients with gastric cancer, another malignancy may develop in other organs. Therefore, physicians should pay attention to detect other cancers early in these patients, and a surgical resection is recommended as the treatment of choice in the management of multiple primary cancer associated with gastric cancer.

• Journal of Pharmacopuncture
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• v.19 no.3
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• pp.197-206
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• 2016

Introduction: This study aims to investigate the effects of acupuncture stimulation on the radial artery's pressure pulse wave, along with various hemodynamic parameters, and to explore the possible underlying mechanism of pulse diagnosis in healthy participants in their twenties. Methods and analysis: This study is a prospective, single-arm, exploratory clinical study. A total of 25 healthy participants, without regard to gender, in their twenties will be recruited by physicians. Written informed consent will be obtained from all participants. The participants will receive acupuncture once at ST36 on both sides. The radial arterial pulse waves will be measured on the left arm of the subjects by using an applicable pulse tonometric device (KIOM-PAS). On the right arm (appearing twice), electrocardiogram (ECG), photoplethysmogram (PPG), respiration and cardiac output (CO) signals, will be measured using a physiological data acquisition system (Biopac module), while the velocity of blood flow, and the diameter and the depth of the blood vessel will be measured using an ultrasonogram machine on the right arm (appearing twice). All measurements will be conducted before, during, and after acupuncture. The primary outcome will be the spectral energy at high frequencies above 10 Hz ($SE_{10-30Hz}$) calculated from the KIOM-PAS device signal. Secondary outcomes will be various variables obtained from the KIOM-PAS device, ECG, PPG, impedance cardiography modules, and an ultrasonogram machine. Discussion: The results of this trial will provide information regarding the physiological and the hemodynamic mechanisms underlying acupuncture stimulation and clinical evidence for the influence of acupuncture on the pressure pulse wave in the radial artery. Ethics and dissemination: This study was approved by the Institutional Review Board (IRB) of Kyung Hee University's Oriental Medical Center, Seoul, Korea (KOMCIRB-150818-HR-030). The study findings will be published in peer-reviewed journals and presented at national and international conferences. Trial registration number: This trial was registered with the Clinical Research Information Service (CRIS) at the Korea National Institute of Health (NIH), Republic of Korea (KCT0001663), which is a registry in the World Health Organization's (WHO's) Registry Network.

• Journal of The Korean Society of Clinical Toxicology
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• v.20 no.2
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• pp.58-65
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• 2022

Purpose: Alcohol is one of the most commonly co-ingested agents in deliberate self-poisoning (DSP) cases presenting at the emergency department (ED). The increased impulsivity, aggressiveness, and disinhibition caused by alcohol ingestion may have different clinical features and outcomes in cases of DSP. This study investigates whether alcohol co-ingestion affects the clinical features and outcomes of DSP patients in the ED. Methods: This was a single-center retrospective study. We investigated DSP cases who visited our ED from January 2010 to December 2016. Patients were classified into two groups: with (ALC+) or without (ALC-) alcohol co-ingestion. The clinical features of DSP were compared by considering the co-ingestion of alcohol, and the factors related to discharge against medical advice (AMA) of DSP were analyzed. Results: A total of 689 patients were included in the study, with 272 (39.5%) in the ALC+ group. Majority of the ALC+ group patients were middle-aged males (45-54 years old) and arrived at the ED at night. The rate of discharge AMA from ED was significantly higher in the ALC+ group (130; 47.8%) compared to the ALC- group (p=0.001). No significant differences were obtained in the poisoning severity scores between the two groups (p=0.223). Multivariate analysis revealed that alcohol co-ingestion (odds ratio [OR]=1.42; 95% confidence interval [CI], 1.01-1.98), alert mental status (OR=1.65; 95% CI, 1.17-2.32), past psychiatric history (OR=0.04; 95% CI, 0.01-0.28), age >65 years (OR=0.42; 95% CI, 0.23-0.78), and time from event to ED arrival >6 hrs (OR=0.57; 95% CI, 0.37-0.88) were independent predictive factors of discharge AMA (p=0.043, p=0.004, p=0.001, p=0.006, and p=0.010, respectively). Conclusion: Our results determined a high association between alcohol co-ingestion and the outcome of discharge AMA in DSP patients. Emergency physicians should, therefore, be aware that DSP patients who have co-ingested alcohol may be uncooperative and at high risk of discharge AMA.

• Journal of Hospice and Palliative Care
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• v.20 no.3
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• pp.177-187
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• 2017

Purpose: From August 2017, hospice-palliative care (HPC) will be provided to patients with acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), and liver cirrhosis in Korea. To contribute to building a non-cancer (NC) hospice-palliative care model, NC specialists were interviewed regarding the goals, details, and provision methods of the model. Methods: Four physicians specializing in HPC of cancer patients formulated a semi-structured interview with questions extracted from literature review of 85 articles on NC HPC. Eleven NC disease specialists were interviewed, and their answers were analyzed according to the qualitative content analysis process. Results: The interviewees said as follows: It is difficult to define end-stage NC patients. HPC for cancer patients and that for NC patients share similar goals and content. However, emphasis should be placed on alleviating other physical symptoms and emotional care rather than pain control. Timing of the care provision should be when patients are diagnosed as "end stage". Special issues should be considered for each NC disease (e.g., use of anti-retroviral drugs for AIDS patients, oxygen supply for COPD patients suffering from dyspnea, liver transplantation for patients with liver cirrhosis) and education should be provided to healthcare professionals. NC patients tend to negatively perceive HPC, and the government's financial assistance is insufficient. Conclusion: It is necessary to define end-stage NC patients through in-depth discussion to minimize issues that will likely accompany the expansion of care recipients. This requires cooperation between medical staff caring for NC patients and HPC givers for cancer patients.

• Clinical and Experimental Pediatrics
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• v.49 no.3
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• pp.251-257
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• 2006

Purpose : In this study, we created a questionnaire and collected answers concerning actual conditions of vaccination and parents' knowledge of vaccination issues, in order to find false knowledge of patients. We tried to give correct information and suggested the role of the pediatrician. Methods : We made questionnaires and collected answers from 466 parents from March 2004 to June 2004. Results : Places of vaccination were pediatric clinics(49.4 percent), health centers(27.7 percent), general/university hospitals(15.0 percent) and other clinics(4.9 percent). We found 38.8 percent of parents thought that the reason for vaccination at pediatric clinics was a belief of speciality, even though there is no difference in the vaccination itself. We also found 15.0 percent of parents thought that there were no differences between pediatricians and other physicians, but 52.0 percent of parents wanted to receive vaccination at pediatric clinics in the future. Our study also found that 62.4 percent of parents wanted to make out a preliminary questionnaire for vaccination. Many parents got vaccination information from vaccination record books(57.9 percent), and 52.6 percent of parents incorrectly believed that Hib vaccination could prevent all kinds of meningitis. Conclusion : Our study suggests that pediatricians need to make efforts to give out correct information. It is necessary to use preliminary questionnaires for vaccination and correct vaccination information should be written on the vaccination record book. Also, there needs to be counselling with parents about weaning, growth and development at the time of vaccination, and to point out the differences between pediatricians and other physicians.

• Quality Improvement in Health Care
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• v.10 no.2
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• pp.176-189
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• 2003

Background : Gastric cancer is the most common malignant tumor in Korea. Surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for reducing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and the unplanned readmission rate between the pre-pathway group (n=67) and the post-pathway group (n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days (p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was not statistically significant (p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group and 0% in the post-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korean hospital settings.

• The Journal of Internal Korean Medicine
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• v.30 no.4
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• pp.813-820
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• 2009

Background : Static blood is a kind of etiological factor including stagnated blood and blood overflowed out of the vessels. It is one of the causes of stroke in oriental medicine. Objectives : The purpose of this study was to evaluate the static blood pattern and its indicators in stroke pattern diagnosis. Methods : For the standardization of pattern diagnosis in stroke, we set 5 patterns (Fire-heat, Dampness-phlegm, Static blood, Qi deficiency, Yin deficiency) and developed 61 indicators. Patients with a first-ever stroke, within 1 month after the onset of stroke. Two physicians checked the indicators independently. They then performed pattern diagnosis and rechecked the indicators which were referred to pattern diagnosis. If pattern identifications were diagnosed the same, it would confirm pattern identification. We examined the frequency of all indicators and referred indicators in static blood pattern patients. Results : In 859 patients, static blood pattern was shared by 24(2.8%). The indicators which affect static blood pattern were mainly rough pulse and bluish purple tongue, other indicators were not major effectors. Conclusion : This result shows that it is inconsistent to set up static blood pattern as a major pattern in stroke. Nevertheless, static blood is still a valuable concept in the clinical field. Other study methods will be required to establish the pattern diagnostic indicators for static blood pattern.