• 한국임상약학회지
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• 제23권2호
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• pp.89-96
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• 2013

This article aimed to introduce 'risk sharing' schemes for pharmaceuticals between drug manufacturers and healthcare payer. Published literature review was undertaken to summarize risk sharing concepts and collect information on existing scheme examples in other countries focusing on new anticancer drugs. Risk sharing schemes could be categorized into health outcomes-based and non-outcomes (financial) based ones. Outcome-based schemes could be broken down into performance-linked reimbursement and conditional coverage. Performance-linked reimbursement can be further broken into outcomes guarantee and pattern or process of care and conditional coverage included coverage with evidence development and conditional treatment continuation schemes. Non-outcome based schemes included market share and price volume at population level, and utilization caps and manufacturer funded treatment initiation at patient level. We reviewed the fifteen examples for anticancer drugs that risk sharing agreements in response to the inherent uncertainties and increased costs of eleven anticancer drugs. Of them, eight cases were coverage with evidence development schemes. The anticancer drugs except bevacizumab and cetuximab were all listed on the national health insurance formulary in Korea, with reimbursement criteria defined on the basis of approved indications and administrations. Risk sharing approach may be a useful tool to ensure values for drug expenditure, but there are a number of concerns such as high administration costs, lack of transparency and conflicts of interest, especially for performance-based health outcomes reimbursement schemes.

• Journal of Korean Neurosurgical Society
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• 제37권6호
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• pp.399-404
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• 2005

Objective: Aneurysms arising from the posterior inferior cerebellar artery(PICA) are uncommon. We review literature on that and surgical results on aneurysmal treatment by choice of surgical approach. Methods: On the basis of radiologic findings & charts, we review retrospectively the surgical results of 12 cases from Mar 1999 to Dec 2003. Results: The mean age of the 12 patients was 55.8(ranged from 36 to 71) and female was predominant (female:male = 8:4). Locations of PICA aneurysms revealed variously(vertebral artery - PICA junction: 8, lateral medullary segment: 2, PICA - anterior inferior cerebellar artery common trunk: 1, telovelomedullary : 1). Surgical approaches & treatments were attempted in 11 cases and embolization was done in 1 case(Far lateral transcondylar or supracondylar approach & clipping: 9, Far lateral transcondylar or supracondylar approach and trapping: 2, suboccipital approach & clipping: 1). The surgical result were 8 of 12 patients were good outcome, 1 of 12 was severely disabled and 3 of 12 were died. Conclusion: First, we choose surgical approach by the laterality of aneurysms and surgical or interventional treatment is attempted as soon as possible. The PICA aneurysm is regarded as having a relatively good surgical outcome without drilling of the posterior arch of the atlas.

• Asian Pacific Journal of Cancer Prevention
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• 제14권9호
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• pp.5043-5047
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• 2013

Background: This is a part of a larger effort to characterize the effects on socio-economic factors (SEFs) on cancer outcome. Surveillance, Epidemiology and End Result (SEER) bone and joint sarcoma (BJS) data were used to identify potential disparities in cause specific survival (CSS). Materials and Methods: This study analyzed SEFs in conjunction with biologic and treatment factors. Absolute BJS specific risks were calculated and the areas under the receiver operating characteristic (ROC) curve were computed for predictors. Actuarial survival analysis was performed with Kaplan-Meier method. Kolmogorov-Smirnov's 2-sample test was used to for comparing two survival curves. Cox proportional hazard model was used for multivariate analysis. Results: There were 13501 patients diagnosed BJS from 1973 to 2009. The mean follow up time (SD) was 75.6 (90.1) months. Staging was the highest predictive factor of outcome (ROC area of 0.68). SEER stage, histology, primary site and sex were highly significant pre-treatment predictors of CSS. Under multivariate analysis, patients living in low income neighborhoods and rural areas had a 2% and 5% disadvantage in cause specific survival respectively. Conclusions: This study has found 2-5% decrement of CSS of BJS due to SEFs. These data may be used to generate testable hypothesis for future clinical trials to eliminate BJS outcome disparities.

• Clinics in Shoulder and Elbow
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• 제24권4호
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• pp.239-244
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• 2021

Background: Radial neck fracture in children is rare. This study attempted to evaluate the outcome of surgically treated patients and any associated complications. Methods: This study evaluated 23 children under 15 years of age with radial neck fracture who were treated with open reduction between 2006 and 2016 to determine their range of motion, postoperative complications, and radiographic outcomes. The results were assessed clinically using the Mayo clinic elbow performance score. Results: The mean follow-up duration for patients was 34.6 months. The average postoperative angulation was 3.6°. Hypoesthesia was reported in only 9% of patients, and none of the patients complained of postoperative pain. The postoperative X-ray results were excellent in 60% and good in 40%. No radiographic complications were identified. The elbow score was excellent in 87% and good in 13% (mean score, 96.74). There was a statistical relationship between range of motion limitations and age, degree of fracture, initial displacement, and surgical pin removal time. Conclusions: Although most patients accept the closed reduction method as a primary treatment, the present study suggests that an open-reduction approach has been associated with optimal therapeutic outcomes for patients in whom closed reduction was not satisfactory or indicated.

• Parasites, Hosts and Diseases
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• 제52권6호
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• pp.631-637
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• 2014

Genetic characteristics of Plasmodium falciparum may play a role in the treatment outcome of malaria infection. We have studied the association between diversity at the merozoite surface protein-1 (msp-1), msp-2, and glutamate-rich protein (glurp) loci and the treatment outcome of uncomplicated falciparum malaria patients along the Thai-Myanmar border who were treated with artemisinin derivatives combination therapy. P. falciparum isolates were collected prior to treatment from 3 groups of patients; 50 cases of treatment failures, 50 recrudescences, and 56 successful treatments. Genotyping of the 3 polymorphic markers was analyzed by nested PCR. The distribution of msp-1 alleles was significantly different among the 3 groups of patients but not the msp-2 and glurp alleles. The allelic frequencies of K1 and MAD20 alleles of msp1 gene were higher while RO33 allele was significantly lower in the successful treatment group. Treatment failure samples had a higher median number of alleles as compared to the successful treatment group. Specific genotypes of msp-1, msp-2, and glurp were significantly associated with the treatment outcomes. Three allelic size variants were significantly higher among the isolates from the treatment failure groups, i.e., $K1_{270-290}$, $3D7_{610-630}$, $G_{650-690}$, while 2 variants, $K1_{150-170}$, and $3D7_{670-690}$ were significantly lower. In conclusion, the present study reports the differences in multiplicity of infection and distribution of specific alleles of msp-1, msp-2, and glurp genes in P. falciparum isolates obtained from treatment failure and successful treatment patients following artemisinin derivatives combination therapy.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권5호
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• pp.488-492
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• 2010

This review evaluates the literature on the relationship between mandibular condylar process fracture and temporomadibular joint (TMJ). The topic of condylar fracture generated more discussion and controversy than any other field of maxillofacial trauma associated with TMJ. Disturbance of occlusal function, devia-tion of mandible, internal derangements of TMJ, and ankylosis of the joint with resultant inability to move the jaw are sequelae of condylar process fracture. Thus it is necessary to understand how the masticatory system adapts to the structural alterations that accompany fractures of the mandibular condyle. Treatment of condylar process fracture include two methods ; closed treatment and open treatment. If one chooses totreat closed, one must understand that adaptations in the musculature, skeleton, and dentition will be necessary. Open treatment of condylar process fractures probably requires fewer adaptations within the masticatory system to provide a favorable functional outcome. However, one must weigh the risk of open surgery against the possible improvement in outcome. The risks are not just surgical risk, but biological risk as well, such as disruption of the blood supply to the condyle. This review presents relevant aspects of change of TMJ associated with condylar process fracture.

• Journal of Korean Neurosurgical Society
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• 제50권4호
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• pp.327-331
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• 2011

Objective : The aim of this study is to investigate the clinical outcomes of surgery and coiling and analyze the predicting factors affecting the clinical outcomes of ruptured posterior inferior cerebellar artery (PICA) aneurysms. Methods : During the last 15 years, 20 consecutive patients with ruptured PICA aneurysms were treated and these patients were included in this study. The Fisher's exact test was used for the statistical significance of Glasgow Outcome Scale (GOS) according to initial Hunt-Hess (H-H) grade, treatment modalities, and the presence of acute hydrocephalus. Results : Eleven (55%) and nine (45%) patients were treated with surgical clipping and endovascular treatment, respectively. Among 20 patients, thirteen (65.0%) patients had good outcomes (GOS 4 or 5). There was the statistical significance between initial poor H-H grade, the presence of acute hydrocephalus and poor GOS. Conclusion : In our study, we suggest that initial H-H grade and the presence of acute hydrocephalus may affect the clinical outcome rather than treatment modalities in the ruptured PICA aneurysms.

• 대한한의학회지
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• 제16권2호
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• pp.62-78
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• 1995

In industrialized countries, low back pam is very common, with up to 60 to 80% of the population being affected at some time in their lives. Herniated lumbar intervertebral disc is one of principal cause of low back pain and radiculopathy. The therapy of the disease is classified into conservative treatment or surgical intervention. The majority of these cases successfully heal with conservative managemant, even though it was claimed that the henirated disc material would not resolved spontaneously without surgical removal. It was reported that there was no significant difference in outcome and cost effectiveness between conservative and surgical therapy group. Also after conservative therapy the resorption of herniated disc with satisfactory improvement of symptom was reported. Conservative treatment includes bed rest, heat, drug therapy, therapeutic exercises, physical therapy such as traction and manipulation, and acupuncture. These managements show favorable outcome in the patients with herniated lumbar intervertebral disc. So conservative management should be applied in the therapy of herniated intervertebral disc, unless there exist aggravation during the first 3 weeks of treatment or apparent surgical care indication. And further investigation to improve effectiveness of conservative therapy should be ensued.

• 대한기관식도과학회지
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• 제16권2호
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• pp.126-130
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• 2010

Background: The esophageal perforation is related to high morbidity and mortality rates if the diagnosis and treatment are delayed. The aim of this study is to evaluate the affecting factors on outcome and prognosis of the patients who suffer from esophageal perforation. Material and Methods: Twenty-six patients were treated with esophageal perforation in our institute from Jan. 1992 to Feb. 2010. We retrospectively reviewed the results of treatment for esophageal perforation to understand the risk factors affecting survival in patients. Results: The subjects are 26 patients suffered with esophageal perforation and the mean age is $52{\pm}17.8$ years old. 16 esophageal perforations were caused spontaneously, 25 cases were treated surgically. The mortality rate is higher in the cases o pre-operative mediastinitis. Conclusion: The shortness time interval until the beginning of treatment should be achieved to reduce the incidence of fatal post-treatment morbidity and mortality.

• 대한예방한의학회지
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• 제27권1호
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• pp.53-68
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• 2023

Objectives : This study was conducted to analyze the Korean Medicine treatment on Tension-type Headache (TTH) in Korean clinical studies. Methods : Articles were searched from four Korean databases(KISS, RISS, OASIS, ScienceON). Study type, publication year, demographic information of participants, intervention type and details, outcome measurements and treatment results of selected articles were analyzed. Results : 17 articles were selected among those published until January 15th 2023. 'Cheonghyulgangki-tang', acupuncture at 'GV20', moxibustion at 'CV12', pharmacopunture at 'GB20', 'ByeolGab' were most frequently used in treatment on TTH. 'Numeric Rating Scale(NRS)' and 'Visual Analog Scale(VAS)' were most frequently used in outcome measurements. All of the articles exhibited that Korean Medicine treatments improved symptoms of TTH. Conclusion : This study showed that various Korean Medicine treatments for TTH were effective. This finding could be used in clinical practice and build the basis for the direction of clinical practice guidelines in future, Nevertheless, this study has few limitations. Further systematic reviews and meta analyses of randomized controlled trials are required for more evidence on Korean Medicine.