• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.24 no.1
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• pp.13-20
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• 2013

Neuroleptic malignant syndrome (NMS) is a severe iatrogenic complication of treatment with antipsychotic medication. The aim of this review is to provide the clinical characteristics and treatments of children and adolescents with NMS. Searches were conducted in Medline, Korean studies Information Service System (KISS), and Research Information Service System (RISS). Sixteen case reports and two review articles were selected in Medline, and two Korean cases reported in department of emergency medicine and pediatrics were selected from RISS. Heterogeneous and atypical presentations of NMS were observed in children and adolescents. Some noticeable differences were observed between adult patients and child patients with NMS. In addition, symptom presentations related to atypical antipsychotic agents differed from those of typical ones. In treatment, bromocriptine and benzodiazepine were recommended for management of symptoms. In particular, electroconvulsive therapy (ECT) was a useful treatment option. For prevention and early detection of NMS in children and adolescents, evaluation of risk factors and understanding of diagnostic features of NMS are very important.

• The Korean Journal of Health Service Management
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• v.6 no.4
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• pp.143-152
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• 2012

This study analyzes Korea health panel data (2008) (beta version 1.2) of Korea Institute for Health and Social Affairs, and National Health Insurance Corporation to figure out determinants of healthcare expenditure. In result of Multiple Logistic Analysis, in-patents felt burden on the medical expenditure were 70.0%. As to the patients' payment of medical expenditure, patients over 65 years old had 4.765 times higher than those under 14 years, disabled patients 2.778 than non-disabled patients, chronic patients 1.632 times than non-chronic patients, patients belonging to 12 million won ~ 46 million won and under 12 million won in family income had 1.680 times and 2.168 times respectively than patients with over 46 million won, patients in professional recuperation facility 1.546 times than patients in hospital, patients in private medical institutions 1.700 times than patients in national and public medical institutions, patients using upper grade rooms 1.701 times than patients in non-upper grade rooms. As a health care safety net mechanism to protect people from medical expenditure burden, there is the patients' payment ceiling in the National Health Insurance System. Thus, in order to facilitate the patient's payment ceiling, it is required that the level of ceiling is to be specified according to the income level, and self-payment items is to be included.

• Korea Journal of Hospital Management
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• no.spc
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• pp.1-13
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• 2016

In a situation where competition becomes intense, health care organizations constantly strive to provide more services with given personnel and time. While not only the 'quantity' of the services but also the 'quality' becomes increasingly important, various problems that can occur during the 'process' of service provision can be effectively managed by applying the methods of management science. In this study, we introduce the cases where the methods of management science can be applied for the management of health care organizations in Korea and abroad. There are many cases where various scenarios for improving the patients' accessibility to the services and for maximizing the efficient use of limited resources are established, and simulation or basic statistical analysis methods are used to solve the problems more systematically or to develop improvement plans. In this study, several exemplary cases, such as no-show of patients, crowding in the emergency room, prediction of the number of available beds in the intensive care units, nurse scheduling, delay of arrival of patients, and ordering of the proper amount of therapeutic materials, are introduced and discussed. From the perspective of administrators or clinicians, however, it may not be easy to master the methodology that requires considerable mathematical background or apply the theories to practice directly. Therefore, it is suggested that more practical and relatively simple analytical methods should be applied. Also, having a more positive attitude toward improving the current performance (e.g., a belief that 'we can always be better than now'), and paying attention to improving the job satisfaction by addressing problems, with experimental spirit and data-driven decision management.

• Korea Journal of Hospital Management
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• v.15 no.4
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• pp.165-190
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• 2010

Objectives : This study was supposed to investigate factors which influence to preference of medical tourism products of Japanese tourists in Seoul, Korea. Methods : Data were collected from 228 Japanese tourists who visited' Seoul Center for Culture & Tourism' in Myeong-dong, Seoul, Korea. We measured factors which influence to preference for medical tourism. The data were analyzed by T-test, ANOVA, and multiple regression analysis. Results : The major findings were as follows ; Japanese tourists preferred medical products in the order of skin care, oriental medicine treatment, health screening, and scaling & teeth whitening. They considered technical level of medical staff most importantly, followed by safety of medical products, communication during diagnosis and treatment, follow-up service, modernization of medical facilities and equipment, and the reasonable medical expenses. Japanese tourists' preferred medical institutions in the order of a university hospital, a specialty clinic, a special hospital, They said they intend to pay 50,000 to 150,000 yen for medical tourism. The preference to medical tourism products are that single women group in their twenties and thirties for skin care, married people group aged over thirties preferred oriental medicine treatment, and married men aged over forties and high income earners favored health screening. Conclusions : It should be considered carefully that the preference exists on some factors especially for Japanese tourist. Further research about preference on medical tourism products for tourists from the other countries is required appropriately to fulfill the needs.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.10 no.12
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• pp.3870-3878
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• 2009

The purpose of this study was to investigate 119 rescue party's violence experiences and to analyze their responses of violence experiences based on the pre-hospital emergency medical field. Data were collected from the self-administered survey of 226 rescue party in Jeollabuk-do area in Korea from January 1 through March 2, 2009. The data were analyzed by descriptive statistics and logistic regression analysis using SPSS Win 12.0. The results were as follows: first, all of 119 rescue unit in the pre-hospital emergency medical field reported that they got violence experiences more than once a week, and 62% of rescue team were exposed to physical violence. Patient's factors that caused violence were drug abuse or alcohol(56.2%), on the other hand rescue party's factors were shortage of human resources. Second, 42% of the respondents replied that they did not have any educational experiences for prevention and coping methods about violence within 5 years. 77.4% of those surveyed indicated that they wanted to receive specific educations which can prevent and cope with violence. Third, the mean value of total violent response scores was 2.53, and emotional response score was 3.2, social response score was 2.22, and physical response score was 2.17. Fourth, violent response score related to general characteristics proposed that physical(t=-2.08, p=o.38), emotional(t=-7.13, p=.006), and total responses(t=-4.764, p=.000) were statistically significant. And emotional(t=4.257, p=.000) and total responses(t=8.1330, p=.000) related to age were also statistically significant. Finally, among current tenure qualification scores, social response(t=9.987, p=.012) and total score(t=8.130, p=.000) were statistically significant. Between fire departments, violent response score suggested that physical(t=9.987, p=.000), emotional(t=2.433, p=.012), social(t=6.738, p=.000), and total score(t=5.943, p=.000) were statistically significant.

• The Korean Society of Law and Medicine
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• v.17 no.1
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• pp.299-346
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• 2016

There were also various decisions made in medical area in 2015. In the case that an inmate in a sanatorium was injured due to the reason which can be attributable to the sanatorium and the social welfare foundation that operates the sanatorium request treatment of the patient, the court set the standard of fixation of a party in medical contract. In the case that the family of the patient who was declared brain dead required withdrawal of meaningless life sustaining treatment but the hospital rejected and continued the treatment, the court made a decision regarding chargeable fee for such treatment. When it comes to the eye brightening operation which received measure of suspension from the Ministry of Health and Welfare for the first time in February, 2011, because of uncertainty of its safety, the court did not accept the illegality of such operation itself, however, ordered compensation of the whole damage based on the violation of liability for explanation, which is the omission of explanation about the fact that the cost-effectiveness is not sure as it is still in clinical test stage. There were numerous cases that courts actively acknowledged malpractices; in the cases of paresis syndrome after back surgery, quite a few malpractices during the surgery were acknowledged by the court and in the case of nosocomial infection, hospital's negligence to cause such nosocomial infection was acknowledged by the court. There was a decision which acknowledged malpractice by distinguishing the duty of installation of emergency equipment according to the Emergency Medical Service Act and duty of emergency measure in emergency situations, and a decision which acknowledged negligence of a hospital if the hospital did not take appropriate measures, although it was a very rare disease. In connection with the scope of compensation for damage, there were decisions which comply with substantive truth such as; a court applied different labor ability loss rate as the labor ability loss rate decreased after result of reappraisal of physical ability in appeal compared to the one in the first trial, and a court acknowledged lower labor ability loss rate than the result of appraisal of physical ability considering the condition of a patient, etc. In the event of any damage caused by malpractice, in regard to whether there is a limitation on liability in fee charge after such medical malpractice, the court rejected the hospital's claim for setoff saying that if the hospital only continued treatments to cure the patient or prevent aggravation of disease, the hospital cannot charge Medical bills to the patient. In regard to the provision of the Medical Law that prohibit medical advertisement which was not reviewed preliminarily and punish the violation of such, a decision of unconstitutionality was made as it is a precensorship by an administrative agency as the deliberative bodies such as Korean Medical Association, etc. cannot be denied to be considered as administrative bodies. When it comes to the issue whether PRP treatment, which is commonly performed clinically, should be considered as legally determined uninsured treatment, the court made it clear that legally determined uninsured treatment should not be decided by theoretical possibility or actual implementation but should be acknowledged its medical safety and effectiveness and included in medical care or legally determined uninsured treatment. Moreover, court acknowledged the illegality of investigation method or process in the administrative litigation regarding evaluation of suitability of sanatorium, however, denied the compensation liability or restitution of unjust enrichment of the Health Insurance Review & Assessment Service and the National Health Insurance Corporation as the evaluation agents did not cause such violation intentionally or negligently. We hope there will be more decisions which are closer to substantive truth through clear legal principles in respect of variously arisen issues in the future.

• The Korean Nurse
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• v.36 no.3
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• pp.49-69
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• 1997

The urgent needs to establish hospice care systems in Korea arise from the following reasons: 0) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e. g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accomodate other medical insurance beneficiaries; (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life; (6) medical and nursing care of AIDS patient in terminal stage; (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage. grouped in hospice and non-hospice care patients. reveal what they want visiting nursing care to help their pain control. psychological. social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains. the non-hospice care patients. in addition to their desire for pain control. demanded more psychological. social and spiritual helps as well. The results of this research could be utilized to 0) define the standard of hospice care. (2) provide the guidance for hospice medical care costs. (3) establish the database of hospice care systems. (4) develop softwares. (5) build communication network through Medinet. and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy. nursing care. and social welfare programs.

• Journal of Korea Multimedia Society
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• v.19 no.2
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• pp.163-169
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• 2016

In Korea, prostate cancer accounted for generating growth rate second the following thyroid cancer, because of western dietary habits. Survival rate of prostate cancer after clinical behavior is changed depend on follow-up management. A telemedicine have been applied to replacement of medical specialist in rural area, and a quick reaction to emergency situation. Our study developed prostate 3-dimensional (3D) visualization program and designed prostate aftercare system architecture, called smart care, using a device that can access the Internet. Region of interest (ROI) in prostate was manually segmented by physicians and visualized to 3D objects and sent to PACS Server as DICOM images. So, medical personnel could confirm patients' data along with 3D images not only PACS system, but also portable device like a smart phone. As a result, we conducted the aftercare service to 98 patients and visualize 3D prostate images. 3D images had advantage to instinctively apprehend where lesion is and make patients to understand state of their disease easily. In the future, should conduct an aftercare service to more patients, and will obtain numerical index through follow-up study to an accurate analysis.

• Psychiatry investigation
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• v.15 no.12
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• pp.1188-1202
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• 2018

Objective This study protocol aims to determine, using a rigorous approach in patients with bipolar disorder (BD) and non-seasonal major depressive episode (MDE), the characteristics of bright light therapy (BLT) administration (duration, escalation, morning and mid-day exposures) depending on the tolerance (hypomanic symptoms). Methods Patients with BD I or II and treated by a mood stabilizer are eligible. After 1 week of placebo, patients are randomized between either morning or mid-day exposure for 10 weeks of active BLT with glasses using a dose escalation at 7.5, 10, 15, 30 and 45 minutes/day. A further follow-up visit is planned 6 months after inclusion. Patients will be included by cohorts of 3, with at least 3 days of delay between them, and 1 week between cohorts. If none meet a dose limiting toxicity (DLT; i.e hypomanic symptoms), the initiation dose of the next cohort will be increased. If one patient meet a DLT, an additionnal cohort will start at the same dose. If 2 or 3 patients meet a DLT, from the same cohort or from two cohorts at the same dose initiation, the maximum tolerated dose is defined. This dose escalation will also take into account DLTs observed during the intra-subject escalation on previous cohorts, with a "Target Ceiling Dose" defined if 2 DLTs occured at a dose. Discussion Using an innovative and more ergonomic device in the form of glasses, this study aims to better codify the use of BLT in BD to ensure a good initiation and tolerance.

• Health Policy and Management
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• v.19 no.3
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• pp.1-26
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• 2009

Objectives : To identify target areas and set priorities among those areas identified for national quality evaluation. Methods : Target areas were identified from: i) analysis of the national health insurance claims data, mortality and prevalence data ii) various group surveys, including representatives from 22 medical specialty associations, 19 physician associations, QI staffs in hospital, civil organizations, and commissioners of Health Insurance Review and Assessment Service(HIRA) ⅲ) literature reviews and RAM(RAND/UCLA appropriateness method). The priority areas for national quality evaluation represented the full spectrum of health care and the entire life span. The criteria for selecting the priority areas were impact, improvability, and measurability. The priority areas were divided into three categories : short-term, mid-term, long-term. Results: Based on the group surveys and the data analysis, 46 candidates were selected as quality evaluation priority areas. 13 areas were selected as having a short-term priority areas: tuberculosis, community acquired pneumonia, stroke, ischaemic heart disease, diabetes, hypertension, chronic lower respiratory disease(asthma, chronic obstructive pulmonary disease), intensive care unit, emergency room, nosocomial infection, use of antibiotics, multiple medication and renal failure. This results suggested that we need to enlarge the target priority areas to the chronic diseases in short-term. Conclusions: The priority areas identified from the study will assist healthcare quality associated institutions as well as HIRA in selecting quality evaluation areas. It is required to develope and implement strategies for improving the quality of care within the next 5 years.