• Health Policy and Management
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• v.20 no.2
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• pp.1-16
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• 2010

Background : Clinical practice guidelines are an increasingly familiar part of clinical practice. Moreover, rigorously developed evidence based guidelines has been widely used. However, in Korea, some of published documents as clinical practice guidelines have shown considerable disparity in structure, contents and quality. This is mainly because there is no consensus on the definition and quality standard of clinical practice guidelines. The purpose of this study was to draw consensus on the definition and the quality standard about clinical practice guidelines. Method : We developed a questionnaire about the definition of clinical practice guidelines with inclusion criteria(23 items) and the quality standard(30 items). We selected 9 experts who had prior experience in developing and implementing guidelines. Rating methods for appropriateness of items were adopted from the RAND method. Consensus was drawn in three rounds. Results : Of the 47 items agreed, 40 items were determined to be appropriate. Clinical practice guidelines were defined as "scientifically and systematically developed statements to assist practitioners and patients on making decisions about appropriate health care for specific clinical circumstances." Narrative reviews, systematic reviews or health technology assessment without recommendations, translation of foreign guidelines, guidelines for patients only and training manuals were not considered as clinical practice guidelines. For the quality standard of clinical practice guidelines, 27 items were deemed necessary. Conclusions : The consensus on the definition with inclusion criteria and the quality standard of clinical practice guidelines carries an important meaning as the first attempt to draw a general agreement in our society. The unique achievement of the consensus reflects the current status of clinical practice guidelines that there has been a high tendency to adapt foreign guidelines. We hope efforts of this kind will continue to bring improvement in clinical practice guidelines.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.467-472
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• 2020

Background Dimples on the cheeks can make the smile look more cheerful and attractive. Therefore, some people who do not have dimples may choose to undergo dimple creation surgery. Although dimple surgery is quite common, those desiring this procedure often lack information about it. Therefore, we conducted the present study to share our surgical tips and clinical experiences regarding safe dimple creation surgery. Methods This study included 2,048 patients who underwent dimple creation surgery at our plastic surgery clinic between April 2010 and June 2014. These patients were selected from those who displayed no scarring from injury or tumor removal in the central face during the presurgical evaluation. Medical records were used to identify the age and sex of each patient, the location of dimple creation, any postoperative complications, reoperation, and the reason for reoperation. Results Of the 2,048 patients, 159 (7.7%) underwent reoperation. The reason for reoperation was undercorrection in 78 cases (49.0%), disappearance of the dimple in 62 cases (38.9%), and overcorrection in nine cases (5.6%). Five patients (3.1%) had their stitches removed to eliminate the created dimple because they changed their minds, and five patients (3.1%) had their stitches removed because of infection. No patients reported complications after reoperation, and no other complications, such as hyperpigmentation or foreign body reaction, were observed. Conclusions Safe surgery with minimal complications and satisfying cosmetic results can be achieved via accurate knowledge of the relevant anatomy and its relationship with dimples, as well as appropriate surgical methodology.

• Journal of Digital Convergence
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• v.16 no.7
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• pp.345-355
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• 2018

The purpose of this study was to investigate the convergence factors affecting of physical activity level on hemodialysis patients' depression, health-related quality of life and sleep disorders. The participants were 193 hemodialysis patients undergoing hemodialysis in five hospitals in two cities. Data were analyzed by technical statistics, correlation and hierarchical regression. The results showed that depression and physical activity were negatively correlated (r = -.259, p <.01), and physical and mental health related quality of life and physical activity correlated positively (R = .273, p <.01, r = .186, p <.01), respectively. Hierarchical regression analysis showed that the higher the quality of life related to physical health, the higher the level of physical activity of hemodialysis patients (${\beta}=.22$, p <.01). Therefore, it is required to develop an intervention program to improve health-related quality of life by improving the physical activity of hemodialysis patients.

• Archives of Craniofacial Surgery
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• v.19 no.2
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• pp.114-119
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• 2018

Background: The ideal absorbable plating system should provide sufficient rigidity and then be absorbed within a timely manner. The Resorb-X has been recently developed as a plating system with a mixture ratio of 50:50 poly(D, L-lactide). Methods: We present seven of 121 patients who experienced delayed degradation with this absorbable plate. One hundred twenty-one patients with facial bone fracture underwent surgical treatment from March 2011 to March 2015, and rigid fixation was achieved with the Resorb-X. Results: Of 121 patients, seven (5.8%) developed complications at the surgical sites. Six of 102 cases underwent fixation of the infraorbital rim and one of 73 underwent fixation of the frontozygomatic buttress; the other sites of fixation did not develop delayed degradation. Foreign body granuloma developed at the earliest by postoperative 20 months and at the latest by postoperative 28 months (average, 23.5 months). Conclusion: We observed that the use of absorbable plates in incision sites or areas with thin skin can increase the possibility of delayed degradation. When performing surgery in these areas, the normal skin above the fixed location should be covered sufficiently.

• Journal of muscle and joint health
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• v.11 no.1
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• pp.74-87
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• 2004

Purpose: This study aims to analyze the outcome of exercise programs for Rheumatoid Arthritis patients and its tendency with network analysis. Method: 30 articles from Medline search of foreign nursing journals(1966-2002) and 5 from three Korean nursing journals(1970-2002) were surveyed. The contents analyses were focused on outcome measures and network analysis of exercise programs. Results: Exercise programs result in improving muscle strength(91.7%), aerobic capacity(72.9%), and 50 feet walk time(57.3%). Among several exercises, water exercise, and Tai-chi are in the middle of weight-bearing exercises. In the experimental design, non-randomized control trials were 40%, and the functional status of subjects were not classified in 40% of the articles surveyed. Conclusion: Considering the results, muscle strength, aerobic capacity, and 50 feet walk time were tested as valid outcome measures. Tai-chi exercise could be recommended as proper exercise for Rheumatoid arthritis patients because of its low intensity of weight-bearing exercise. In terms of research methods, the randomized trials and functional classifications of rheumatoid arthritis should be done more strictly.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.130-133
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• 2016

Rheumatoid arthritis (RA) is a connective tissue disease involving the larynx in 30 % of the patients. Foreign body sensation, hoarseness, and cough are common symptoms in laryngeal involvement. An urgent tracheostomy is required when acute airway obstruction occurs in case of bilateral vocal fold paralysis. The most common cause of bilateral vocal fold paralysis in RA patients is a cricoarytenoid joint arthritis. Laryngeal nerve degeneration is rare cause of bilateral vocal fold paralysis in RA patients. In this case report, an emergent tracheostomy was performed on a 64-years-old male patient with acute dyspnea, and concurrent involvement of RA on laryngeal nerve and cricoarytenoid joint was revealed by laryngeal electromyography and histopathology. The vocal fold mobility was restored after 3-months medical treatment.

• Journal of The Korea Institute of Healthcare Architecture
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• v.22 no.4
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• pp.97-104
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• 2016

Purpose: Facilities for infection prevention according to the characteristics of the patients, caregivers and medical personnel are needed in the patient triage room of the emergency department as a space for the first medical examination and classification of the patients. This study focus on the patient tirage room with the highest frequency of use in the emergency department to prevent the hospital acquired infection of the emergency department. Methods:: This study analyzed the facilities standard needed for the infection prevention through interviews with the medical personnel and analyses on the facilities standard/cases of foreign hospitals and facilities standard at home and abroad Results: And based on this, it attempted to present improvement measures by analyzing the line of circulation and space used by infected patients in a hospital designated in the regional emergency medical center among hospitals whose emergency department overcrowding index is high. Implications: The facilities standard for the infection prevention among the courses for patient classification of the emergency medical centers could be identified and implemented to prevent infection.

• Korean journal of aerospace and environmental medicine
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• v.31 no.1
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• pp.21-23
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• 2021

Purpose: Human papillomavirus (HPV) vaccination schedule is recommended by Strategic Advisory Group of Experts on Immunization of World Health Organization to achieve high efficacy and immunogenicity. However, the patients often cannot keep up their schedule for several reasons. Methods: Monthly numbers of visitors for HPV vaccination between 2019 and 2021 were analyzed to measure the impact of coronavirus disease-19 (COVID-19) outbreak which was the main cause of this delay. Results: In February 2020, the number of foreign patients vaccinated with HPV was dropped suddenly due to COVID-19. Prior to this impact, the average patients per month for HPV vaccination was 160 (95% confidence interval [CI]: 143-176). It was then 30 (95% CI: 20-40). However recent trends show a gradual recovery. Conclusion: If a woman is pregnant after starting the HPV vaccine series, the reminder doses should be delayed until she is no longer pregnant. If this series is interrupted for any length of time, it can be resumed without restarting the series. HPV vaccine series need to be administered with a minimum interval of 14 days before or after administration of COVID-19 vaccines.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.79-84
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• 2000

Background: Esophageal perforation is an extremely lethal injury that requires careful management for survival,. Material and Method: We performed a retrospective clinical revi-ew of 14 patients treated for esophageal perforation at the Department of Thoracic and Cardiovascular Surgery hanyang University Hospital between July 1986 and August 1998. Cardiovascular Surgery Hanyang University Hospital between July 1986 and August 1998. Result: The ration between male and female patients was 12:2 and their ages ranged from 9 to 68 years( average: 446 years). Iatrogenic perforations were found in 6 patients(42.9%) spontaneous perforations in 3 patients(21.4%) traumatic perforations in 2 patients(14.3%) and caustic perforations foreign body origin and esophagel cancer in 1 patient (7.1%) each. Four of the patients(28.6%) had esophageal ruptures located cancer in 1 patient (7.1%) each. Four of the patients (28.6%) had esophageal ruptures located in the cervical esophagus and 10 patients (71.4%) in the thoracic esophagus, The most frequent location was in the mid third portion of the esophagus (35.7%) there were also 2 patients(14.3%) in the upper third portion and 3 patients(21.4%) in the lower third portion. Complications encountered included mediastinitis empyema or pleural effusion mediastinal or lung abscess sepsis and aspiration pneumonia. The most frequent complication that occurred was mediastinitis in 9 cases (57%) Three patients underwent conservative treatment. Among the patients who underwent surgical treatment 5 patients underwent primary closure 6 patients underwent open drainage and 2 patients underwent reconstrumction (1 patients had an initial primary closure and 1 patient had an initial open drainage procedure). The mortality rates for those with conservative and surgical treatment were 66.7% (2cases) and 9.1% (1 cases) respec- tively. Conclusion: Perforation of the esophagus although very rare has a high mortality rate and thus aggressive operative therapy is necessary.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1133-1137
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• 1996

From September 1994 to October 1995, we are reporting clinical results of 67 patients whom underwent video-assisted trio rabic surgery(VATS). 1. They were diagnosed as spontaneous pneumothorax In )5, diffuse interstitial lung disease in 9, empyema in 7, hemothorax in 5, malignant pleural effusion in 3, hyperhidrosis in 3, foreign body in chest cavity in 2, mesothelioma in 1, miliary tuberculosis in 1 and organizing pneumonia in 12. In pneumothorax, bullectomy in 33 and open bellectoiny in 2 due to pleural adhesion was done Hemostasis in 5, irrigation in 7, foreign body removal in 2, talcum powder insufrlation in 3, sympathectomy 3 as done. Thoracoscopic biopsy watt done In 12 3. For pneumothorax, operation was indicated as recurrent pneumothorax in 18, persistent air leak in 12, visible bullae In chest X-ray in 5. 4 Thoracoscopic biopsy was done in 12. They were interstitial pulmonary fibrosis in 9, miliary tuberculosis in 1, mesothelioma in 1, and organizing pneumonia in 1 .Among interstitial pulmonary fibrosis, usual interstitial pneumonia were 2 and diffuse interstitial pneumonia were 7. 5. Wo complication was found in 6) patients among 67 patients. The complication was found in 4 patients (2 persistent air leak, 2 contralateral lung atelectasis). We concluded that VATS was safe and beneficial in reducing postoperative complication and the role of thoracic surgery will increase markefdly.