• Title/Summary/Keyword: Gynecology Surgery

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Standardization and Management of Interface Terminology regarding Chief Complaints, Diagnoses and Procedures for Electronic Medical Records: Experiences of a Four-hospital Consortium (전자의무기록 표준화 용어 관리 프로세스 정립)

  • Kang, Jae-Eun;Kim, Kidong;Lee, Young-Ae;Yoo, Sooyoung;Lee, Ho Young;Hong, Kyung Lan;Hwang, Woo Yeon
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.22 no.3
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    • pp.679-687
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    • 2021
  • The purpose of the present study was to document the standardization and management process of interface terminology regarding the chief complaints, diagnoses, and procedures, including surgery in a four-hospital consortium. The process was proposed, discussed, modified, and finalized in 2016 by the Terminology Standardization Committee (TSC), consisting of personnel from four hospitals. A request regarding interface terminology was classified into one of four categories: 1) registration of a new term, 2) revision, 3) deleting an old term and registering a new term, and 4) deletion. A request was processed in the following order: 1) collecting testimonies from related departments and 2) voting by the TSC. At least five out of the seven possible members of the voting pool need to approve of it. Mapping to the reference terminology was performed by three independent medical information managers. All processes were performed online, and the voting and mapping results were collected automatically. This process made the decision-making process clear and fast. In addition, this made users receptive to the decision of the TSC. In the 16 months after the process was adopted, there were 126 new terms registered, 131 revisions, 40 deletions of an old term and the registration of a new term, and 1235 deletions.

Effect of Water Extract of Aloe in RANKL-induced Osteoclast Differentiation (파골세포 분화에 미치는 노회(蘆會) 추출물의 효과)

  • Lee, Jeong-Hugh;Lee, Myeung-Su;Chae, Soo-Uk;Kim, Ha-Young;Moon, Seo-Young;Jeon, Byung-Hoon;Cho, Hae-Joong
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.25 no.6
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    • pp.1008-1013
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    • 2011
  • Osteoporosis is the leading underlying cause of fractures, particularly in postmenopausal women, due to the loss of estrogen-mediated suppression of bone resorption. More than 50% of adults 50 years of age or older are estimated to have osteoporosis. Osteoclast which is main target for treatment of osteoporosis is originated from hematopoietic cell line. Aloe has been widely used in worldwide country as a coadjuvant medicine. Extracts of the leaves of Aloe have been used in condition to improve dermatologic problem such as seborrheic dermatitis, aphthous stomatitis, xerosis, lichen planus and has been known to exert anti-inflammatory, anti-oxidant and anti-tumor effects. However, despite the popularity of aloe as a plant food supplements, the evaluation of its efficacy as a possible therapeutic option for osteoporosis remains scarce. Thus, we evaluated the effect of Aloe on receptor activator of nuclear factor-${\kappa}B$ ligand (RANKL)-induced osteoclast differentiation. Here we found that Aloe significantly inhibited osteoclast differentiation induced by RANKL. Aloe suppressed the activation of p38 pathway and $NF{\kappa}B$ in bone marrow macrophages (BMMs) treated with RANKL. Also, Aloe significantly inhibited the mRNA expression of c-Fos, tartrate-resistant acid phosphatase (TRAP), osteoclast-associated receptor (OSCAR), nuclear factor of activated T cells (NFAT)c1 and cathepsin K in BMMs treated with RANKL. Particularly, Aloe greatly inhibited the protein expression of c-fos and NFATc1. Taken together, our results suggested that Aloe may be useful tool for treatment of osteoporosis by inhibition of osteoclast differentiation.

The anti-climacterium effects of red clover dry extracts combined with pomegranate concentration powder in ovariectomized rats

  • Kim, Kyung Hu;Kang, Su Jin;Choi, Beom Rak;Kim, Seung Hee;Yi, Hae Yeon;Kim, Dong Chul;Choi, Seong Hun;Han, Chang Hyun;Park, Soo Jin;Song, Chang Hyun;Ku, Sae Kwang;Lee, Young Joon
    • Journal of Society of Preventive Korean Medicine
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    • v.18 no.2
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    • pp.133-145
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    • 2014
  • Objective : In this study, the addition of dried pomegranate concentrate powder (PCP) was affected the anti-climacterium activity of red clover dry extracts (RC) in ovariectomized (OVX) rats. Materials and methods : After bilateral OVX surgery, RC 40 mg/kg, PCP 20 mg/kg and RC:PCP 2:1 mixture (g/g) 120, 60 and 30 mg/kg (of body weight) were orally administered, once a day for 84 days, and then the changes on the serum estradiol levels, abdominal fat pad and uterus weights were observed for estrogenic effects. In addition, liver weights, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were also evaluated for hepatoprotective effects, and serum total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglyceride (TG) levels were monitored for hypolipidemic effects. Results : As a result of OVX, the estrogen-deficient climacterium symptoms, increments of abdominal fat pad weights, serum AST, ALT, TC, LDL and TG levels with decrease of uterus and liver weights, serum estradiol levels, were demonstrated. However, these estrogen-deficient climacterium symptoms induced by bilateral OVX in rats were significantly inhibited by continuous oral treatment of RC 40 mg/kg, PCP 20 mg/kg and RC:PCP 2:1 mixture (g/g) 120, 60 and 30 mg/kg, respectively. Conclusion : The results suggested that RC:PCP 2:1 mixtures synergistically increased the anti-climacterium effects of RC in OVX rats. It, therefore, is expected that RC:PCP 2:1 mixture will be promising as a new potent protective agents for relieving the climacterium symptoms.

Effect of Chungpaesagan-tang on Ischemic Damage Induced by Middle Cerebral Artery Occlusion in Diabetic Rats (청폐사간탕이 탕요유발 흰주의 뇌허혈손상에 미치는 영향)

  • Jeong Chun-geun;Kim Eun-Young;Shin Jung-Won;Sohn Youngjoo;Lee Hyun-Sam;Jung Hyuk-Sang;Sohn Nak-Won
    • The Journal of Korean Medicine
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    • v.26 no.2 s.62
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    • pp.217-230
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    • 2005
  • Objectives: Chungpaesagan-tang (CPSGT), which is frequently used for treating patients of cerebrovascular disease, has not been reported by clinical doctors concerning the effect of neuronal aptosis caused by brain ischemia. To study the effect of CPSGT on focal cerebral ischemia in normal and diabetic rats and SHR, focal cerebral ischemia was induced by transient MCAO, and after onset CPSGT was administrated. Methods: Rats (Sprague-Dawley) were divided into four groups: sham-operated group, MCA-occluded group, CPSGT­administrated group after MCA occlusion, and normal group. The MCA was occluded by intraluminal method. CPSGT was administrated orally twice (l and 4 hours) after middle cerebral artery occlusion. All groups were sacrificed at 24 hours after the surgery. The brain tissue Was stained with $2\%$ triphenyl tetrazolium chloride (TTC) or $1\%$ cresyl violet solution, to examine effect of CPSGT on ischemic brain tissue. The blood samples were obtained from the heart.~. Tumor necrosis $factor-\alpha$ level and interleukin-6 level of serum was measured from sera using enzyme-linked immunoabsorbent assay (ELISA). Then changes of immunohistochemical expression of $TNF-\alpha$ in ischemic damaged areas were observed. Results: In NC+MCAO+CP and DM+MCAO+CP, CPSGT significantly (p<0.01) decreased the number of neuron cells compared to the control group. CPSGT markedly reduced (p<0.01) the infarct size of the forebrain in distance from the interaural line on cerebral ischemia in diabetic rats. CPSGT significantly reduced the $TNF-\alpha$ expression in penumbra region of damaged hemisphere in diabetic rats. Conclusions: CPSGT had a protective effect on cerebral ischemia in SD rats, especially in diabetic rats compared with normal SD rats.

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Comparison of work measures for some physician services in Obstetrics & Gynecology (산부인과 의사의 일부 서비스 진료업무량 측정방법 비교에 관한 연구)

  • Hur, Yeong-Joo;Sohn, Myong-Sei;Park, Eun-Cheol;Kang, Hyung-Gon;Kim, Han-Joong
    • Journal of Preventive Medicine and Public Health
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    • v.28 no.3 s.51
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    • pp.623-639
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    • 1995
  • We have never seen any method to cope basically with complicated situation and problems around medical reimbursement rates here in Korea since 1977 witnessed by the beginning of medical insurance. By the way researchers concerned are beginning to propose some kinds of innovative and detailed ideas to government these days. They are Diagnosis-related group(DRG) and Resource-based .elative value scale(RBRVS). In the light of this situation it is so encouraging that our government can come up with that and move. In case of RBRVS research we have already been reaching even to the level of reviewing and revising methodology for its further development after naive pilot study on internal medicine and general surgery last year. However there might be something different conditions between USA and Korea to apply the same Dr. Hsiao's method and it must be vital to check so called' total work approach' compared with 'intra-service work approach' before expanding to the whole medical fields. According to the' Intra-service approach', the physician's work is supposed to be divided into three sub-works by the name of intraservice work, pre, and post service work. These sub-works, again should be merged together to be the pre-postwork subset through some statistical methods of the estimation process applied by Dr. Hsiao's methodology in RBRVS development later on. But in this paper that estimation process was not taken because we could have real values for all of those surveyed items related to just one specialty, OB & GY. Instead, We used some statistical comparison procedures relevant to demographic characteristics, reliability & validity and correlation analysis with American RVU(Relative value unit) between the total work and merged total work from intraservice work approach. The unit of analysis was individual physicians of OB & GY and 300 physicians were selected for each approach through statistical sampling method based on national population of OB & GY physicians in Korea. And also with the thankful help of Advisory Committee under Korean Association of OB & GY, questionnaires were made and mailed to the subjects, two times. As a result there were not any statistically significant differences in demographic characteristics between the two approaches except for the variable 'Response time for the questionnaires', but in other sections of comparisons, response rate, representative values, reliability & validity test, correlation analysis with American RVU, all showed 'Total approach' was not only more rational and statistically meaningful than 'Intra-service approach' but also had considerable merits. But we are not absolutely sure about this paper's robustness. Because of some limitations, we'd rather like to suggest further researches should be followed. In that sense the first thing would be a research for the influence of doctor's characteristics, especially 'frequency' on the rating of work and the way to define total work more clearly.

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Reliability of Standardized Patients as Raters in Objective Structured Clinical Examination (객관 구조화 절차 기술 평가에서 채점자로서의 표준화환자의 신뢰도)

  • Son, Hee-Jeong;Moon, Joong-Bum;Lee, Hyang-Ah;Roh, Hye-Rin
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.12 no.1
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    • pp.318-326
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    • 2011
  • The purpose of this study is to investigate whether standardized patient(SP) can be used as a reliable examiner in Objective Structured Clinical Examination(OSCE). 4 SPs and 4 faculties who have more than 2 years experience of OSCE scoring were selected. For 1 assignment 2 members of faculty and 2 SPs were designated as raters. SPs were educated for assessing 2 technical skills, male Foley catheter insertion and wound dressing, for 8 hours (4 hours / day, each topic). The definition, method, cautions and complications for each of procedural skills were covered in the education. Theoretical lectures, video learning, faculty demonstration and practical training on mannequins were employed. The 8 raters were standardized for an hour with simulated OSCE scoring using previous videos on the day before the OSCE. Each assessment was composed of 14 checklists and 1 global rate. The allotted time for each assignment was 5minutes and for evaluation time 2 minutes per student. The evaluation from the faculty and SPs were compared and analyzed with the GENOVA program. The overall generalizability coefficient (G coefficient) was 0.839 from two cases of OASTS. The reliability of the raters was high, 0.946. The inter-rater agreement between faculty group and SP group was 0.949 for checklist and 0.908 for global rating. Therefore SPs can play a role of raters in OSCE for procedural skills, if they are given the appropriate training.

Study on Literatures of Symptoms and Signs of Tussiculaltion on Treatise on the Pathogenesis and Manifestations of All Diseases ("제병원후론(諸病源候論)" 중(中) "해수병제후(咳嗽病諸候)"에 대(對)한 연구(硏究))

  • Lee, Nam-Goo;Choi, Han-Baek;Kim, Jeong-Wan;Song, Min-A
    • Journal of Korean Medical classics
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    • v.23 no.5
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    • pp.11-22
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    • 2010
  • Treatise on the Pathogenesis and Manifestations of All Diseases(諸病源候論)was written by Chao Yuanfang that was most active during the Sui Dynasty at A.D. 610. It classified clinical medicine by some departments of internal medicine, surgery, obstetrics and gynecology, pediatrics, and otorhinolaryngology and within each specific department, categorizes etiology and pathology according to characteristics of various diseases. It was the total disease classification book that based on the bibles of the Oriental medicine, (Huangdi''s) Internal Classic(黃帝內經), Classic of Difficult Issues(難經) and Treatise on Cold Damage and Miscellaneous Diseases(傷寒雜病論), A-B Classic of Acupuncture and Moxibustion(鍼灸甲乙經), Essential Prescriptions Worth a Thousand Gold for Emergencies(備急千金要方) and Medical Secrets of an Official(外臺秘要). It was arranged tussive causes, classes, diagnosis, prognosis and stretching for treatment by Volume 13, all symptoms of tussiculation. Dialectic part was divided into cough(咳嗽), cough with dyspnea(咳逆上氣), cough with pus and blood(咳嗽吐膿血), cough with duck crying sound(?嗽), sudden cough(暴氣咳嗽), cough with dyspnea(咳逆), cough with dyspnea and vomiting(咳逆上氣嘔吐). Disease situation part was divided into the new cough(新咳) and old cough(舊咳), deficiency syndrome(虛證) and excess syndrome(實證), visceral cough(藏府咳), etc. Out of these, cough with counterflow(咳嗽上氣), cough with dyspnea(咳逆上氣), cough with dyspnea and vomiting(咳逆上氣嘔吐), cough with shortness of breath(咳逆短氣) have a close connection with dyspnea(上氣), counterflow of qi(逆氣), dyspnea and vomiting(上氣嘔吐) and shortness of breath(短氣) in the Pathogenesis and Manifestations of All qi(氣病諸候) of vol 13. So two parts may be refer to each other. However, the content on the original book has been addition and subtraction on the original context along with many reprints. Therefore, this paper, with regard to the prints of former editions, tried to help in better comprehension of the original context through readings and Korean translation.

A Literature Review and A Clinical Examination of Burning Acupuncture Therapy of using D.I.T.I. (화침요법(火鍼療法)의 연구동향(硏究動向)과 D.I.T.I를 활용(活用)한 임상적(臨床的) 고찰(考察))

  • Park Sang-Jun;Ahn Soo-Gi
    • Journal of Acupuncture Research
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    • v.15 no.2
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    • pp.407-425
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    • 1998
  • We have studied the clinical application of burning acupuncture by examining 18recent-published papers in the journal 'ZHONGGUO ZHENJIU(中國鍼灸)' for the bibliographical study and clinical study and have given medical treatment of burning acupuncture on 21 Patients who suffered 'the body chill symptoms(冷症)' at the oriental hospital of Won-Kwang University, Kwang-Ju. As a result, we have come to some conclusions as below. 1. The diseases for which the modern borning acupuncture is efficacious are widely extended to various kinds of field such as surgery, internal medicine, gynecology, ophthalmology, otolaryngology. etc. as well as numbness, meridian muscle disease(經筋病) mentioned in 'Neijing(內徑)' . 2. The effects of burning acupuncture therapy are wen zhuang yang qi(溫壯陽氣), sheng ji lian chuang(生肌斂瘡), san han chu shi(散寒除濕), qu fens zhi yang(祛風止痒), qu yu chu fu pai nong(祛瘀除腐排膿), san jie xiao zhong(散結消腫), zhi tong huan ji chu ma mu(止痛緩急除麻木), qing re xie hue jie du(淸熱瀉火解毒). 3. The recently reported diseases for which burning acupuncture is good are internal and external humeral epicondylitis, atheroma, menorrhalgia, thecal cyst, tragomaschalia, pruritus, traumatic onychophemia, gout of feet, prostatomegaly, aacne, supprative infection of body surface, snapping finger, backache, numbness, pyocyst etc. 4. The subjective symptoms of 'the body chill symptoms(冷症)' were, most of all, feeling cold accompanied by pain(16 case), while just 4 cases were feeling cold only. 5. In the related diseases of the body chill symptoms(冷症), feeling pain like arthralgia was the most case, and then dysmenorrhea, menorralgia, depression, anemia in order. 6. In the D.I.T.I before and after burning acupuncture treatment, 6 patients had shown 'excellent' effects and 8 patients had turned out 'good', while 7 patients had become'fair'. 7. In the degree of patient-satisfaction, 5 patients announced 'excellence' and 6 patients expressed 'good', 4 expressed 'fair', while the other 6 showed no change. 8. In the correlation of D.I.T.I and patient-satisfaction, the better the result of clinical treatment was, the more satisfied the patient was, however, in the case 'fair', we saw the degree of patient-satisfaction was relatively low, so we could admit the judging significance of D.I.T.I.

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Prognostic Model in Patients with Early-stage Squamous Cell Carcinoma of the Uterine Cervix: A Combination of Invasive Margin Pathological Characteristics and Lymphovascular Space Invasion

  • Khunamornpong, Surapan;Lekawanvijit, Suree;Settakorn, Jongkolnee;Sukpan, Kornkanok;Suprasert, Prapaporn;Siriaunkgul, Sumalee
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.11
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    • pp.6935-6940
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    • 2013
  • Background: This study aimed to develop a prognostic model in patients with early-stage cervical squamous cell carcinoma based on clinicopathological features, including invasive margin characteristics. Materials and Methods: Clinicopathological features and outcomes of 190 patients with FIGO stage IB-IIA cervical squamous cell carcinoma treated by surgery were collected and analyzed for factors associated with tumor recurrence. In addition to well-recognized pathological risk factors, the pathological characteristics of invasive margin (type of invasive pattern and degree of stromal desmoplasia and peritumoral inflammatory reaction) were also included in the analysis. Multiple scoring models were made by matching different clinicopathological variables and/or different weighting of the score for each variable. The model with the best performance in the prediction of recurrence and decreased survival was selected. Results: The model with the best performance was composed of a combined score of invasive pattern, lymphovascular space invasion (LVSI), and degree of inflammatory reaction and stromal desmoplasia (total score =10). Compared to those with score ${\leq}8$, the patients with score 9-10 had a significantly higher recurrence rate in the overall group (p<0.001) and the subgroup without adjuvant therapy (p<0.001), while the significance was marginal in the subgroup with adjuvant therapy (p=0.069). In addition, the patients with score 9-10 had a higher rate of tumor recurrence at distant sites (p=0.007). The disease-free survival was significantly lower in the patients with score 9-10 than those with score ${\leq}8$ among the overall patients (p<0.001), in the subgroup without adjuvant therapy (p<0.001), and the subgroup with adjuvant therapy (p=0.047). Conclusions: In this study, a prognostic model based on a combination of pathological characteristics of invasive margin and LVSI proved to be predictive of tumor recurrence and decreased disease-free survival in patients with early-stage cervical squamous cell carcinoma.

Early and Late Complications after Inguinofemoral Lymphadenectomy for Vulvar Cancer

  • Cirik, Derya Akdag;Karalok, Alper;Ureyen, Isin;Tasci, Tolga;Kalyoncu, Rukiye;Turkmen, Osman;Kose, M Faruk;Tulunay, Gokhan;Turan, Taner
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.13
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    • pp.5175-5179
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    • 2015
  • Background: We aimed to determine the frequency of early and late complications following groin surgery for vulvar cancer and analyze possible risk factors. Materials and Methods: This retrospective cohort study included 99 women who underwent for vulvar cancer. The early (${\leq}1$ month) complications were wound infection, breakdown and lymphocyst and late (>1 month) complications were lower limb lymphedema, incontinence and erysipelas. The risk factors for developing each of the complications were analyzed with regression analysis. Results: In the entire cohort, 29 (29.3%) women experienced early and 12 (12.1%) had late complications. Wound complications including infection and breakdown were the leading early complications (23.2%). In the multivariate analysis, both obesity (body mass index ${\geq}30kg/m^2$) and advanced age (${\geq}65years$) were found as independent predictive factors for early complications. Obese women of advanced age had 6.32 times more risk of experiencing any of the early complications, when compared to non-obese and young women (55.6% vs 8.7%). The most common late complication was lower limb lymphedema (10.1%) that was more frequently seen in young women. However, neither age nor lymph node count were significantly associated with the occurrence of lower limb lymphedema. Conclusions: More than 40% of the women suffered from postoperative complications after inguinofemoral lymphadenectomy in the current study. While advanced age and obesity were the significant predictors for any of the early complications, there was no identified risk factor for lower limb lymphedema.