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Analysis of Status and Success Factor of Referral and Return of Patients to Clinics: Focusing on Patients with Endocrinology and Cardiology at a General Hospital in Goyang (진료회송 사업 현황 및 성공요인 분석: 고양시 소재 종합병원급 내분비내과와 심장내과 환자를 중심으로)

  • Park, Hee Sun;Choi, Jung Kyu;Tae, Eun Sook;Choi, Sang Gil;Kim, Eui Hyeok
    • Health Policy and Management
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    • v.32 no.3
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    • pp.323-329
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    • 2022
  • Background: This study aimed to identify the characteristics of the referral and return of patients to clinics in the endocrinology and cardiology departments at the National Health Insurance Service Ilsan Hospital to evaluate the "referral and return of patients to clinics" program and reduce the rate of returning patients. Methods: From May 2018 to December 2020, we identified the number of visits to referral hospitals and hospital usage status at Ilsan Hospital after returning to clinics. We also identified the patients who returned to Ilsan Hospital within 6 months, defined as "failure to transport," among those recommended to be transported to clinics of the Medical Cooperation Center. Additionally, we evaluated the characteristics of the "failure to transport" patients. Results: Among the returning patients, the rate of visiting Ilsan Hospital within 6 months was higher in cardiology than in endocrinology (25.1% vs. 16.7%). Older age, more severe disease, and more number of visits to the department were associated with a high rate of failure to transport. The rate of failure to return was low in cases diagnosed with hyperlipidemia/lipoprotein metabolism disorder. With respect to diabetes, the rate of failure to transport differed according to each type of diagnosis of diabetes. Conclusion: The success rate of the "referral and return of patient to clinics" program differed based on each patient's characteristics, department of visit, and diagnosis. Individualizing according to the visit department and diagnosis is required to ensure successful transfers, and infrastructure expansion and institutional arrangements must be facilitated.

Elective tracheostomy scoring system for severe oral disease patients

  • Kim, Yong-Hwan;Kim, Moon-Young;Kim, Chul-Hwan
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.40 no.5
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    • pp.211-219
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    • 2014
  • Objectives: The purpose of this research was to create a scoring system that provides comprehensive assessment of patients with oromaxillofacial cancer or odontogenic infection, and to statistically reevaluate the results in order to provide specific criteria for elective tracheostomy. Materials and Methods: All patients that had oral cancer surgery (group A) or odontogenic infection surgery (group B) during a period of 10 years (2003 to 2013) were subgrouped according to whether or not the patient received a tracheostomy. After a random sampling (group A: total of 56, group B: total of 60), evaulation procedures were observed based on the group classifications. For group A, four factors were evaluated: TNM stage, reconstruction methods, presence of pathologic findings on chest posterior-anterior (PA), and the number of systemic diseases. Scores were given to each item based on the scoring system suggested in this research and the scores were added together. Similarly, the sum score of group B was counted using 5 categories, including infection site, C-reactive protein level on first visit, age, presence of pathologic findings on chest PA, and number of systemic diseases. Results: The scoring system rendered from this research shows that there is a high correlation between the scores and TNM stage in oral cancer patients, or infection sites in odontogenic infection patients. However, no correlation between pathologic findings on chest PA could be found in either group. The results also indicated that for both groups, the hospital day increased with the tracheostomy score. The tracheostomy score cutoff value was 5 in oral cancer patients and 6 in odontogenic infection patients which was used for elective tracheostomy indication. Conclusion: The elective tracheostomy score system suggested by this research is a method that considers both the surgical and general conditions of the patient, and can be very useful for managing patients with severe oral disease.

Utilization of Preventive Therapy in Korean Migraine Patients

  • Kim, Yewon;Park, Susin;Kim, Eonjeong;Je, Nam Kyung
    • Korean Journal of Clinical Pharmacy
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    • v.31 no.1
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    • pp.35-43
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    • 2021
  • Background: Migraine is a common neurological disorder that affects the quality of life and causes several health problems. Preventive migraine treatment can reduce migraine frequency, headache severity, and health care costs. This study aimed to estimate the utilization of migraine preventive therapy and associated factors in eligible patients. Methods: We studied 534 patients with migraine who were eligible for migraine preventive therapy using 2017 National Patient Sample (NPS) data from the Health Insurance Review and Assessment Service (HIRA). We estimated the migraine days by calculating the monthly average number of defined daily dose (DDD) of migraine-specific acute drug. Patients with a monthly average number of DDD of 4 or more were considered as subjects for preventive treatment. Chi-square test and multiple logistic regression analysis were used to determine the association between the preventive therapy and the influencing variables. Results: Less than half of the eligible patients for prophylaxis (n=234, 43.8%) were prescribed preventive therapy. Multiple logistic regression results show that migraine preventive therapy was influenced by age, the type of migraine, and some comorbidities. Patients over the age of 50 tend to receive less prophylactic treatment than under the age of 40. On the other hand, migraine patients with epilepsy or depression were more likely to receive preventive therapy. Sumatriptan was the most preferred medication for acute treatment, and propranolol was the most commonly prescribed drug for prevention. Conclusions: More than half of the patients who were candidates for migraine prophylaxis were not receiving suitable preventive treatment. Positive factors affecting the use of migraine prevention were the presence of comorbidities such as epilepsy and depression.

A Clinical Survey of the Patients in Neuro-Pain Clinic at Ajou University (신경통증클리닉 환자의 1년간 통계고찰)

  • Park, Eun Jung;Han, Kyung Ream;Kim, Do Wan;Kim, Chan
    • The Korean Journal of Pain
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    • v.20 no.2
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    • pp.181-185
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    • 2007
  • Background: The first pain clinic opened in korea in 1973 at Yonsei University Hospital, however, since then the number of pain clinics has gradually increased, as has the number of patients visiting them. This increase in patient has caused concerns about the way in which pain is managed, therefore, we conducted a retrospective review of data according to the sex, age and disease in an attept to aid us in planning for the future of our pain clinic. Methods: We analyzed 1,282 new patients who had visited our pain clinic and 828 inpatients who were admitted to our pain clinic between March 2006 and February 2007. Results: The most frequent age group was in the sixties in outpatient and in the seventies in inpatient. In addition, the incidence of disease in new patients and inpatients was as follows: in new patients, lumbar herniated intervertebral disc 16.5%, hyperhidrosis 12.3%, cervical disc disorder 10.5%, acute herpes zoster 8.2%, postherpetic neuralgia 7.9%, and trigeminal neuralgia 7.0%; in admitted patients, acute herpes zoster 17.6%, trigeminal neuralgia 15.6%, lumbar herniated intervertebral disc 13.0%, postherpetic neuralgia 11.2%, hyperhidrosis 9.8%, and complex regional pain syndrome 7.0%. Conclusions: The patients visiting our pain clinic have presented with a wide variety of diseases. This improved care reflects an effort to expand our fields not only to the management of outpatients but also inpatients, as well as to the treatment of new fields of disease. In the future, We need to manage various pain patients not only in outpatients but also in inpatients to expand our field even through pain clinic is rapidly growing in Korea.

Facial injury patterns associated with stand-up electric scooters in unhelmeted riders

  • Kim, Hyeon Seok;Kim, Woo Seob;Kim, Han Koo;Kang, Shin Hyuk;Bae, Tae Hui
    • Archives of Plastic Surgery
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    • v.49 no.1
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    • pp.50-54
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    • 2022
  • Background In recent years, the number of people riding stand-up electric scooters in South Korea has increased rapidly. This study analyzed the facial injury patterns associated with stand-up electric scooter-related trauma in patients who visited our emergency center. Methods In this retrospective review, we collected data from patients who had visited our emergency center for stand-up electric scooter-related trauma between January 1, 2018 and December 31, 2020. Results The average age of the patients was 26.7 years. Of the 73 patients, 47 were male and 26 were female, highlighting a male predominance. Seven patients were injured after alcohol consumption. None of the patients had worn helmets. Additionally, upon comparing the frequency of facial injuries according to the quarter of the year, the facial injury rate was higher in the second and third quarters than in the first and fourth quarters. Facial soft tissue injuries were classified into facial cosmetic subunits and analyzed according to their location. The highest number of injuries was on the chin (n=18, 20.9%). Of the 73 patients with stand-up electric scooter-related facial injuries, 16 had acute facial osseous fractures. The commonest acute facial osseous fractures were those of the orbit (n=7, 26.9%). Conclusions The patterns of facial trauma reported here can be helpful for quickly evaluating and treating patients with facial trauma related to stand-up electric scooters. Additionally, people riding stand-up electric scooters should be aware of the risks associated with facial trauma and the importance of wearing protective devices, such as helmets and masks.

Clostridioides difficile Infection in a Japanese Tertiary Children's Hospital

  • Meguro, Mariko;Nambu, Ryusuke;Hara, Tomoko;Ebana, Ryo;Yoshida, Masashi;Yamamoto, Saki;Mori, Koki;Iwama, Itaru
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.25 no.5
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    • pp.387-395
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    • 2022
  • Purpose: Toxins produced by Clostridioides difficile infection (CDI) can cause enteritis and diarrhea. Although the number of pediatric CDI cases is increasing, the clinical management of pediatric CDI, including patient characteristics and prognosis, remains unclear. This study aimed to elucidate the background and clinical course of patients with CDI and evaluate the reliability of diagnostic tests in a tertiary pediatric hospital in Japan. Methods: We retrospectively analyzed the clinical data of children diagnosed with CDI between 2011 and 2021 at the Saitama Children's Medical Center in Saitama, Japan. Results: During the study period, 1,252 C. difficile antigen/toxin tests were performed, and 37 patients were diagnosed with CDI. The main underlying diseases among the patients were hematological and malignant disorders and gastrointestinal diseases, including inflammatory bowel disease (IBD) (59.4%). Two patients (5.4%) had an unremarkable medical history. Among the 37 patients, 27 (73.0%) were immunocompromised, 25 (67.6%) had a history of antibiotic use within the past two months, and 6 (16.2%) were negative on the initial test but were positive on the second test. Finally, 28 patients (75.7%) required primary antibiotic therapy only, and two patients with IBD required additional antibiotic therapy as secondary treatment. Conclusion: The number of pediatric patients with CDI is increasing. Both a comprehensive interview, including underlying diseases and history of antibiotic use, and an understanding of the features of clinical examinations should be emphasized to appropriately diagnose and treat CDI.

Is Surgical Staging Necessary for Patients with Low-risk Endometrial Cancer? A Retrospective Clinical Analysis

  • Kokcu, Arif;Kurtoglu, Emel;Celik, Handan;Kefeli, Mehmet;Tosun, Migraci;Onal, Mesut
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.13
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    • pp.5331-5335
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    • 2015
  • Purpose: The aim of this study was to compare the tumor-free and overall survival rates between patients with low-risk endometrial cancer who underwent surgical staging and those who did not undergo surgical staging. Materials and Methods: Data, including demographic characteristics, grade of the tumor, myometrial invasion, cervical involvement, peritoneal washing, lymph node involvement, lymphovascular space invasion, postoperative complication, adjuvant treatment, cancer recurrence, and tumor-free and overall survival rates, for patients with low-risk endometrioid endometrial cancer who were treated surgically with and without pelvic and paraaortic lymph node dissection (LND) were analyzed retrospectively. The patients diagnosed with endometrioid endometrial cancer including the following criteria were considered low-risk: 1) a grade 1 (G1) or grade 2 (G2) endometrioid histology; 2) myometrial invasion of <50% upon magnetic resonance imaging (MRI); 3) no stromal glandular or stromal invasion upon MRI; and 4) no evidence of intra-abdominal metastasis. Then the patients at low-risk were divided into two groups; group 1 (n=117): patients treated surgically with pelvic and paraaortic LND and group 2 (n=170): patients treated surgically without pelvic and paraaortic LND. Results: There was no statistical significance when the groups were compared in terms of lymphovascular space invasion, cervical involvement, positive cytology, and recurrence, whereas the administration of an adjuvant therapy was higher in group 2 (p<0.005). The number of patients with positive pelvic nodes and the number of metastatic pelvic nodes were significantly higher in the group with positive LVI than in the group without LVI (p<0.005). No statistically significant differences were detected between the groups in terms of tumor-free survival (p=0.981) and overall survival (p=0.166). Conclusions: Total hysterectomy with bilateral salpingo-oophorectomy and stage-adapted postoperative adjuvant therapy without pelvic and/or paraaortic lymphadenectomy may be safe and efficient treatments for low-risk endometrial cancer.

Assessment of the Effectiveness of a Film-Forming Cream in the Management of Oral Aphthous Ulcers: A Placebo-Controlled Randomized Clinical Trial

  • Simone Marconcini;Giacomo Oldoini;Annamaria Genovesi;Enrica Giammarinaro
    • Journal of dental hygiene science
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    • v.23 no.2
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    • pp.88-92
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    • 2023
  • Background: Aphthous stomatitis is a common disease of the oral mucosa and its pathogenesis is associated with several risk factors. Frequently, minor ulcers are idiopathic in nature and often resolve naturally. However, those ulcers are painful and sensibly compromise patients' eating. There are different treatment strategies for the clinical management of oral aphthae. Methods: The present study assessed the efficacy of a film-forming cream in accelerating the healing and diminishing the pain associated with minor aphthae in a randomized fashion design. The test product (AphtoFix®) was compared with placebo cream in a cohort of patients with a diagnosis of minor recurrent stomatitis. Patients were randomly distributed into two groups and were followed for 10 days. The primary outcomes included the number of days until symptoms were relieved and the number of days to complete healing. Results: Thirty-six patients completed the follow-up, eighteen per group. All lesions eventually healed within day 10. However, patients in the test group experienced significantly less pain, already from day 1. Patients in the test group also showed a faster healing rate of the lesion with an average of 7 days against the 9 days required for patients in the control group. Conclusion: The present study supported the utility of a film-forming in cream in relieving the patient from symptoms associated with aphthous stomatitis already at day 1 of product use. Patients also displayed faster healing of the lesions when compared to the control group. Further studies with greater sample size and patient stratification according to age and risk factors are recommended to support the present findings.

Development of a Computer-assited Patients Menu Planning System for Hospital Dietetics (병원 영양과의 환자식 식단 관리 전산 프로그램 개발에 관한 연구)

  • Park, Shin-Jeong;Choi, Seong-Kyung;Kwak, Tong-Kyung
    • Journal of the Korean Society of Food Culture
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    • v.8 no.3
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    • pp.257-266
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    • 1993
  • The purpose of this study was to develop a computer-assisted patients menu planning program for hospital dietetics in order to improve the quality of menu for patients and to release managers from repetitive and routine tasks. Using this program, dietitians can spend more time on professional tasks. Moreover, few studies have been done on computer assisted patients menu planning for patients who need special diets for treatment in domestic hospital dietetics, therefore this program could be a great contribution. A 16-bit personal computer compatible with IBM-PC/AT was used. The data base files and processing program were created by Clipper package ver 5.0. This system can collect a number of meals, plan patients menu and computerize nutrient analysis. The future study will develop program(s) for purchasing, inventory control and data correction. The contents of computerized system are summarized as follows. 1. The number of daily meals of special and general diets given to the patients are collected and saved in database. These data were for the monthly list of meal census which could be printed out on the screen and/or the printer. 2. The menu planning was largely consisted of 2 sections. One was for the patients who require special diets and the other was general diet. And the special diets was divided into 6 sub-sections: diabetic, low-salt, low-fat, low-salt/low-protein, low-fat/low-cholesterol and low residue diets. 3. The nutrient analysis was composed of 11 diet. Sections and diebetic diet was divided into 9 sub-sections according to the calorie requirement. The calculated results were compared with the standards which were established by the hospital dietetic department.

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Outcome of Rectal Cancer in Patients Aged 30 Years or Less in the Pakistani Population

  • Akbar, Ali;Bhatti, Abu Bakar Hafeez;Khattak, Shahid;Syed, Aamir Ali;Kazmi, Ather Saeed;Jamshed, Aarif
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.15
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    • pp.6339-6342
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    • 2014
  • Background: The incidence of rectal cancer is increasing in younger age groups. Limited data is available regarding survival outcome in younger patients with conflicting results from western world. The goal of this study was to determine survival in patients with rectal cancer <30 years of age and compare it with their older counterparts in the Pakistani population. Materials and Methods: A retrospective chart review of patients operated for rectal adenocarcinoma between January 2005 and December 2010 was performed. Patients were divided into two groups, Group 1 aged ${\leq}30years$ and Group 2 aged >30years. Patient characteristics, surgical procedure, histopathological details and number of loco-regional and distant failures were compared. Expected 5 year survival was calculated using Kaplan Meier curves and significance was determined using the Log rank test. Results: There were 38 patients in group 1 and 144 in group 2. A significantly high number of younger patients presented with poorly differentiated histology (44.7% vs 9.7%) (p=0.0001) and advanced pathological stage (63.1% vs 38.1%) (p=0.04). Predicted overall 5 year survival was 38% versus 57% in groups I and II, respectively (p=0.05). Disease free survival was 37% versus 52% and was significantly different (p=0.007). Conclusions: Early onset rectal cancer is associated with poor pathological features and a worse outcome in Pakistani population.