• Journal of Korean Neurosurgical Society
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• v.64 no.2
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• pp.217-228
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• 2021

Objective : Given the high risk of rebleeding and recurrence of blood blister-like aneurysms (BBAs), we treated ruptured BBAs of the internal carotid artery (ICA) with stent-assisted coil embolization (SAC). This study aimed to evaluate the efficacy and safety of SACs. Methods : We retrospectively reviewed clinical and radiological data from eight patients with ruptured BBAs of the supraclinoid ICA. The modified Rankin Scale (mRS) was used to assess clinical outcomes, while radiological outcomes were evaluated on angiographs. For a pooled analysis, data from literature reporting the outcomes of ruptured BBAs treated with SAC were collected and analyzed in conjunction with our data. Results : In our cohort, the mean Raymond classification score was 1.57±0.53 immediately after initial endovascular treatment. There were no perioperative complications or rebleeding events during the follow-up period. The mean mRS score at patient discharge was 1.00±0.81 and improved to 0.28±0.48 by the last follow-up day. The recurrence rate was 25% with an asymptomatic presentation and successful treatment with multiple stent insertion. Pooled analysis of 76 cases of SAC revealed a complete occlusion rate immediately after treatment of 54.8%, rebleeding rate 7.94%, and recurrence rate 24.2%. Good clinical outcomes with mRS score 0-2 were observed in 89.9% by the last clinical follow-up. Total mortality rate was 7.7%. Conclusion : This treatment appears to not only minimize the hemodynamic burden on the fragile dome specific to this type of aneurysm, but also provides an opportunity for safe and effective treatment in recurrent cases.

• The korean journal of orthodontics
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• v.51 no.2
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• pp.115-125
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• 2021

Objective: To evaluate the reasons influencing the preferences for a certain type of orthodontic appliance over another among prospective patients (PP) and orthodontists. Methods: A total of 49 PP and 51 orthodontists were asked about their preferences for the following appliances: clear aligners (CA), lingual metallic brackets (LMB), polycrystalline and monocrystalline ceramic brackets, and buccal metallic brackets (BMB). The participants rated the importance of 17 potential reasons that would explain their choices. The reasons that contributed most to these preferences were identified. Non-parametric tests (Fisher's exact, χ2 and Mann-Whitney tests) and multivariate analyses (regression and discriminant analysis) were used to assess the data (α = 0.05). Results: CA and BMB were the most chosen appliances by PP and orthodontists, respectively. LMB was the most rejected option among both groups of participants (p < 0.001). Rates of the importance of pain/discomfort, smile esthetics, finishing details, and feeding/speech impairment showed the highest differences between PP and orthodontists (p < 0.0005). Discriminant analyses showed that individuals who considered treatment time and smile esthetics as more important were more likely to prefer CA, while those who prioritized finishing details and cost were more likely to choose BMB (p < 0.05). Conclusions: Reasons related to comfort and quality of life during use were considered as more important by PP, while those related to the results and clinical performance of the appliances were considered as more relevant by orthodontists.

• Integrative Medicine Research
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• v.3 no.2
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• pp.60-66
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• 2014

Background: Medically unexplained symptoms (MUSs) are common in primary care. Atpresent, there are no proven, comprehensive treatments available in primary care forpatients with MUSs. However, MUS has parallels with "subhealth" or Mibyeong from tradi-tional East-Asian medicine, and thus, Mibyeong interventions could be effective in treatingMUS. Unfortunately, studies on Mibyeong and its intervention methods are relatively rare.Methods: We administered a web-based survey to 17,279 Korean medicine (KM) practitionersregistered with the Association of Korean Medicine. The response rate was 4.9% (n = 849).Based on the responses received, we assessed how much they agreed with concepts relatedto Mibyeong on a 7-point scale from "do not agree" to "strongly agree." Respondents werealso asked to indicate how frequently they encountered various subtypes and patterns ofMibyeong, and how frequently they use listed intervention methods.Results: Data from 818 respondents were analyzed after excluding those with no clinicalexperience. On average, respondents were male general practitioners aged between 30 yearsand 49 years, working or living in metropolitan areas such as Seoul, Incheon, and Gyeonggi-do. Responses did not differ by demographics. Respondents generally thought that Mibyeongreferred to subjective or borderline findings without certain disease, and that Mibyeong hasvarious subtypes and patterns. Subtypes included fatigue, pain, and digestion problems; pat-terns were either deficiencies (e.g., qi, blood, and yin deficiency) or stagnations (e.g., liver qidepression and qi stagnation). Decoction was the most frequently used type of interventionfor Mibyeong of all items listed, followed by acupuncture and moxibustion. Patient educa-tion was also recommended, suggesting healthy eating, promoting healthy environment,and exercise.Conclusion: We were able to provide preliminary results on KM practitioners' recognition ofand interventions for Mibyeong, but further research is needed to develop a detailed defi-nition of Mibyeong and its myriad subtypes and patterns, and evaluations of the efficacy ofMibyeong interventions.

• Korean Journal of Clinical Pharmacy
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• v.30 no.4
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• pp.264-269
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• 2020

Background: Inflammatory diseases can increase the prevalence of anemia. Recent studies confirmed that the prevalence of anemia is increased by atopic dermatitis (AD), a chronic inflammatory disease. Therefore, we aimed to elucidate the correlation between AD severity and prevalence of anemia. Methods: We used data of pediatric patients from the Health Insurance Review and Assessment Service (HIRA-PPS-2016). We included pediatric patients (<18 years) with AD diagnosis who were prescribed medications for AD. We applied a propensity score method with inverse probability of treatment weighting (IPTW) adjusting for differences in prevalence of confounders and performed IPTW logistic regression to evaluate associations between the anemia and severity of AD. Results: In total, 91,501 patients (mild AD: 47,054 patients; moderate-to-severe AD: 44,447 patients) <18 years who were prescribed drugs for AD were analyzed. Analysis of the probability of patients with mild AD and prevalence of anemia as a reference revealed an odds ratio (OR) of 1.159 (95% CI, 1.109-1.212; p<0.001) in moderate-to-severe AD patients, indicating a correlation between anemia prevalence and AD severity. Subgroup analysis according to gender, age group, and type of health insurance revealed there was an association between AD severity and anemia except in patients equal or older than 7 years. Conclusion: The prevalence of anemia increased with AD severity despite adjusting for confounding factors. Our results support the hypothesis that AD can cause anemia, and anemia prevalence could be increased in severe AD patients. Further studies are needed to establish a pathological basis.

• Clinical and Experimental Reproductive Medicine
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• v.48 no.2
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• pp.163-173
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• 2021

Objective: This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. Methods: This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-E_max, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. Results: The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women's age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. Conclusion: Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.

• The Korean Journal of Emergency Medical Services
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• v.25 no.2
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• pp.71-97
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• 2021

Purpose: This study aimed to examine the development and improvement direction of university education according to job type and investigate the types of knowledge required for employment after graduation for departments of emergency medical technology in preparation for the era of the fourth industrial revolution in a converged society. Methods: From June 3 to June 10, 2019, data were collected through structured questionnaires from 90 paramedics working in firefighting, hospitals, different industries, and emergency patient transportation. Data were analyzed using the software SPSS version 18.0. Results: For employment after graduation in departments of emergency medical technology, character and sincerity education should be strengthened. To prepare for the fourth industrial revolution, educational innovations such as improving the field practice system and devising a convergence curriculum are needed. Preparation for the fourth industrial revolution should be accomplished through the development of convergence subjects such as forensic science, information and communications technology, and safety engineering. Ninety percent of the study respondents indicated their need for convergence subjects. Conclusion: The demands of future society should be responded to flexibly by holding and conducting convergence subjects. Furthermore, preparations should be made in anticipation of a shortage of 120,000 college freshmen for the 2024-2025 school year by increasing the competitiveness of departments of emergency medical technology.

• Journal of Gastric Cancer
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• v.20 no.4
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• pp.421-430
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• 2020

Purpose: Currently, there is no clear evidence to support any specific treatment as a principal therapy for stage IV gastric cancer outlet obstruction (GCOO) patients. This study evaluated the outcomes of palliative gastrectomies and survival prognostic factors in patients with stage IV resectable GCOO. Materials and Methods: We retrospectively reviewed the medical records of 48 stage IV GCOO patients who underwent palliative gastrectomies between June 2010 and December 2019. Palliative gastrectomies were performed only in patients with resectable disease. Early surgical outcomes and prognostic factors were analyzed using univariate and multivariate analyses. Results: There were no specific risk factors for postoperative complications, except for being underweight. Severe postoperative complications developed in five patients, and most of the patients underwent interventional procedures and received broad-spectrum antibiotics for intra-abdominal abscesses. The multivariate survival analysis showed that palliative chemotherapy is a positive prognostic factor, while the specific type of hematogenous and lymphatic metastasis is a negative prognostic factor. Conclusions: We recommend that the treatment method for stage IV GCOO should be selected according to each patient's physical condition and tumor characteristics. In addition, we suggest that palliative gastrectomies can be performed in stage IV resectable GCOO patients without unfavorable prognostic factors (types of hematogenous and lymphatic metastases).

• 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.

• Korea Journal of Hospital Management
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• v.26 no.1
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• pp.71-82
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• 2021

Purpose: The purpose of this study is to estimate incomes and costs of the medical clinics by using secondary data. Methodology: The medical incomes and costs were estimated from 405 clinics operated by sole practitioner providing out-patient services among all clinics subject to the Medical Cost Survey on National Health Insurance Patients in 2017, excluding dental clinics and oriental medical clinics. The incomes and costs of the medical clinics were reflected with incomes and costs of health insurance benefits and were calculated by types of medical services (i.e., basic care, surgery, general treatment, functional test, specimen test and imaging test). The costs were classified as follows: labor costs, equipment costs, material costs and overhead costs. Secondary data was used to estimate the incomes and costs of the medical clinics. For allocation bases for costs for each type of the medical service, the ratio of revenue from health insurance benefits by types of medical services was applied. However, labor costs were calculated with the activity ratio by types of medical services and occupations, using clinical expert panel data. Finding: The percentage of health insurance income for all medical income was 73.1%. The health insurance cost per clinic was 401,864 thousand won. Labor cost accounted for the largest portion of the health insurance income was 191,229 thousand won (47.6%), followed by management cost was 170,018 thousand won (42.3%), materials cost was 35,434 thousand won (8.8%), and equipment costs was 5,183 thousand won (1.3%). Practical Implications: This study suggests a method of estimating incomes and costs of medical clinic services by using secondary data. It could efficiently provide incomes and costs to assess an appropriate level of the health insurance fee to the clinics.

• Journal of the Korea Convergence Society
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• v.13 no.4
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• pp.137-145
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• 2022

The usability evaluation of the remote fluid monitoring device, which was introduced to reduce the work of nurses and increase the efficiency, was performed due to the expansion of the non-face-to-face medical system. Remote fluid monitoring is a fusion of various technologies such as fluid measurement and analysis, error correction technology, and transmission technology. The range of use by users, the information they want to obtain, and the control device, etc. are wide, and the factors that evaluate the product are also diverse. Therefore, it is difficult to improve the product through evaluation. In this study, a quantitative index was developed to help improve the product for commercialization by conducting 20 usability evaluations in three areas of product stability, operability, and satisfaction with the remote sap monitoring system device. It was performed through infrared and load cell-type sap monitoring devices. In terms of stability, there was a difference in installation work such as fixing the pole of the device, and high satisfaction was shown for operability and accuracy. In terms of product satisfaction, the satisfaction of load cell devices was generally high.