Validation of Cancer Diagnosis Based on the National Health Insurance Service Database versus the National Cancer Registry Database in Korea / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study aimed to assess the feasibility of operational definitions of cancer patients in conducting cancer-related studies using the claims data from the National Health Insurance Service (NHIS). @*Materials and Methods@#Cancer incidence data were obtained from the Korean Central Cancer Registry, the NHIS primary diagnosis, and from the rare and intractable disease (RID) registration program. @*Results@#The operational definition with higher sensitivity for cancer patient verification was different by cancer type. Using primary diagnosis, the lowest sensitivity was found in colorectal cancer (91.5%; 95% confidence interval [CI], 91.7 to 92.0) and the highest sensitivity was found in breast cancer (97.9%; 95% CI, 97.8 to 98.0). With RID, sensitivity was the lowest in liver cancer (91.9%; 95% CI, 91.7 to 92.0) and highest in breast cancer (98.1%; 95% CI, 98.0 to 98.2). In terms of the difference in the date of diagnosis in the cancer registration data, > 80% of the patients showed a < 31-day difference from the RID definition. @*Conclusion@#Based on the NHIS data, the operational definition of cancer incidence is more accurate when using the RID registration program claims compared to using the primary diagnosis despite the relatively lower concordance by cancer type requires additional definitions such as treatment.

Factors of Specific Comorbidities Severity on the Risk of Mortality among Breast Cancer Survivors

Background@#For cancer patients, comorbidities affect the risk, progression, and process of treatment. They negatively affect prognoses by increasing mortality. It is therefore necessary to predict prognoses accurately for cancer survivors by measuring comorbidities and their severity. @*Methods@#In this study, the frequency of comorbidities was analyzed on the basis of the Charlson comorbidity index (CCI) in breast cancer patients drawn from the National Health Insurance Service-National Sample Cohort data. This study examined the relative effects of certain factors (age, diagnosis period, and CCI) between deaths and cancer survivors with logistic regression analysis. We applied Cox's proportional hazard regression analysis to predict the risk of mortality according to CCI as a survival predictor of breast cancer patients using three models with correction for age, including the body mass index (BMI), smoking status, alcohol intake, and childbirth history. @*Results@#The frequency analysis based on CCI found that the most frequent type of condition was pulmonary disease (2,262; 21.5%), followed by peptic ulcer (2,019; 19.2%), and metastatic cancer (1,821; 17.3%). The older one gets, the greater one’s risk of mortality with more severe comorbidities. Age and BMI led to greater risk of mortality, with correction for the variables (age, BMI, smoking status, alcohol intake and childbirth history) that could cause confounding. @*Conclusions@#Severity of comorbidities significantly increased the risk of mortality for breast cancer patients. In particular, those cancer survivors who are aged ≥60 years, who have high BMI, and who once smoked need to get continuous care due to poor prognoses.

Pain-related Prescribing Patterns and Associated Factor in Breast Cancer Patients

Background@#With an increase in the number of breast cancer survivors, greater importance is attached to health-related quality of life, particularly pain and symptom control. This study aimed to identify the factors that are associated with pain in cancer patients based on the patterns of prescribing opioid, non-opioid, and adjuvant analgesics. @*Methods@#This analysis included new patients who had developed breast cancer between 2003 and 2012. The degree of pain was analyzed based on the socio-demographic (age, income quintile, number of hospitalizations, and duration of disease), indicator (Body Mass Index; BMI, Charlson Comorbidity Index; CCI, Cumulative Analgesic Consumption Score; CACS), operation (mastectomy, lymph node dissection), and therapy (chemotherapy, radiation therapy), as well as complication-related variable (lymphedema). @*Results@#As for the patterns of prescribing analgesics by stages, non-opioid and opioid analgesics constituted 30.7 and 69.3%, respectively. The mean value and variance of CACS were 5.596 and 12.567, respectively. The factors that significantly affected the degree of pain were age (≥50; IRR: 1.848, 95% CI 1.564-2.184, p=0.000), income quintile (IRR: 0.964, 95% CI 0.938-0.991, p=0.008), BMI (≥ 25; IRR: 1.479, 95% CI 1.222-1.795, p= 0.000), CCI (≥ 4; IRR: 1.649, 95% CI 1.344-2.036, p=0.000), and lymphedema (yes; IRR: 1.267, 95% CI 1.006-1.610, p=0.047). @*Conclusions@#It is necessary to develop systematic and comprehensive pain control measures to improve the quality of life for breast cancer survivors, especially for those who are 50 years or older, lie in the lower-income quintile, have BMI of ≥25 and CCI score ≥ 4, or have lymphedema.

Pain-related Prescribing Patterns and Associated Factor in Breast Cancer Patients

Background@#With an increase in the number of breast cancer survivors, greater importance is attached to health-related quality of life, particularly pain and symptom control. This study aimed to identify the factors that are associated with pain in cancer patients based on the patterns of prescribing opioid, non-opioid, and adjuvant analgesics. @*Methods@#This analysis included new patients who had developed breast cancer between 2003 and 2012. The degree of pain was analyzed based on the socio-demographic (age, income quintile, number of hospitalizations, and duration of disease), indicator (Body Mass Index; BMI, Charlson Comorbidity Index; CCI, Cumulative Analgesic Consumption Score; CACS), operation (mastectomy, lymph node dissection), and therapy (chemotherapy, radiation therapy), as well as complication-related variable (lymphedema). @*Results@#As for the patterns of prescribing analgesics by stages, non-opioid and opioid analgesics constituted 30.7 and 69.3%, respectively. The mean value and variance of CACS were 5.596 and 12.567, respectively. The factors that significantly affected the degree of pain were age (≥50; IRR: 1.848, 95% CI 1.564-2.184, p=0.000), income quintile (IRR: 0.964, 95% CI 0.938-0.991, p=0.008), BMI (≥ 25; IRR: 1.479, 95% CI 1.222-1.795, p= 0.000), CCI (≥ 4; IRR: 1.649, 95% CI 1.344-2.036, p=0.000), and lymphedema (yes; IRR: 1.267, 95% CI 1.006-1.610, p=0.047). @*Conclusions@#It is necessary to develop systematic and comprehensive pain control measures to improve the quality of life for breast cancer survivors, especially for those who are 50 years or older, lie in the lower-income quintile, have BMI of ≥25 and CCI score ≥ 4, or have lymphedema.

Attitudes, Perception and Preventive Behaviors for Health and Safety among College Students

BACKGROUND@#The purpose of this study was to analyze the correlation between risk perception and attitudes and preventive behaviors among college students with poor health and safety consciousness.@*METHODS@#A survey was conducted in students at three universities in the metropolitan area from May 11 to 18, 2018. Four kinds of instruments were used for this study, questionnaires about attitudes, perception, prevention education and preventive behaviors.@*RESULTS@#The safety-related attitude depended on age: those aged <21 years had the best attitude. Education experience significantly affected perception. Preventive behaviors were more strongly and positively correlated with attitudes than with perception. The factor most significantly affecting preventive behaviors were attitudes to preventive health.@*CONCLUSIONS@#To allow the students to change their awareness and behaviors related to sickness and accidents, first it is necessary to give education on a continuous basis so that they can obtain perception to cope with sickness and accidents; second, it is necessary to develop behavioral guidelines related to accidents in each area so that they can practice and make it a habit through attitudinal changes.

Attitudes, Perception and Preventive Behaviors for Health and Safety among College Students

BACKGROUND: The purpose of this study was to analyze the correlation between risk perception and attitudes and preventive behaviors among college students with poor health and safety consciousness. METHODS: A survey was conducted in students at three universities in the metropolitan area from May 11 to 18, 2018. Four kinds of instruments were used for this study, questionnaires about attitudes, perception, prevention education and preventive behaviors. RESULTS: The safety-related attitude depended on age: those aged <21 years had the best attitude. Education experience significantly affected perception. Preventive behaviors were more strongly and positively correlated with attitudes than with perception. The factor most significantly affecting preventive behaviors were attitudes to preventive health. CONCLUSIONS: To allow the students to change their awareness and behaviors related to sickness and accidents, first it is necessary to give education on a continuous basis so that they can obtain perception to cope with sickness and accidents; second, it is necessary to develop behavioral guidelines related to accidents in each area so that they can practice and make it a habit through attitudinal changes.

Care Pathway for Cancer Survivorship in Korea: Trend of Breast Cancer Pathway from 2003 to 2010 / 대한의료정보학회지

OBJECTIVES: The survival rate of cancer patients has exceeded 60%. Although cancer survivors may die of other diseases except cancer, the health management system including chronic disease prevention-management for cancer survivors, has not been established in the diverse aspects. Therefore, services according to care pathway of cancer patients need to be provided through a support system based on a platform concept that can be used to meet patient needs in various ways. METHODS: A sample cohort database (2002–2010) of approximately 1 million persons—2% of the whole nation (50 million)—was used to estimate cancer survivors through a principal care pathway for cancer management. The sample cohort database was built to estimate the number of breast cancer survivors in the five stage: ‘Diagnosis and treatment,’‘Supportive care,’‘Monitoring,’‘Progress illness,’ and ‘Hospice care’. In this way, the scale of breast cancer survivors was estimated. RESULTS: There were 330 (9.8%) cases of the incidence of cancer in 2010 in the ‘Diagnosis and treatment.’ Among the cases of the incidence of cancer in the previous year, the number of one-year survivors was 328 (9.7%); these were included in the category ‘Supportive care.’ In the ‘Monitoring’ category, 2,593 (76.9%) who maintained health lives were included. A total of 84 (2.5%) survivors were checked to identify an ongoing disease; these were included in the category ‘Progress illness.’ In the category ‘Hospice care,’ 36 (1.1%) end-stage cancer patients requiring hospice care were included. CONCLUSIONS: We established a care pathway by survival stage in order to fulfill prevention and health management services post-treatment management steps.

Development of a Tailored Analysis System for Korean Working Conditions Survey

BACKGROUND: Korean Working Conditions Surveys (KWCS), referencing European Working Conditions Surveys, have been conducted three times in order to survey working condition and develop work-related policies. However, we found three limitations for managing the collected KWCS data: (1) there was no computerized system for managing data; (2) statistical KWCS data were provided by limited one-way communication; and (3) the concept of a one-time provision of information was pursued. We suggest a web-based public service system that enables ordinary people to make greater use of the KWCS data, which can be managed constantly in the future. METHODS: After considering data characteristics, we designed a database, which was able to have the result of all pairwise combinations with two extracted data to construct an analysis system. Using the data of the social network for each user, the tailored analysis system was developed. This system was developed with three methods: clustering and classification for building a social network, and an infographic method for improving readability through a friendly user interface. RESULTS: We developed a database including one input entity consisting of the sociodemographic characteristics and one output entity consisting of working condition characteristics, such as working pattern and work satisfaction. A web-based public service system to provide tailored contents was completed. CONCLUSION: This study aimed to present a customized analysis system to use the KWCS data efficiently, provide a large amount of data in a form that can give users a better understanding, and lay the ground for helping researchers and policy makers understand the characteristics.

Acceptability of Service Targets for ICT-Based Healthcare / 대한의료정보학회지

OBJECTIVES: In order to adopt and activate telemedicine it is necessary to survey how medical staff, who are providers of medical service, and consumers, who are the service targets, perceive information and communication technology (ICT)-based healthcare service. METHODS: This study surveyed the awareness and acceptability of ICT-based healthcare by involving service targets, specifically workers and students living in the Seoul and Gyeonggi regions who are consumers of healthcare service. To determine the correlation among awareness of ICT-based healthcare, the need for self-management, and acceptability, this study conducted a correlation analysis and a simple regression analysis. RESULTS: According to the responses to the questions on the need for ICT-based healthcare service by item, blood pressure (n = 279, 94.3%) and glucose (n = 277, 93.6%) were revealed to be the physiological signal monitoring area. Among the six measurement factors affecting ICT-based healthcare service acceptability, age, health concerns, and effect expectation had the most significant effects. As effect expectation increased, acceptability became 4.38 times higher (p < 0.05). CONCLUSIONS: This study identified a positive awareness of service targets on ICT-based healthcare service. The fact that acceptability is higher among people who have family disease history or greater health concerns may lead to service targets’ more active participation. This study also confirmed that a policy to motivate active participation of those in their 40s (who had high prevalence rates) was needed.

Effects of Awareness and Knowledge of Energy Drinks on Consumption Patterns among College Students

BACKGROUND: We examined the consumption patterns and the knowledge and awareness of energy drinks to draw up a guideline for energy drink consumption and to give accurate information to college student. METHODS: Data from 324 subjects (186 males and 138 females) were collected using self-administered questionnaires. The study participants were recruited from the Gyeonggi-do, Seongnam area between March and June 2013. RESULTS: The results showed that there was a significant gender-based difference in awareness of energy drinks- 56.5% (78/139) of the males and 78.9% (71/90) of the females had negative awareness (P<.001). As for recognizability of taurine by awareness of energy drinks, there were intergroup differences: the mean was 3.89 for the group with positive awareness and 3.31 for the negative awareness group (P=.001). The odds ratio for awareness of energy drinks was 2.75 (95% CI:1.05-7.18) and those with positive awareness consumed more than those with negative awareness (P=.039). CONCLUSIONS: This investigation on the factors that affect energy drinks consumption behaviors is of significance in that it helps make known the high caffeine content of energy drinks, and accurate knowledge of the side effects and appropriate consumption.

CCR+: Metadata Based Extended Personal Health Record Data Model Interoperable with the ASTM CCR Standard / 대한의료정보학회지

OBJECTIVES: Extension of the standard model while retaining compliance with it is a challenging issue because there is currently no method for semantically or syntactically verifying an extended data model. A metadata-based extended model, named CCR+, was designed and implemented to achieve interoperability between standard and extended models. METHODS: Furthermore, a multilayered validation method was devised to validate the standard and extended models. The American Society for Testing and Materials (ASTM) Community Care Record (CCR) standard was selected to evaluate the CCR+ model; two CCR and one CCR+ XML files were evaluated. RESULTS: In total, 188 metadata were extracted from the ASTM CCR standard; these metadata are semantically interconnected and registered in the metadata registry. An extended-data-model-specific validation file was generated from these metadata. This file can be used in a smartphone application (Health Avatar CCR+) as a part of a multilayered validation. The new CCR+ model was successfully evaluated via a patient-centric exchange scenario involving multiple hospitals, with the results supporting both syntactic and semantic interoperability between the standard CCR and extended, CCR+, model. CONCLUSIONS: A feasible method for delivering an extended model that complies with the standard model is presented herein. There is a great need to extend static standard models such as the ASTM CCR in various domains: the methods presented here represent an important reference for achieving interoperability between standard and extended models.

HealthTWITTER Initiative: Design of a Social Networking Service Based Tailored Application for Diabetes Self-Management / 대한의료정보학회지

OBJECTIVES: Diabetes is a chronic disease of continuously increasing prevalence. It is a disease with risks of serious complications, thus warranting its long-term management. However, current health management and education programs for diabetes mainly consist of one-way communication, and systematic social support backup to solve diabetics' emotional problems is insufficient. METHODS: According to individual behavioral changes based on the Transtheoretical Model, we designed a non-drug intervention, including exercise, and applied it to a mobile based application. For effective data sharing between patients and physicians, we adopted an SNS function for our application in order to offer a social support environment. RESULTS: To induce continual and comprehensive care for diabetes, rigorous self-management is essential during the diabetic's life; this is possible through a collaborative patient-physician healthcare model. We designed and developed an SNS-based diabetes self-management mobile application that supports the use of social groups, which are present in three social GYM types. With simple testing of patients in their 20s and 30s, we were able to validate the usefulness of our application. CONCLUSIONS: Mobile gadget-based chronic disease symptom management and intervention has the merit that health management can be conducted anywhere and anytime in order to cope with increases in the demand for health and medical services that are occurring due to the aging of the population and to cope with the surge of national medical service costs. This patient-driven and SNS-based intervention program is expected to contribute to promoting the health management habits of diabetics, who need to constantly receive health guidance.

Standard-based Integration of Heterogeneous Large-scale DNA Microarray Data for Improving Reusability

Gene Expression Omnibus (GEO) has kept the largest amount of gene-expression microarray data that have grown exponentially. Microarray data in GEO have been generated in many different formats and often lack standardized annotation and documentation. It is hard to know if preprocessing has been applied to a dataset or not and in what way. Standard-based integration of heterogeneous data formats and metadata is necessary for comprehensive data query, analysis and mining. We attempted to integrate the heterogeneous microarray data in GEO based on Minimum Information About a Microarray Experiment (MIAME) standard. We unified the data fields of GEO Data table and mapped the attributes of GEO metadata into MIAME elements. We also discriminated non-preprocessed raw datasets from others and processed ones by using a two-step classification method. Most of the procedures were developed as semi-automated algorithms with some degree of text mining techniques. We localized 2,967 Platforms, 4,867 Series and 103,590 Samples with covering 279 organisms, integrated them into a standard-based relational schema and developed a comprehensive query interface to extract. Our tool, GEOQuest is available at http://www.snubi.org/software/GEOQuest/

A SWOT Analysis of the Various Backup Scenarios Used in Electronic Medical Record Systems / 대한의료정보학회지

OBJECTIVES: Electronic medical records (EMRs) are increasingly being used by health care services. Currently, if an EMR shutdown occurs, even for a moment, patient safety and care can be seriously impacted. Our goal was to determine the methodology needed to develop an effective and reliable EMR backup system. METHODS: Our "independent backup system by medical organizations" paradigm implies that individual medical organizations develop their own EMR backup systems within their organizations. A "personal independent backup system" is defined as an individual privately managing his/her own medical records, whereas in a "central backup system by the government" the government controls all the data. A "central backup system by private enterprises" implies that individual companies retain control over their own data. A "cooperative backup system among medical organizations" refers to a networked system established through mutual agreement. The "backup system based on mutual trust between an individual and an organization" means that the medical information backup system at the organizational level is established through mutual trust. RESULTS: Through the use of SWOT analysis it can be shown that cooperative backup among medical organizations is possible to be established through a network composed of various medical agencies and that it can be managed systematically. An owner of medical information only grants data access to the specific person who gave the authorization for backup based on the mutual trust between an individual and an organization. CONCLUSIONS: By employing SWOT analysis, we concluded that a linkage among medical organizations or between an individual and an organization can provide an efficient backup system.

Radiologic study of mandibular foramen of mandibular prognathism by three-dimensional computed tomography / 대한구강악안면방사선학회지

PURPOSE: This study is aimed to evaluate the position of mandibular foramen of mandibula prognathism patients using 3-dimensional CT images in order to reduce the chance of an anesthetic failure of the mandibular nerve and to prevent the damage to the inferior alveolar nerve during the orthognathic surgery. MATERIALS AND METHODS: The control group consist of 30 patients with class I occlusion. The experimental group consist of 44 patients with class III malocclusion. Three-dimensional computed tomography was used to evaluate the position of the mandibular foramina. RESULTS: The distance between mandibular plane and mandibular foramen, class I was 25.385 mm, class III was 23.628 mm. About the distance between occlusal plane and mandibular foramen, class I was 1.478 mm, class III was 5.144 mm. The distance between posterior border plan of mandibular ramus and mandibular foramen had not statistically significant. About the distance between sagittal plane of mandible and mandibular foramen did not also showed statistically significant. CONCLUSION: The result of this study could help the clinicians to apprehend more accurate anatomical locations of the foramina on the mandible with various facial skeletal types. thereby to perform more accurate block anesthesia of the mandibular nerve and osteotomy with minimal nerve damage. In addition, this study could provide fundamental data for any related researches about the location of the mandibular foramina for other purposes.

Impact of Registration Program after Hypertensive or Diabetic Patient Detection through Community Partnership on Compliance and Blood Pressure or Blood Sugar Control / 農村醫學 地域保健

OBJECTIVES: Incheon metropolitan city has set a model program of community partnership for hypertensive or diabetic patients detection and follow-up since 2005. This study examines the effects of the model on the compliance and the control of blood pressure or blood sugar level METHODS: Telephone-surveys were done for 140 persons selected from 408 patients who were detected newly as hypertensive or diabetic patients at Gangwha-Gun and Seo-Gu in Incheon between January 1st and August 31th in 2006, and finally completed in 110 patients(78.6%). Survey questionnaires included socio-demographic(age, gender, and educational level), health behavioral (smoking, drinking, physical activity, and diet), and therapy-related (registration state, compliance, blood pressure or blood sugar control) variables. Odds ratio and 95% CI were derived from logistic regression model. RESULTS: Registered group exhibited high compliance and well managed blood pressure or blood sugar level. The odds ratio of registration were 5.55(95% CI:1.83~16.89) for compliance and 3.78(95% CI:1.43~9.99) for blood pressure or blood sugar control after adjusting for age, gender, disease, and area CONCLUSIONS: It is independently related to compliance and blood pressure or blood sugar control whether the patient is registered or not. To control hypertension or diabetes mellitus in terms of compliance and control state, a community-based registration program through community partnership could be a powerful tool.

Presentation of Structural Constraints for Discharge Note According to Clinical Document Architecture Standard / 대한의료정보학회지

OBJECTIVE: HL7(Health Level 7) develops standards for the representation of clinical documents like discharge and consultation notes. The goal of the present study is to develop XML(eXtensible Markup Language)-based communication standard for discharge note. METHODS: This paper presents the use of XML for electronic communication in a document-based EMR, first, as a format for the exchange of structured message, and second, as a comprehensible way to represent patient document. A retrospective analysis of 1165 discharge notes, from the department Seoul National University Hospital, were extracted by querying OCS(Order Communication System) and taking every discharge note of main disease issued over one year period (2003.01.01~2003.12.31). RESULTS: An XML-based prototype for discharge note has been put into place representing the required "section" and "specific instance". In addition, a subset of the CDA(Clinical Document Architecture) Level One details has been described and integrated. CONCLUSION: Through the introduction of definitions for sections and specific instances, progress in the development of CDA Level Two and Three might be realized. An XML-based prototype was implemented, allowing a special view on XML data to generate this document type.

A Study of Effective Unified Medical Language System Concept Indexing in Radiology Reports / 대한의료정보학회지

OBJECTIVE: For the effective retrieval of clinical information, the elaborate indexing is essential. Two major types of indexing are the human indexing and the automatic or machine indexing. Human indexing shows higher quality but is time consuming, labor-intensive and inconsistent in term assignment activity. METHODS: Using the Unified Medical Language System (UMLS) MetaMap program, we mapped the free text from the diagnosis section of radiology reports into UMLS concepts. To improve the precision of UMLS concept indexing by MetaMap, we evaluated the UMLS subset mapping and semantic type filtering methods, determining the best combination for improved precision. RESULTS: After calculating the candidates from subset combinations, we obtained more enhanced results by semantic-type filtering. CONCLUSION: The results may be improved for the complete automation of indexing process.

Development of Microarray Gene Expression Database for MicroArray Gene Expression Markup Language / 대한의료정보학회지

OBJECTIVE: Gene expression microarrays become a widely used tool in biomedicine. With growing needs of microarray data sharing, there are efforts for the development of microarray standards. MAGE-OM(Microarray Gene Expression Object Model) is a data exchange model and MAGE-ML is an XML-based data exchange format. Most database, however, do not have a suitable structure for MAGE-ML storage and maximum use of the data. Therefore, we have created relational database implementing MAGE-OM for the storage of MAGE-ML with importing and exporting capabilities. METHODS: A relational schema is derived from MAGE-OM with simple object-relational mapping strategy to reduce complexity of MAGE-OM. Data transfer between database and MAGE-ML document is performed via MAGE-OM using the MAGE Software Toolkit(MAGEstk). RESULTS: Our database accepts microarray data as MAGE-ML files through web-based interface, classifying into two types of submission, array or experiment. MAGE-ML import-export function is flexible to accommodate changing data model by separating model definition and implementation layers. CONCLUSION: Standard-based implementation of gene expression database enhances the collection and the structured storage of large-scale gene expression data from heterogeneous data sources.

Web-based Paper Submission Management System of The Korean Society of Medical Informatics / 대한의료정보학회지

The scientific societies have provided with important resources of scientific research products, archived in journals and proceedings. Use of advanced information technology would benefit the scientific information management processes. Korean Society of Medical Informatics (KOSMI) has developed a web-based and XML-enabled paper submission management system since 2002. This paper describes KOSMI's a web-based paper submission management system which manages the processes of submitting, reviewing and distributing papers online. We demonstrate in the paper management system XML (eXtensible Markup Language) technology which is an emerging standard for information exchange on the World Wide Web. One user's request, the management program generates an electronic document in an XML format, which can be systematically managed via standardized way of modern information processing. We believe that the current effort will facilitate more scientific information exchange in a standard format and enhance the lead of knowledge-based information society.