Implementation of Medical Information Exchange System Based on EHR Standard / 대한의료정보학회지

OBJECTIVES: To develop effective ways of sharing patients' medical information, we developed a new medical information exchange system (MIES) based on a registry server, which enabled us to exchange different types of data generated by various systems. METHODS: To assure that patient's medical information can be effectively exchanged under different system environments, we adopted the standardized data transfer methods and terminologies suggested by the Center for Interoperable Electronic Healthcare Record (CIEHR) of Korea in order to guarantee interoperability. Regarding information security, MIES followed the security guidelines suggested by the CIEHR of Korea. This study aimed to develop essential security systems for the implementation of online services, such as encryption of communication, server security, database security, protection against hacking, contents, and network security. RESULTS: The registry server managed information exchange as well as the registration information of the clinical document architecture (CDA) documents, and the CDA Transfer Server was used to locate and transmit the proper CDA document from the relevant repository. The CDA viewer showed the CDA documents via connection with the information systems of related hospitals. CONCLUSIONS: This research chooses transfer items and defines document standards that follow CDA standards, such that exchange of CDA documents between different systems became possible through ebXML. The proposed MIES was designed as an independent central registry server model in order to guarantee the essential security of patients' medical information.

47,XYY male with increased nuchal fold thickness, choroid plexus cyst and limb anomaly: A case report / 대한산부인과학회지

47,XYY males are found in approximately 1 per 1,000 men. There is no significant difference in intelligence compared with a normal karyotype group. 47,XYY males are fertile and are considered to be relatively tall in stature owing to the increased growth velocity during the earliest childhood. It has been known that 47,XYY males are usually quite normally developed at birth with normal birth weight and length without any physical abnormalities. We have experienced a case of 47,XYY male with increased nuchal fold thickness, choroid plexus cyst and limb anomaly and we report the case with brief review of the literature. A 31-year-old woman, who had terminated her first pregnancy due to limb anomaly at 24 weeks gestation, received ultrasonography at about 16 weeks gestation and was found having a fetus with increased nuchal fold, choroid plexus cyst and limb anomaly. Through the genetic counselling, her pregnancy was terminated and the chromosome karyotyping was performed with the fetal tissue and parent's peripheral blood. The results revealed that the parents had normal karyotypes, but the karyotype of the fetus showed 47,XYY.

Prevalence of Diabetes Mellitus in the Elderly of Namwon County, South Korea

BACKGROUND: Ethnic and geographic differences exist in the prevalence of diabetes mellitus which has increased dramatically in South Korea. A few community-based epidemiologic studies with oral glucose tolerance test were performed in South Korea. The purpose of this study was to determine the prevalence of diabetes mellitus by the World Health Organization (WHO) and the American Diabetic Association (ADA) diagnostic criteria and to investigate their associated risk factors. Also, we compared and analyzed the characteristics of Koreans by WHO and ADA diagnostic criteria. METHODS: Between March 22, 1999 and July 14, 1999, a random sampling of 1,445 residents over 40 years of age in five villages (3 myons and 2 dongs) in Namwon City, Chollabuk-do Province, South Korea was carried out. WHO and ADA diagnostic criteria were used for the prevalence of DM, IGT and IFG. The associated factors of subjects were analyzed. RESULTS: After age adjustment for the population projection of Korea (1999), the prevalence of DM and IGT was 13.7% and 13.8%, respectively, by WHO criteria, while the prevalence of DM, IGT and IFG was 15.8%, 12.8% and 5.7%, respectively, by ADA criteria, and the previous diagnosed diabetics were 5.8% in 665 adults over 40 years of age in the Namwon area. The age-adjusted prevalence of previously diagnosed diabetics was 5.8%. When the subjects classified by both criteria were compared, the level of agreement between WHO and ADA diagnostic criteria, except IFG, was very high (kappa=0.94; p < 0.001). The ROC curve analysis determined FSG of 114.5 mg/dL (6.4 mmol/L) to yield optimal sensitivity and specificity corresponding to a PP2SG 200 mg/dL (11.1 mmol/L). The prevalence of DM and IGT with ADA diagnostic criteria rose with increasing age (p < 0.05). The body mass index was mean 23.8+/-3.4 in all the subjects, 23.75+/-3.46 in NGT group and 23.67+/-3.16 in DM group, but the differences in the prevalence of DM, IGT and IFG by BMI were not significant. The prevalence of DM rose significantly with the increase in the waist-hip ratio (p < 0.05). The prevalence of DM significantly increased in subjects by increases in blood pressure, and triglyceride and the relative risk in the prevalence of DM was significantly high with dyslipidemia (Odds ratio 2.29, 95% CI: 1.16-3.49). CONCLUSION: The prevalence of Diabetes Mellitus in the population over 40 years of age in Namwon City, South Korea remarkably increased compared with the 1970s and 1980s and was similar to that of the West. Ethnic differences in obesity of normal, DM and IGT subjects and in the effect on the prevalence of DM may exist in the Korean population, but they were not significant. As there is a limit in number, it is considered that a general population-based epidemiologic study on a large scale is required to investigate ethnic and geographic differences for the risk factors of DM in South Korea. The level of agreement, except IFG, by WHO and ADA diagnostic criteria was high, which indicates that these results may show that not only fasting serum glucose but also postprandial 2-h serum glucose are important for diagnosing diabetes in Korean.

Prevalence of diabetes mellitus in the elderly of Namwon county, South Korea / 대한내과학회지

BACKGROUND: Significant ethnic and geographic differences exist in the prevalence of diabetes mellitus, which has increased dramatically in South Korea. But a few population-based studies were performed in South Korea. The purpose of this study was to determine the prevalence of diabetes mellitus, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) by the World Health Organization (WHO) and the American Diabetic Association (ADA) diagnostic categories, and to investigate their associated risk factors. METHODS: Between march 22, 1999 and July 14, 1999, a random sampling of 1445 residents over 40 year of age in five villages in the Namwon county of South Korea was carried out. Among these subjects, 665 (46.0%) participants completed 75 g OGTT. WHO and ADA diagnostic criteria were used for the diagnosis of diabetes mellitus, IGT and IFG. Detailed questionnaire were performed and anthropometric data were collected. RESULTS: After age-adjustment for population projection for Korea (1999), the prevalence of diabetes and IGT were 13.7% and 13.8% with WHO criteria, while the prevalence of diabetes, IGT and IFG were 15.8%, 12.8% and 5.7% with ADA criteria. The age-adjusted prevalence of previously diagnosed diabetes was 5.8%. The level of agreement between WHO and ADA diagnostic criteria except IFG was high (K=0.94; p<0.001). The ROC curve analysis determined FSG of 114.5 mg/dL (6.4 mmol/L) to yield optimal sensitivity and specificity corresponding to a PP2SG 200 mg/dL (11.1 mmol/L). The prevalence of diabetes and IGT with ADA diagnostic criteria rose with increasing age (p<0.05). The difference in the prevalence of diabetes, IGT and IFG by BMI was not significant. The prevalence of diabetes rose with increase in the waist-hip ratio. The prevalence of diabetes was increased in subjects with dyslipidemia (Odds ratio 2.29, 95% CI: 1.16-3.49). CONCLUSION: The age-adjusted prevalence of Diabetes Mellitus in populations over 40 year of age in the Namwon county was substantially higher than previously observed. Ethnic differences in obesity with BMI and in the effect on diabetes risk of obesity may exist in the Korean population. The adequate cut-off point for fasting serum glucose was lower than that by the ADA diagnostic category. These results may show that not only fasting serum glucose but also postprandial 2-h serum glucose are important for diagnosing diabetes in Korean.

The effect of patient education on correct use of metered dose inhalers in patients with asthma / 천식및알레르기

BACKGROUND: Medications for asthma can be administered either by inhaled or systemic routes. The major advantages of delivering drugs directly into the lungs via inhalation are that higher concentrations can be delivered more effectively to the airways and that systemic side effects are avoided or minimized. Inhaled medications, or aerosols, are available in a variety of devices that differ in required technique and quantity of drugs delivered to the lung. OBJECTIVE: The purpose of this study was to determine the effects of patient education on correct use of metered dose inhaler in patients with asthma. METHODS: Twenty patients with asthma were instructed three times on proper inhaler usage by a physician at two-week intervals. Practical performance and theoretical knowledge were assessed (ten-item assessment). Scoring was done by one physician using a score of 1-3 for each item. RESULTS: The practical performance and theoretical knowledge scores were higher in patients after being instructed three times compared with those who were instructed once (26.2+/-2.2 vs 18.1+/-3.6, p< 0.01). The scores were higher in patients with higher education level com- pared with those with lower education level after three lessons (27.3+/-1.94 vs 24.3+/-1.80, p< 0.05). The most common errors included inadequate actuation time and breath holding, and insufficient activations. CONCLUSION: These findings suggest that patients with asthma be instructed in inhaler use and that their technique be checked regularly and repeatedly depending on education level.

The Prognostic Factors In Progression Of Pneumoconiosis / 결핵

BACKGROUND: Pneumoconiosis is the parenchymal lung disease that results from the inhalation and deposition of dust, usually mineral dust of occupational or environmental origin. Most of the pneumoconiosis can be categorized to coal workers' pneumoconiosis (CWP) in Korea. No effective treatement is currently available, and the therapy for symptomatic CWP is limited to treatment of complication. Therefore authors analyzed and reviewed clinical features and radiological findings of 95 patients with pneumoconiosis for assessing the prognostic factors in disease progression. METHOD: We reviewed medical records of 95 cases with pneumoconiosis including history, chest X-ray, pulmonary function test, electrocardiography, AFB stain and culture of sputum, and routine blood examination between June 1995 and June 1997 in Seonam University Namkwang Hospital. RESULTS: All of cases are male(mean age, 57.4 years), 91 cases out of them are miners. The mean duration of exposure to dust is 18.8 years. 2) Major clinical symptoms are dyspnea (100%), sputum (71.6%), chest pain (55.8%), cough (23.2%), and hemoptysis (6.3%). 82% of cases are over Morgan-Seaton Grade 2 in the degree of dyspnea. Small opacity on chest x-ray is 82.1% and large opacity is 17.9%. Small opacity has t/t type (37.2%), q/q type (25.6%) and r/r type (11.5%). B type is 42.2% in large opacity. For the pulmonary function test, restrictive type is 40.3%, mixed type 19.5% and obstructive type 8.3%. The more increasing chest X-ray density, the more decreasing FEV1 (p<0.01). 38% of patients show tuberculosis in chest X-ray, 15.8% positive smear of acid fast bacilli in sputum. The prevalence of pulmonary tuberculosis is high in patients with poor clinical condition. The cases with the active pulmonary tuberculosis have severe dyspnea. 6) Expired cases show 100% and 75% of positive pulmonary tuberculosis in chest X-ray and sputum examination, respectively. 75% of expired cases show the chronic cor pulmonale, who died of acute respiratory failure. CONCLUSION: These findings indicate that tuberculosis infection has a decisive influence on the progress and prognosis of pneumoconiosis.

A Case of Multiple Esophageal Ulcerations in Behcet's Disease / 대한소화기내시경학회지

The diagnostic criteria of Behcet' s disease - which requires the presence of recurrent oral ulceration plus any two of recurrent genital ulceration, typical defined eye lesions, typical defined skin lesions or a positive pathergy test - was proposed by the International Study Group for Behcet' s Disease (ISGBD). Intestinal Behcet' s disease most commonly affects the ileocecal region, but esophageal involvement of Behcet' s disease is rare, only 8 cases have previously been reported in Korea. A 23-year old female who had a 10-year history of recurrent oral and genital ulcer and recurrent erythematous skin eruption, was admitted to our hospital because of dysphagia and substernal pain. Endoscopic exami-nation showed multiple small sized ulcers on oral cavity and two diffuse deep ulcers surrounded with irregularly nodular and hyperemic edematous mucosa at distal esophagus. The pathologic finding was subepithelial accumulation of chronic inflammatory cells, especially around the vessels. So she was treated with steroid under the diagnosis of esophageal involvement of Behcet' s disease. She has been followed in improvement status without recurrence.