Relationship between Percutaneous Transluminal Coronary Angioplasty Volume and Associated Immediate Outcome / 예방의학회지

OBJECTIVES: To explore the relationship between Percutaneous Transluminal Coronary Angioplasty (PTCA) volume and the associated immediate outcome. METHODS: A total of 1,379 PTCAs were performed in 25 hospitals in Korea between October 1 and December 31 in 1997. Data from 1,317 PTCAs (95.5%) were collected through medical record abstraction. Inter-observer reliability of the data was examined using the Kappa statistic on a subsample of 110 PTCA procedures from five hospitals. Intra-observer reliability of the data was also examined. PTCA success and immediate adverse outcomes were selected as the outcome variables. A successful PTCA was defined as a case that shows less than 50% diameter stenosis and more than 20% reduction of diameter stenosis. Immediate adverse outcomes included deaths during the same hospitalization, emergency coronary artery bypass graft (CABG) within 24 hours after PTCA, and acute myocardial infarction within 24 hours after PTCA. The numbers of PTCAs performed in 1997 per hospital were used as the volume variables. RESULTS: Without adjusting for patient risk factors that may affect outcomes, procedures at high volume hospitals (200 cases per year) had a greater success rate (P=0.001) than low volume hospitals. There was a marginally significant difference (P=0.070) in major adverse outcome rates between high and low volume hospitals. After adjusting for risk factors, there were significant differences in procedural failure and major adverse outcome rates between high and low volume hospitals. CONCLUSIONS: After adjusting for patient clinical risk factors, the hospital volume of PTCA was associated with immediate outcomes. It is recommended that a PTCA volume per year be established in order to improve the immediate outcome of this procedure in Korea.

Prevalence of Dementia in the Elderly of an Urban Community in Korea / 예방의학회지

OBJECTIVES: In Korea, as in most countries, there will be a sharp increase in the number of dementia patients in the near future. However basic data on dementia prevalence, which is important in defining epidemiologic characteristics and in implementing preventive strategy, are limited. This study was conducted to estimate the prevalence rate of dementia in the urban elderly aged 65 or older in Kwangmyung, Korea. METHODS: A two phase design was used for case finding and case identification. In phase I, a representative sample aged 65 or older was selected and interviewed by door-to-door survey with a Korean version of the Mini-Mental State Examination (K-MMSE). In phase II, Of the 946 subjects interviewed in phase I, 356 elderly were randomly selected disproportionately according to K-MMSE score. Of these elderly, 223 (61.5%) underwent standardized clinical evaluations, including psychiatric interview, neurological examination, and neuropsychological assessment. Dementia was diagnosed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. The diagnosis of Alzheimer's disease (AD) was made by National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association(NINCDS-ADRDA) criteria and vascular dementia (VD) by DSM-IV. RESULTS: The overall weighted prevalence rate of all dementia among Kwangmyung residents aged 65 or older was 12.8%(age-adjusted rate: 13.0%, 95% Confidence Interval[CI]: 10.6-15.3%). Women had much higher prevalence rate than men even when age was controlled(15.9%[95% CI 12.6-19.2%] vs 7.5%[95% CI 4.6-10.4%]). The rates of dementia were 5.2%, 12.2%, 17.0%, and 34.3% for the age groups of 65-69, 70-74, 75-79 and 80 and over, respectively. The rate of AD appeared to be slightly higher than that of VD(5.2% vs 4.8%), though not statistically significant. Most of the cases(69%) were mild dementia according to CDR(<1) in these subjects. CONCLUSIONS: These results showed that the prevalence rate of dementia among urban elderly in Korea appears to be higher than those of other Asian countries.

Cost-benefit Analysis of Massive Screening for Inborn Errors of Metabolism in Korea / 예방의학회지

OBJECTIVES: Since 1991, nationwide massive neonatal screen-ing program for phenylketonuria (PKU) and congenital hypothyroidism have been performed in Korea. As in many other countries, efficiency of this program has not been definitely concluded. For the purpose of evaluation of this program, from the perspective of efficiency, a cost-benefit analysis was carried out. METHODS: Costs of the detection and the treatment program were compared with the projected benefit(avoided costs) that results from the prevention of the mental retardation associated with the disorders due to PKU and hypothyroidism. Costs and benefits were discounted at an annual rate of 5 %, and duration of life-long labor was assumed to be 30 years. Cost and benefit were estimated based on the detection rates of one case of PKU per 5,572 and one case of congenital hypothyroidism per 32,554 babies screened during 1991-1997. RESULTS: The benefit-cost ratio was 0.418. The sensitivity analysis for the discount rates and labor durations showed that most cost-benefit ratios were lower than one(1.0) except when discount rate was changed to 3% and detection rate to two- or threefold and/or labor duration to 40 years. CONCLUSIONS: The result of this study suggested that present program of mass screening for PKU and congenital hypothyroidism could not be justified in terms of efficiency. It doesn't coincide with the results of previous studies in major developed countries, presumably because of difference in detection rates and welfare cost for the disabled.

Quality Assessment of Group Occupational Health Service for Small and Medium Scale Enterprises in Korea / 대한산업의학회지

Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme ; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization ; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially In continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions. Quality in terms of accessibility and continuity highly varied among institutions. To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.

Are Medical Educators Satisfied with Educational Environment and Their Practice in Medical Schools? / 한국의학교육

OBJECTIVES: To evaluate undergraduate medical education in Korea, we investigated educators' satisfaction. Also analysis of the factors affecting educator satisfaction was intended. SUBJECTS: Of the entire educators(4,683 persons) of all medical schools, 585 persons were sampled systematically, based on the published list of medical educators. Of the sampled target, 275 persons(47.5%) responded. METHODS: We developed the questionnaire, asking educators' satisfaction on six categories of medical education in terms of educational input and process; educator, facilities and equipments, educational contents, educational method and skill, the evaluation of students, and the performance of students. The questionnaire were mailed to each educator and returned back for analysis. RESULTS: Overall satisfaction of educators was rather low. In particular, educators were more dissatisfied with avaliability of assistant personnel and general environment for education. As for the contents of medical education, they were more dissatisfied with the clinical training in bedside setting. Geographically, educators in the 'kangwon' and 'chungcheong' area had more discontent than others. Educators of private schools were more satisfied with the facilities than those of public ones. CONCLUSION: It is necessary to develop continuous program that evaluate and improve the quality of medical education. Among them the clerkship and general environment for education would be focused. Periodic assessment of educators' satisfaction would be a tool to ensure more concern for quality of medical education.

Future Supply of and Demand for Diagnostic Radiologists in Korea

PURPOSE: To project the supply and demand of diagnostic radiologists in Korea. MATERIALS AND METHODS: With the year 2010 in mind, the 'in-and-out moves' method was applied in order to estimate the supply of diagnostic radiologists. We also used the health need approach and the physician population ratio method for the projection of demand. As sources of information, administrative and demographic statistics were analyzed. RESULTS: If the current situation in terms of the supply of newly qualified diagnostic radiologists is maintained, the projected number will be in short supply by as many as 790 in 2000 and by 370 in 2005. There will, however, be an oversupply of about 110 in 2010. CONCLUSION: To accomplish a balanced state of supply and demand in 2010, the numbers of newly qualifying diagnostic radiologists should be maintained at the current level.