Development of Psychiatric Computerized Medical Records System / 신경정신의학

OBJECTIVES: Computer-based patient record (CPR, Electronic medical record) improves the quality of medical record which reflects the quality of clinical practice. It provides more efficient and convenient way of input, retrieval, storage, communication and management of medical data. The purpose of this study was to develop a practical domestic model and theoretical basis for CPR for psychiatric patients. This model can be applied in other clinical departments. METHODS: The contents and types of items to be included in the data-base were determined through consensus meetings of investigators on the basis of our previous works on the 'comprehensive assessment of symptoms and history in psychiatric disorders' and analysis of structure and items of medical records. The computer program(Asan Medical Center Psychiatric Information System, APIS, version 1.0) was developed using Oracle 7-3-4, Power builder 4.0, Hangul Windows NT and TCP/IP as a programming, development tools, system operation and transmission protocol. RESULTS: The characteristics of APIS are as follows. 1) APIS ensures comprehensive and high quality psychiatric record through combinations of free-text and structured data format and through many available 'help pop-up windows' of required items for better documentations. 2) APIS provides convenient and efficient ways of data input, particularly for narrative input of texts, with various tools such as 'template copy', various 'pop-up lists for block or phrase copy'. 3) APIS enables users to create and modify the template files or scales for research. 4) APIS which adopted principles of POMR (Problem Oriented Medical Record) makes cumbersome management of problem titles very convenient 5) APIS also provides additional statistics necessary for hospital audit and managements as well as mail communication and schedule management of department. 6) Access to APIS requires authorized ID and password where several levels of privileges (view only, edit allowed, master) are assigned to secure the data. And also modification of data was not allowed after completion of medical record except by persons with master ID. User's password and the data before modification can be traced. CONCLUSIONS: Our study results demonstrate the practical model and theoretical basis for CPR for psychiatric patients. We believe that this model and methods contained in this program can also be applied for developments of CPR for other clinical departments.

Prevalence of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among Korean College Women / 신경정신의학

OBJECT: More than 75% of women have been reported to experience premenstrual symptoms and three to eight percent of them suffer from premenstrual dysphoric disorder(PMDD). But little is known about prevalence of premenstrual syndrome(PMS) and PMDD among Korean women. The purpose of this study was to investigate the prevalence of PMDD and PMS in Korean women who attended universities at the time of survey. METHODS: One thousand four hundred and nineteen subjects were randomly selected with cluster sampling method among four women's university in Seoul. We measured the severity of premenstrual symptoms using six-point rating scale developed by the authors on the basis of the research criteria for PMDD in DSM-IV. Premenstrual worsening of symptoms was defined as increase in symptom scores of more than 75% from follicular to luteal phase score. And also, we compared characteristic symptoms, eating behaviors, and functional impairments between PMS and PMDD. RESULT: After excluding inadequate data according to our exclusion criteria, 873 of 1419 subjects(61.5%) were included in the estimation of the prevalence of PMS and PMDD. Each prevalence rate of PMS and PMDD was found to be 83.3% and 5.0% on the basis of 75% change method respectively. The most frequent symptom was physical symptoms such as headache or breast tenderness(56.4%) in PMS and 'felt irritable'(95.5%) in PMDD. Of the 44 subjects with PMDD, 39(88.6%) reported to have experienced the impairment in work or school at least once per month because of premenstrual symptoms. CONCLUSION: Our results indicate that prevalence and symptoms of PMDD in Korean university women are similar to those in western culture. The finding that mood symptoms were more frequent and severe in PMDD than in PMS implies that the former may be a disordered condition to be distinguished from the latter physiologic one.