An Unusual Case of Meningioma Showing Increased CaSR Expression with Parathyroid Carcinoma

No abstract available.

Intensive Care Unit Nurses' Death Perception, End of Life Stress and End of Life Nursing Attitudes / 임상간호연구

PURPOSE: This study aimed to identify the view of life and death among ICU nurses and to analyze the problems related to end-of-life care in the current ICUs. METHODS: A descriptive study design was used. The participants were 975 nurses working in the intensive care units of 16 general hospitals. Using a descriptive survey design, data were collected from August to December in 2016 and were analyzed using descriptive statistics, t-test, ANOVA, correlation analysis, and multiple regression analysis. RESULTS: As a result of a correlation analysis of the data, Death perception had a significant positive correlation with EOL of nursing attitudes(r=.100, p=.002), and negative correlation with EOL stress care(r=−.221, p= < .001). The regression model explained for individual characteristics in the model, age(β=.126, p < .001) and death perception(β=.182, p < .001), Satisfaction of the EOL care(β=.173, p < .001), Healing training needs on the EOL(β=−.144, p < .001) were the most influential factors for EOL stress. CONCLUSION: Results reveal that ICU nurses have a moderate level of EOL stress, and that individual, age, death perception, Satisfaction of the EOL care, Healing traning needs on the EOL relevant in ICU nurses' EOL stress. Programs or interventions to reduce EOL stress and to should be developed taking into account these multidimensional factors.

The Socioeconomic Burden of Coronary Heart Disease in Korea / 예방의학회지

OBJECTIVES: We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data. METHODS: A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective. RESULTS: Estimated national spending on CHD in 2005 was 2.52 billion dollar . The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was 3183 dollar, which is about 2 times higher than the cost for angina (1556 dollar). CONCLUSIONS: The total insurance-covered medical cost (1.13 billion dollar) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.

Patient assessment of primary care under the Designated Practice Scheme for Medical Aid beneficiaries, using the Korean Primary Care Assessment Tool (K-PCAT): a district of Seoul, South Korea

To control excessive utilization of medical care services by Medical Aid beneficiaries (MABs), the Korean government has introduced the Designated Practice Scheme (DPS, July 2007). The purpose of this study was to assess the primary care quality of the DPS using the Korean Primary Care Assessment Tool (K-PCAT). Data were collected from the survey (2008-2009) of MABs who had to designate a community clinic as the first contact practice obligatorily in one district of Seoul. Among all eligible (n=164), we analyzed the data of 154 beneficiaries, excluding those who did not meet the K-PCAT criteria of a usual source of care. Primary care quality under the DPS was poor (58.1 points) on a 100-point scale, compared with those previously studied under the Korean health care system. More seriously it was very poor (48.9 points) in MABs without intention to continue participation in the DPS, who were 50% of all participants. Among 5 domains of the K-PCAT, comprehensiveness (44.7 points) and coordination (39.3 points) were lower in score than other domains, comparable to previous studies, representing the reality of primary care in South Korea. Primary care quality was better in MABs using primary care practices including general practice, family medicine, and internal medicine instead of other specialty practice groups (60.2 vs. 53.9 points, P=0.015), and in MABs with longer duration (> or =3 vs. <3 years) since the first visit (59.7 vs. 51.9 points, P=0.010). These patterns were maintained after multivariate analysis, controlling for confounding variables. This research suggests that a complete overhaul of the scheme itself, such as the introduction of pay-for-performance method, etc., is necessary to improve primary care quality of the DPS.

Factors influencing on review adjustment rate in National Health Insurance: focusing on outpatient services in clinics

The aim of this study was to investigate the adjustment amount for outpatient services of clinics and to identify the factors affecting the variation of the cost between clinics in National Health Insurance in South Korea. Adjustment rate in the process of claims data review was defined as the percentage of the adjusted amount in the total claimed amount. From a total of 23,593 clinics in South Korea, 4,160 clinics accounting for 17.6% of total were selected for the study. The National Health Insurance claim data were collected during April 2007. To identify factors affecting the variation in adjustment rate between clinics, multiple regression method was used for the analysis. Older physicians were more likely to have high adjustment rate. General practitioners, orthopedic surgeons, and family physicians were more likely to have higher adjustment rate than those of internists. Physicians who have practiced between 1 and 10 years and physicians practicing in metropolitan areas had lower than their counterparts. There was a great variation in adjustment rate among physicians and the variation was affected by physicians' clinical behaviors as well as the characteristics of the clinics. Therefore, introduction of an effective management scheme for physicians' clinical behaviors is essential. Since many review adjustment occur due to the incomplete understanding about the review criteria and rules and procedure of claiming, continuing education will be a way of preventing these unnecessary review adjustments. The fact that no review adjustments were found even from the close-review implies that the current two-tiered review system (close-review and indicator-review) is an efficient way of review. Future studies are needed to classify possible cause of review adjustment such as simple errors, errors in applying the benefit scheme, and over use of services.

Socioeconomic Costs of Stroke in Korea: Estimated from the Korea National Health Insurance Claims Database / 예방의학회지

OBJECTIVES: To estimate the annual socioeconomic costs of stroke in Korea in 2005 from a societal perspective. METHODS: We identified those 20 years or older who had at least one national health insurance (NHI) claims record with a primary or a secondary diagnosis of stroke (ICD-10 codes: I60-I69, G45) in 2005. Direct medical costs of the stroke were measured from the NHI claims records. Direct non-medical costs were estimated as transportation costs incurred when visiting the hospitals. Indirect costs were defined as patients' and caregivers' productivity loss associated with office visits or hospitalization. Also, the costs of productivity loss due to premature death from stroke were calculated. RESULTS: A total of 882,143 stroke patients were identified with prevalence for treatment of stroke at 2.44%. The total cost for the treatment of stroke in the nation was estimated to be 3,737 billion Korean won (KRW) which included direct costs at 1,130 billion KRW and indirect costs at 2,606 billion KRW. The per-capita cost of stroke was 3 million KRW for men and 2 million KRW for women. The total national spending for hemorrhagic and ischemic stroke was 1,323 billion KRW and 1,553 billion KRW, respectively, which together consisted of 77.0% of the total cost for stroke. Costs per patient for hemorrhagic and ischemic stroke were estimated at 6 million KRW and 2 million KRW, respectively. CONCLUSIONS: Stroke is a leading public health problem in Korea in terms of the economic burden. The indirect costs were identified as the largest component of the overall cost.

Molecular cloning of ribosomal P protein in Toxoplasma gondii and the availability to detect antibody against recombinant protein in toxoplasmosis patients

Among the panel of monoclonal antibodies (mAb) against Toxoplasma gondii, mAb of Tg621 (Tg621) clone blotted 38 kDa protein which localized in the cytoplasm of tachyzoites by immunofluorescence microscopy. The protein was not released into the parasitophorous vacuole during or after invasion. The cDNA fragment encoding the protein was obtained by screening a T. gondii cDNA expression library with Tg621. The full length cDNA sequence was completed with 5'-RACE as 1, 592 bp, which contained open reading frame of 942 bp. The deduced amino acid sequence of Tg621 consisted of a polypeptide of 313 amino acids, with significant homology to ribosomal P proteins (RPP) of other organisms especially high to those of apicomplexan species. The expressed and purified TgRPP was assayed in western blot with the sera of toxoplasmosis patients and normal sera, which resulted in the 74.0% of positive reactions in toxoplasmosis patients whereas 8.3% in normal group. Therefore, the antibody formation against TgRPP in toxoplasmosis patients was regarded as specific for T. gondii infection and suggested a potential autoantibody.

ELISA detection of IgG antibody against a recombinant major surface antigen (Nc-p43) fragment of Neospora caninum in bovine sera

An ELISA was established to measure bovine IgG directed against the recombinant antigenic determinant of Nc-p43, a major surface antigen of Neospora caninum. In a previous study, two thirds of the Cterminal of the molecule was expressed as a 6 x His tagged protein (Ncp43P) for ELISA using 2/3 of the N-terminal of SAG1 from Toxoplasma gondii as a control (TgSAG1A). Among 852 cattle sera collected from stock farms scattered nation-wide, 103 sera (12.1%) were found to react with Ncp43P positively, but no positive reaction was observed with TgSAG1A. This study shows that Ncp43P could be available as an efficient antigen for the diagnosis of neosporosis in cattle. Furthermore, it together with TgSAG1A, could be useful for the differential diagnosis of N. caninum and T. gondii infections in other mammals.

ELISA detection of vivax malaria with recombinant multiple stage-specific antigens and its application to survey of residents in endemic areas

An ELISA was developed for the diagnosis of vivax malaria using multiple stage-specific recombinant antigens of Plasmodium vivax. The DNA from the whole blood of a malaria patient was used as template to amplify the coding regions for the antigenic domains of circumsporozoite protein (CSP-1), merozoite surface protein (MSP-1), apical merozoite antigen (AMA-1), serine repeat antigen (SERA), and exported antigen (EXP-1). Each amplified DNA fragment was inserted into pQE30 plasmid to induce the expression of His-tagged protein in Escherichia coli (M15 strain) by IPTG. His-tagged proteins were purified by Ni-NTA metal-affinity chromatography and used as antigens for ELISA with patient sera that were confirmed previously by blood smear examinations. When applied to patient sera, 122 (80.3%) out of 152 vivax malaria cases reacted to at least one antigen, while no reactions were observed with 128 uninfected serum samples. We applied this ELISA to the screening of 3, 262 civilian residents in endemic regions near the DMZ, which resulted in 236 positively detected (7.2%) cases. This method can be applied to serological diagnosis and mass screening in endemic regions, or can be used as a safety test for transfusion blood in endemic areas.