How can be reduced discharges against medical advice from the emergency department?

Objective@#Discharge against medical advice (DAMA) from emergency departments (EDs) accounts for 0.1% to 2.7%. DAMA carries a risk of increased mortality and readmissions, and higher medical nationwide cost. Our aim was to investigate the general characteristics of DAMA patients from ED and discover for methods to reduce DAMA. @*Methods@#In this study, we collected and analyzed the medical records of patients who visited the ED of a general hospital from 2015 to 2020. The subjects were categorized into a DAMA group and a non-DAMA group. We compared these groups with respect to gender, age, duration of ED stay, way to visit, the reason for the visit, insurance type, accompanied by guardian, and severity classification. In addition, the factors related to ED revisits or hospitalization within one month after DAMA were analyzed. @*Results@#Of the 209,076 patients, 1,982 were subject to DAMA from ED. The DAMA group had a higher ratio of visits to ED by ambulance (53.2% vs. 21.4%, P<0.001), critically ill patients (74.1% vs. 51.7%, P<0.001), and medical aid type 1 (7.7% vs. 3.4%, P<0.001). The factors for the high ratio of ED revisit within one month after DAMA were as follows: critically ill patients (odds ratio [OR], 1.916; 95% confidence interval [CI], 1.305-2.814), accompanied by a guardian (OR, 1.525; 95% CI, 1.105-2.105), and medical aid type 1 (OR, 2.025; 95% CI, 1.358-3.02). @*Conclusion@#Developing a manual on DAMA procedures and a system that can provide economic and social support to patients is to be established to reduce DAMA from ED.

Estimating the Burden of Irritable Bowel Syndrome: Analysis of a Nationwide Korean Database

BACKGROUND/AIMS: Management of irritable bowel syndrome (IBS) imposes a heavy economic burden. This study was to estimate the epidemiologic features of IBS and to report the IBS burden for the first time in the Korean population. METHODS: A cross-sectional study was conducted using the National Health Insurance (NHI) system database, which covers the entire population of Korea. IBS was defined as diagnostic code -10 in adults with any outpatient clinic visits or hospitalization related to IBS. We excluded diseases that mimic IBS symptoms. RESULTS: A total of 2.42 million (58.2% female) individuals were identified as patients with IBS, yielding an age- and gender-adjusted prevalence of 5.1% in males and 6.9% in females. The prevalence of IBS increased proportionally with age, with higher medical costs in middle-aged patients. Outpatient clinics were visited by 98.6% of IBS patients, and 1.9% were treated upon admission. Of these patients, 87.6% were given a prescription. Co-morbidities that commonly accompanied IBS included upper gastrointestinal (36.1%), respiratory (12.3%), musculoskeletal (8.0%) disease, somatoform (4.3%) and depression/anxiety disorders (3.1%). The NHI costs of IBS, which include the NHI covered cost and beneficiary copayment charges, were estimated to be 155 million USD, which accounts for 0.46% of the total NHI costs for the entire Korean population. CONCLUSIONS: According to the Korean national claims database, about 6% of the Korean population seeks medical care for IBS at least once per year. This high prevalence places a large economic burden on the Korean healthcare system, accounting for 0.46% of overall national medical expenditure.

Health Care Costs of Digestive Diseases in Korea / 대한소화기학회지

BACKGROUND/AIMS: Gastrointestinal (GI) diseases impose a heavy economic burden. We aimed to provide the first report on the health care utilization and costs of GI diseases in Korea. METHODS: We collected the data from all insurance claims database of National Health Insurance Corporation in Korea and the cause of death database in 2007 of Korea National Statistical Office. We compiled information about all digestive disease as a primary diagnosis on clinic visits, hospitalization, and cause of death from these databases. RESULTS: Seventeen million people (35.6%) had a diagnosis of GI diseases during the year 2007. Among them, the proportion of patients with upper GI diseases was prevalent in 54.9% (9.5 million patients/year). The 1/4 patients in out-patients clinic had any one of gastroesophageal reflux disease, irritable bowel syndrome and constipation. Thirteen percent of the total direct cost in 2007 was attributed to all GI diseases, which was 3,649 billion won (0.4% of GDP). The patients with hospitalization occupied by 5% of all patients with GI diseases, however, attributed to 58.9% of GI-related direct costs. GI malignancy was the major cause of medical expenses in hospitalization. Stomach cancer continues to be the leading cause of GI-related death in Korea. CONCLUSIONS: GI diseases causes a heavy socioeconomic burden with high morbidity of functional GI disorders in outpatients care and high mortality of GI malignancy in inpatient care. This report highlights the healthcare utilization burden of GI diseases for researchers and public health policy maker to create new directions of integrated researches and health care plan.

Economic Evaluation of Iron Chelation Agents: Oral Deferasirox versus Infusional Deferoxamine

BACKGROUND: Patients with transfusional iron overload have relied on treatment with deferoxamine, a standard chelating agent. Deferoxamine is administered by intravenous or subcutaneous infusion over an 8~12 hour period 5~7 times per week; however, administration of deferoxamine may lead to poor compliance and reduced quality of life in patients. The use of deferasirox, a once daily oral chelation agent, was recently approved. We conducted an economic evaluation of these two iron-chelating medications in transfusion-dependent patients. METHODS: The efficacy of oral deferasirox and infusion deferoxamine was assumed equal based on clinical trials of non-inferiority with the administration of 20mg/kg/day deferasirox versus 40mg/kg/day deferoxamine. Depending on the methods utilized for measuring administration time, travel time and convenience between the use of infusion and oral therapy, either cost analysis or cost-utility analysis was undertaken, respectively. Cost analysis included determination of direct medical costs (drug costs and administration costs), non-medical costs (travel costs), and indirect costs (productivity loss associated medical utilization). For cost utility analysis, the cost per QALYs (quality-adjusted life years) was calculated based on costs subtracting indirect costs (productivity loss) and gains of QALYs between the two agents. RESULTS: Deferasirox therapy resulted in a cost savings per patient of 23,471,777 Korean won based on cost analysis. Based on cost utility analysis, the cost per QALYs gained was -398,576 Korean won (4,527,819 Korean won savings with a gain of 11.5 QALYs per patient). CONCLUSION: The results of cost analysis and cost utility analysis of the use of oral deferasirox versus infusion deferoxamine showed that deferasirox is a more economical and potentially socially beneficial iron-chelating agent in Korea.

The societal cost of rotavirus infection in South Korea / 소아과

PURPOSE: This study aims to estimate the financial cost of rotavirus infection in Korea in the year of 2005. METHODS: The incidence rates used were from the epidemiological profile at Jeoungeub District (5.8 cases/1,000 children <5 years old for inpatients, and 22.65 cases/1,000 children <5 years old for outpatients, per year). The health care cost per capita of rotavirus infection (ICD code: A08.0) was extracted from the Health Insurance Review and Assessment Service database in Korea. The patient survey was conducted to capture information about non-medical costs and associated productivity loss incurred by adult caregivers. RESULTS: The number of annual national cases among children <5 years old with rotavirus infection was estimated to be 69,122 (i.e., 55,030 outpatients and 14,092 inpatients). The total cost of rotavirus infection was estimated at 13.3 billion Korean won, comprising 11 billion Korean won (82.7%) of direct medical costs, 1.6 billion Korean won (12.0%) of direct non-medical costs (e.g., transportation and supplies), and 0.68 billion Korean won (5.1%) of productivity lost by adult caregivers. CONCLUSION: Rotavirus infection carries not only medical costs but also non-medical and indirect costs; together, these costs incur a significant burden on South Korean society. The impact of rotavirus on quality of life and health among patient caregivers was not considered in this study, but it does merit further research.

The societal cost of rotavirus infection in South Korea / 소아과

PURPOSE: This study aims to estimate the financial cost of rotavirus infection in Korea in the year of 2005. METHODS: The incidence rates used were from the epidemiological profile at Jeoungeub District (5.8 cases/1,000 children <5 years old for inpatients, and 22.65 cases/1,000 children <5 years old for outpatients, per year). The health care cost per capita of rotavirus infection (ICD code: A08.0) was extracted from the Health Insurance Review and Assessment Service database in Korea. The patient survey was conducted to capture information about non-medical costs and associated productivity loss incurred by adult caregivers. RESULTS: The number of annual national cases among children <5 years old with rotavirus infection was estimated to be 69,122 (i.e., 55,030 outpatients and 14,092 inpatients). The total cost of rotavirus infection was estimated at 13.3 billion Korean won, comprising 11 billion Korean won (82.7%) of direct medical costs, 1.6 billion Korean won (12.0%) of direct non-medical costs (e.g., transportation and supplies), and 0.68 billion Korean won (5.1%) of productivity lost by adult caregivers. CONCLUSION: Rotavirus infection carries not only medical costs but also non-medical and indirect costs; together, these costs incur a significant burden on South Korean society. The impact of rotavirus on quality of life and health among patient caregivers was not considered in this study, but it does merit further research.

Expression of Tissue Tissue-transglutaminase-2 (TGM2) and Cyclo-oxygenase (COX) in the Fetal Membrane of Preterm Birth / 대한주산의학회잡지

BACKGROUND: Preterm labor accounts for one third of preterm deliveries. However, the causes and the mechanism of preterm labor are still under investigation. The purpose of this study was to investigate the changes of tissue transglutaminase 2 (TGM2) and cyclo-oxigenase I,II in the fetal membrane of patients with preterm birth compared with patients with term delivery. METHODS: Fetal membrane were obtained from women with preterm birth due to preterm labor (n=3) and from the women with term delivery (n=3) after each vaginal birth. The expression of TGM2, COX I & II were assessed by RT-PCR and immunoblotting analysis of the amnion and chorion. Nonparametric statistics were used for analysis. RESULTS: In the amnion in patients with preterm delivery, the expression of TGM2, COX I and COX II mRNA were increased by 2.3-fold, 2.7-fold, 1.3-fold, respectively, compared to term delivery with labor. The protein expression of TGM2 and COX I in these patients was increased in 1.9-fold and 2.1-fold but COX II protein expression showed no significant change, compared to term delivery with labor. In the chorion in patients with preterm delivery, the expression of TGM2, COX I and COX II mRNA showed no significant change, compared to term delivery with labor, but the protein concentration was significantly increased in 14.6-fold, 1.4-fold and 1.3-fold respectively, compared to term delivery with labor. CONCLUSION: This study shows that TMG2 and COX I are expressed more in the fetal membrane at preterm delivery caused by preterm labor, compared to term delivery with labor. These data suggests that the mechanism of preterm labor might be different form term labor.

Comparison of diagnostic methods used for detection of preterm premature rupture of membrane / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to compare the detection rate among diagnostic methods used for preterm premature rupture of membrane (PPROM). METHODS: The study population was composed of pregnant women who visited delivery room at our hospital due to vaginal watery discharge from 1 March 2002 to 28 February 2003. The gestational age was between 15 and 36+6/7 weeks of gestation. The study group was composed of 74 pregnant women. The rupture of membrane was tested by nitrazine test, ROM-check test and actim PROM test. It was regarded true positive that normal spontaneous preterm delivery was occurred within 72 hrs. The detection rates of each test were analyzed. RESULTS: There were positive results in 65 cases of nitrazine test, 23 cases of ROM-check test and 53 cases of actim PROM test. Of these positive cases, cases that delivered within 72 hours were in 33 cases of nitrazine test, 13 cases of ROM-check test and 30 cases of actim PROM test. Among three diagnostic methods, the sensitivity is highest for nitrazine test (86.8%) and the specificity is highest for ROM- check test (72.2%). The positive predictive value shows no significant difference among three methods and the negative predictive value is highest for actim PROM test (61.9%). The combination of ROM-check test and actim PROM test shows most accurate detection rates for diagnosis of preterm premature rupture of the membranes (sensitivity 84.2%, specificity 42.3%, positive predictive value 56.1%, negative predictive value 64.7%). CONCLUSION: Our data shows that combination of diagnostic methods might improve detection rate for PPROM. Future studies remain to improve detection rate of PPROM.

Association of polymorphism in the tumor necrotic factor-alpha (TNF-alpha) gene and interleukin-1beta (IL-1beta) gene with preterm delivery / 대한산부인과학회잡지

OBJECTIVE: To elucidate whether polymorphisms of tumor necrotic factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) are associated with preterm delivery caused by preterm labor and preterm premature rupture of membrane (PPROM) in korean pregnant women. METHODS: From August 2002 to October 2003, we recruited 93 pregnant women who delivered before 37 weeks in gestation. In 93 cases, there were 66 cases with preterm labor and 27 cases with PPROM. 288 pregnant women who delivered after 37 weeks in gestation served as controls. Maternal blood was collected and Genomic DNA was extracted from peripheral blood and the relevant genomic region was amplified using polymerase chain reaction (PCR). PCR products were digested with the restriction enzymes, Nco I for TNF-alpha and Ava I for IL-1beta. Data was analyzed by 2-tailed unpaired t test, x2 test, odds ratio with 95% confidence interval using SPSS 10.0. RESULTS: In normal pregnant group, the proportions of TNF-alpha*1/ TNF-alpha*1, TNF-alpha*1/ TNF-alpha*2, and TNF-alpha*2/ TNF-alpha*2 were 91%, 8%, and 1%, respectively. In normal pregnant group, the proportions of IL-1beta*A/IL-1beta*A, IL-1beta*A/IL-1beta*a, and IL-1beta*a/IL-1beta*a were 29%, 40%, and 31%,respectively. The carrier rate of TNF-alpha*2 was significantly different in PPROM group compared with control group (22% vs. 9%, P=0.03), while not in preterm labor group (15% vs. 9%, P=0.138). The allelic frequency of TNF-alpha*2 was significantly different neither in preterm labor group nor in PPROM group compared with control group (0.08 vs. 0.05, P=0.248; 0.11 vs. 0.5, P=0.062, respectively). The carrier rate of IL-1beta*a was significantly different neither in preterm labor group nor in PPROM group compared with control group (68% vs. 71%, P=0.671; 67% vs. 71%, P=0.65, respectively). The allelic frequency of IL-1beta*a was significantly different neither in preterm labor group nor in PPROM group compared with control group (0.44 vs 0.52, P=0.151; 0.52 vs. 0.52, P=0.512, respectively). CONCLUSION: These results suggest that TNF-alpha polymorphism may be, at least in part, associated with PPROM.

A Case Report of Familial Silver-Russell Syndrome / 대한산부인과학회잡지

The Silver-Russell syndrome (SRS) is characterized by severe asymmetric intrauterine growth restriction, with a preserved head circumference, leading to a lean body habitus and short stature. Facial dysmorphism and asymmetry are considered typical features of the syndrome, although the range of phenotypic variance is unknown. There is no definite known etiology of SRS. Most cases occur sporadically with no previous family history. However, there are rare occurrences where SRS is present in more than one member of a family. We report a case of familial Silver-Russell syndrome with literatures.

A Study on Depression, Anxiety and Quality of Life in Amenorrhea Schizophrenics Treated with Risperidone / 신경정신의학

OBJECTIVES: Amenorrhea, one of the most common side effects of neuroleptics, has known to be associated with prolactin elevation. Hyperprolactinemia seriously affects mental health causing depression, anxiety or hostility, while also affecting physical health causing amenorrhea, galactorrhea or sexual dysfunction. The possible correlation between risperidone-induced amenorrhea and depression, anxiety and quality of life was evaluated in a cross-sectional open study. METHODS: During a five-month period, WHO quality of life-BREF (WHOQOL), Beck depression inventory (BDI) and Statetrait anxiety inventory (STAI) were applied twice at two-month intervals for 30 patients with risperidone-induced amenorrhea and 22 patients without amenorrhea. RESULTS: Amenorrhea group had significantly higher scores in BDI and STAI-state, while showing lower scores in the quality of life than control group. The total BDI and STAI-state scores were more negatively correlated with WHOQOL score in amenorrhea group. CONCLUSION: Patients with risperidone-induced amenorrhea rated themselves significantly more depressed and more anxious, and a lower quality of life compared to the control group. Clinicians should be more active in evaluating and treating hyperprolactinemic side effects such as amenorrhea, galactorrhea, depression and anxiety.

A case of false positive amniotic acetylcholinesterase in a normal pregnancy / 대한산부인과학회잡지

Maternal serum alpha-fetoprotein (AFP) has been used for a long time for the prenatal diagnosis of neural tube defects in women at midtrimester of gestation. But AFP is elevated not only in cases of neural tube defects, but also in fetus with congenital nephrosis, abdominal wall defects, fetal demise, low birth weight or simply erroneously calculated gestational age. So, when maternal serum AFP is increased, gestational age of the fetus must be re-evaluated and targeted ultrasonographic evaluation is indicated to rule out neural tube defects. If NTDs are suspected or ultrasound is non-diagnostic, amniotic fluid AFP are measured and when AF-AFP is elevated, the presence or absence of acetylcholinesterase should be evaluated. The detection rate of open neural tube defects using amniotic acetylcholiesterase is reported to be as high as 96 to 99% with a 0.06% and 0.14% of false positive rate in amniotic fluids non-contaminated and contaminated by blood, respectively. We report a case with elevated mid-trimester MS-AFP, AF-AFP and positive amniotic acetylcholin-esterase, but in which repeated sonographic findings were normal, and result in delivery of a heathy baby without anomalies.

A case of false positive amniotic acetylcholinesterase in a normal pregnancy / 대한산부인과학회잡지

Maternal serum alpha-fetoprotein (AFP) has been used for a long time for the prenatal diagnosis of neural tube defects in women at midtrimester of gestation. But AFP is elevated not only in cases of neural tube defects, but also in fetus with congenital nephrosis, abdominal wall defects, fetal demise, low birth weight or simply erroneously calculated gestational age. So, when maternal serum AFP is increased, gestational age of the fetus must be re-evaluated and targeted ultrasonographic evaluation is indicated to rule out neural tube defects. If NTDs are suspected or ultrasound is non-diagnostic, amniotic fluid AFP are measured and when AF-AFP is elevated, the presence or absence of acetylcholinesterase should be evaluated. The detection rate of open neural tube defects using amniotic acetylcholiesterase is reported to be as high as 96 to 99% with a 0.06% and 0.14% of false positive rate in amniotic fluids non-contaminated and contaminated by blood, respectively. We report a case with elevated mid-trimester MS-AFP, AF-AFP and positive amniotic acetylcholin-esterase, but in which repeated sonographic findings were normal, and result in delivery of a heathy baby without anomalies.

The effects of capsaicin on the neurosecretory cells of the paraventricular and supraoptic nucei in the adult rat / 대한해부학회지

Capsaicin, the pungent algesic substance of the red pepper is known to be a neurotoxic substance, interrupting the pain conducting pathway. To investigate the effects on the adult animals, immunohistochemical staining have been done after capsaicin treatment. Capsaicin 50 mg/kg was injected subcutaneously to the adult rats and after 1 week, 1 month and 2 months later, the morphometric change of vasopressin & oxytocin-secreting cells in supraoptic and paraventricular nuclei of the hypothalamic area were investigated. The count of vasopressin- and oxytocin-immunoreactive cells in supraoptic & paraventricular nuclei were decreasing from 1 month after capsaicin treatment and these decreasing was continued until 2 months. The area of neurons in the supraoptic & paraventricular nuclei were measured and they diminished in the all kinds of neurons. With the above results, capsaicin treatment in adult rats had no effects in central nervous system neurotransmitters, however, some part of the hypothalamus where blood brain barrier was not formed were affected. Therefore central nervous system could be affected by capsaicin depending upon the location.

Four Cases of Steroid-Induced Lipodystrophy

No abstract available.