No abstract available.
Asthma* ; Asthma, Exercise-Induced ; Bronchoconstriction* ; Child* ; Humans

The effort to measure and improve the quality of healthcare is a common health policy issue worldwide. Korean Value Incentive Programme is one of that effort, but some concerns exist. Compared to pay for performance program in other countries, it measures healthcare quality with relatively narrow performance domain using a small number of clinical indicators. It was designed without involving hospitals and other key stakeholder, and program participation was mandated. Highest and lowest performers get bonus and penalty using relative ranking. As a suggestion for development, the direction for quality management at the national level should be given first. Therefore the philosophy or strategy for quality improvement should be reflected to the program. And various domains and indicators of healthcare quality should be developed with active communication with healthcare providers. The evaluation method is necessary to be changed to provide achievable goal to the healthcare providers and attract quality improvement.
Health Personnel ; Health Policy ; Humans ; Methods ; Motivation* ; Philosophy ; Quality Improvement ; Quality of Health Care ; Reimbursement, Incentive

PURPOSE: This study was to evaluate the effect of repeated ultrasonic scaling and surface polishing with intraoral polishing kits on the surface roughness of three different restorative materials. MATERIALS AND METHODS: A total of 15 identical discs were fabricated with three different materials. The ultrasonic scaling was conducted for 20 seconds on the test surfaces. Subsequently, a multi-step polishing with recommended intraoral polishing kit was performed for 30 seconds. The 3D profiler and scanning electron microscopy were used to investigate surface integrity before scaling (pristine), after scaling, and after surface polishing for each material. Non-parametric Friedman and Wilcoxon signed rank sum tests were employed to statistically evaluate surface roughness changes of the pristine, scaled, and polished specimens. The level of significance was set at 0.05. RESULTS: Surface roughness values before scaling (pristine), after scaling, and polishing of the metal alloys were 3.02±0.34 µm, 2.44±0.72 µm, and 3.49±0.72 µm, respectively. Surface roughness of lithium disilicate increased from 2.35±1.05 µm (pristine) to 28.54±9.64 µm (scaling), and further increased after polishing (56.66±9.12 µm, P<.05). The zirconia showed the most increase in roughness after scaling (from 1.65±0.42 µm to 101.37±18.75 µm), while its surface roughness decreased after polishing (29.57±18.86 µm, P<.05). CONCLUSION: Ultrasonic scaling significantly changed the surface integrities of lithium disilicate and zirconia. Surface polishing with multi-step intraoral kit after repeated scaling was only effective for the zirconia, while it was not for lithium disilicate.
Alloys* ; Ceramics* ; Lithium ; Microscopy, Electron, Scanning ; Ultrasonics*

Esotropia that is related to accommodative effort may be divided into two major categories: (1) refractive accommodative esotropia with a normal AC/A ratio and (2) nonrefractive accommodative esotropia with a high AC/A ratio. To evaluatedthe clinical characteristics and the results of therapy, we performed a clinical analysis of 54 cases of accommodative esotropia. Female were 28 cases and male 26. The age of onset were 0 to 6 years with most of the cases were 0 to 2 years. The refractive errors were ranged from less than +2.00D to over +6.00D. The amount of deviation before correction with glasses were 20-29delta in 16 cases, 30-39delta in 25, 40-49delta in 12 and one cases was over 50 delta. The refractive type was 46 cases and 8 cases were nonrefractive type. It is recommended that the patients with accommodative esotropia should be followed up for a long time even with their glasses, because of variable clinical course.
Age of Onset ; Esotropia* ; Eyeglasses ; Female ; Glass ; Humans ; Male ; Refractive Errors

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.
Angioplasty, Balloon ; Aspirin ; Coronary Vessels* ; Dilatation ; Dilatation, Pathologic ; Humans ; Liver Cirrhosis* ; Liver* ; Myocardial Infarction* ; Platelet Aggregation Inhibitors ; Prognosis ; Stents ; Thrombosis*

The frequency and the correlation to leukoariosis were evaluated in the l00 cases of hypertension, in the 46 cases of diabetes mellitus and in 50 controls. The results were as follows: 1. The frequencies of leukoaraiosis were 35% in hypertension, 15% in diabetes mellitus and 4% in control. And there is significant difference in the frequency of leukoaraiosis between hypertension and control 2. The severity of leukoaraiosis significantly correlated with the level of diastolic blood poressure( p<0.05).
Diabetes Mellitus* ; Hypertension* ; Leukoaraiosis* ; Risk Factors*

We report clinical and electrophysiological findings in the four patients of anterior tarsal tunnel syndrome. All four patients, there was decreased pinprick sensation at the 1st interdigital space and limitation of digital dorsiflexion with atrophy of extensor digitorum brevis. Nerve conduction tests in the superficial peroneal, tibial and sural nerve were normal, but in the common peroneal nerve, the compound muscle action potential was decreased, while nerve conduction velocity between the knee and the ankle was normal with prolonged or upper normal limited terminal latency. Denervation potentials or giant MUPs had been found in the extensor digitonn brevis muscle, but absent in the tibialis anterior, extensor hallucis longus muscles.
Action Potentials ; Ankle ; Atrophy ; Denervation ; Humans ; Knee ; Muscles ; Neural Conduction ; Peroneal Nerve ; Sensation ; Sural Nerve ; Tarsal Tunnel Syndrome*

Unmet healthcare needs do not end with the phenomenon itself, but lead to possibilities of increased severity of illness. Missed opportunities for treatment at the right timing increase possibilities of complications, and affect prognosis of disease. To examine current status and trends of unmet needs in Korea, we used data from four sources: the Korea National Health and Nutrition Examination Survey (KNHNES, '2007–2016); the Community Health Survey (CHS '2008–2016); the Korea Health Panel Survey (KHP '2011–2014); and the Korean Welfare Panel Study (KOWEPS '2006–2016). The proportion of individual reporting unmet healthcare needs as of 2016 was 8.8% (KNHNES), 11.5% (CHS), and 12.8% (KHP, as of 2014). Annual percentage change which characterizes trend for the follow-up period was −9.9%, −3.1%, and −1.3%, respectively. The proportion of individuals reporting unmet healthcare needs due to cost was 1.8% (KNHNES), 1.5% (CHS), and 3.0% (KHP). The proportion of households reporting unmet healthcare needs due to cost was 1.0% (KOWEPS). Annual percentage change was −10.0%, −15.2%, −5.4%, and −17.5%, respectively. Low income populations had more unmet healthcare needs than high income populations. Therefore, in order to improve unmet healthcare needs, it is necessary to focus on low income populations.
Delivery of Health Care ; Family Characteristics ; Follow-Up Studies ; Health Surveys ; Korea ; Nutrition Surveys ; Population Growth ; Poverty ; Prognosis

PURPOSE: The purpose of this study was to compare the effect of recirculation rate according to cannulation direction and interval among hemodialysis patients with arteriovenous fistula (AVF).METHOD: The research used repeated measures design. This study was conducted among thirty patients who received hemodialysis three times a week for longer than a year through AVF at the I University hospital. Three different types of interventions were administered to the participants each week for three weeks. Needles were placed at a different distance and in a different direction each week: 7 cm apart from each other in antegrade direction during the first week, 5 cm apart in retrograde direction in the following week, and 7 cm apart in retrograde direction in the third week.RESULTS: No significant differences in the recirculation rate were found due to any of the three tested methods (p = 1.00).CONCLUSION: This finding suggests that, if the patients have well-functioned AVF, we can choose an appropriate intervention from among the three methods in consideration of the patient's diverse needs.
Arteriovenous Fistula ; Catheterization ; Humans ; Methods ; Needles ; Punctures ; Renal Dialysis

PURPOSE: We wanted to investigate the accuracy of axillary ultrasonography for detecting axillary nodal metastasis in patients with T1-2 breast cancer and we also wanted to determine the factors affecting the sensitivity. MATERIALS AND METHODS: Two radiologists performed axillary ultrasonography in 119 consecutive patients with T1-2 breast cancer and clinically uninvolved axillae. We analyzed the accuracy of ultrasonography for detecting axillary nodal metastasis with the histologic results being used as a reference standard. We evaluated the number of involved lymph nodes, T staging and the histologic grade of the tumors. RESULTS: Axillary nodes were involved in 39% of total patients (46/119); 30% of the patients with T1 cancer and 55% of the patients with T2 cancer. The sensitivity, specificity, positive predictive value and negative predictive value were for 52%, 92%, 80% and 75%, respectively. The sensitivity was significantly lower for the cases with one to two lymph nodes metastasis and T1 cancer than in those cases with 3 or more lymph nodes metastasis and T2 cancer (35% and 75% in the cases with 1-2 cancer and the cases with > 3 lymph nodes metastasis, respectively, p = 0.009; 38% and 68% in the cases with T1 and the cases with T2 cancer, respectively, p = 0.045). CONCLUSIONS: The ultrasonographic sensitivity for detecting axillary lymph node metastasis is low, especially in the cases with one to two lymph nodes metastasis and the cases with T1 cancer. Detailed analysis and adoption of cytologic examination of the axillary lymph nodes are necessary to improue the accuracy of ultrasonography.
Adoption ; Axilla ; Breast ; Breast Neoplasms ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Sensitivity and Specificity