OBJECTIVES: This study aimed to explore dimensions in addition to the 5 dimensions of the 5-level EQ-5D version (EQ-5D-5L) that could satisfactorily explain variation in health-related quality of life (HRQoL) in the general population of South Korea. METHODS: Domains related to HRQoL were searched through a review of existing HRQoL instruments. Among the 28 potential dimensions, the 5 dimensions of the EQ-5D-5L and 7 additional dimensions (vision, hearing, communication, cognitive function, social relationships, vitality, and sleep) were included. A representative sample of 600 subjects was selected for the survey, which was administered through face-to-face interviews. Subjects were asked to report problems in 12 health dimensions at 5 levels, as well as their self-rated health status using the EuroQol visual analogue scale (EQ-VAS) and a 5-point Likert scale. Among subjects who reported no problems for any of the parameters in the EQ-5D-5L, we analyzed the frequencies of problems in the additional dimensions. A linear regression model with the EQ-VAS as the dependent variable was performed to identify additional significant dimensions. RESULTS: Among respondents who reported full health on the EQ-5D-5L (n=365), 32% reported a problem for at least 1 additional dimension, and 14% reported worse than moderate self-rated health. Regression analysis revealed a R2 of 0.228 for the original EQ-5D-5L dimensions, 0.200 for the new dimensions, and 0.263 for the 12 dimensions together. Among the added dimensions, vitality and sleep were significantly associated with EQ-VAS scores. CONCLUSIONS: This study identified significant dimensions for assessing self-rated health among members of the general public, in addition to the 5 dimensions of the EQ-5D-5L. These dimensions could be considered for inclusion in a new preference-based instrument or for developing a country-specific HRQoL instrument.
Cognition ; Hearing ; Korea* ; Linear Models ; Patient Outcome Assessment ; Quality of Life* ; Surveys and Questionnaires ; Visual Analog Scale

PURPOSE: Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. The synergistic effect and low drug volume of each vasoactive drug in polypharmacotherapy for erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. We evaluated the treatment outcome of intracavernosal injection therapy with Trimix(the mixture of papaverine, phentolamine and prostaglandin E1). MATERIALS AND METHOD: From July 1993 to June 1997, 1000 patients with erectile dysfunction underwent a trial of intracavernous self injection therapy with Trimix(the mixture of papaverine 4.8mg, phentolamine 0.2mg and prostaglandin E1 1.8 microgram in 0.2ml). Underlying diseases were diabetes mellitus (33.1%), hypertension(7.5%) and others(12.3%). 471(47.1%) patients had no underlying disease. The volume of drug used ranged from 0.03 to 0.6ml(average: 0.18ml). RESULTS: After a mean follow-up of 10.9 months(3-44 months), 524 patients stayed on the home injection program. The drop-out rate was 47.6% with most of the cases during early home phase. The reasons for drop-out were inadequate response to medication, failure of injection, return of spontaneous erection, switch to other treatments, priapism, fear of needle or injection, loss of interest and economic reason. 88.3% of patients and 85.3% of the partners were satisfied wilts the result of home injection program. Priapism(3.9%), pain or discomfort(2.4%) and granuloma on injection site(1.5%) were noticeable complications, but corporal fibrosis and systemic side effect were not noticed. CONCLUSIONS: Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and most of all, very effective method for the treatment of the patients with erectile dysfunction.
Alprostadil ; Diabetes Mellitus ; Drug Therapy ; Erectile Dysfunction* ; Fibrosis ; Follow-Up Studies* ; Granuloma ; Humans ; Male ; Needles ; Papaverine ; Phentolamine ; Priapism ; Treatment Outcome

In order to improve patient safety, it is important to manage and respond to patient safety incidents that have already occurred. Disclosure of patient safety incidents (DPSI) can be regarded as a prudent strategy, as it has the potential to decrease the number of medical disputes in advance. DPSI is defined as follows: “When a patient safety incident occurs, medical professionals preemptively explain the incident to the patients and their caregivers, express sympathy and regret for the incident, deliver apology and compensation appropriately if needed, and promise to prevent recurrence.” Although DPSI is known to be effective for reducing the number of medical lawsuits, it can be also viewed as reflecting important ethical and quality of care issues. In particular, medical professionals have an ethical imperative to conduct DPSI with the patient, if patient safety incidents have occurred. In this paper, we review the necessity of DPSI from ethical and quality of care perspectives. The ethical basis of DPSI includes autonomy, transparency, trust, and professional standards. Furthermore, DPSI will become inevitable as society comes to emphasize safer and more patient-centered care. In order to make DPSI a routine practice in South Korea, various efforts, such as the development of DPSI guidelines and educational programs, as well as the introduction of an apology law, will be required.
Caregivers ; Compensation and Redress ; Disclosure* ; Dissent and Disputes ; Humans ; Jurisprudence ; Korea ; Patient Safety* ; Patient-Centered Care

This paper reviewed structure and current status of laws related to patient safety using patient safety law matrix to promote systematic approach in legal system of patient safety. Laws related to patient safety can be divided into three areas: laws for preventing; laws for knowing about; and laws for responding. In the case of Korea, gaps are especially prominent in the areas of laws for knowing about and responding. Patient safety law which will be enacted in July 2016 will fill the gap in the area of laws for knowing about. This law will be comprehensive law, covering the full spectrum of laws related to patient safety. However, after reviewing current patient safety law in Korea, the following drawbacks were identified: absence of code for grasping the current patient safety level; absence of code for mandatory reporting in patient safety reporting system; and absence of code for privilege about patient safety work product. Furthermore we need wider discussions about covering issues of open disclosure, apology law, coroners system, and complaint management system in patient safety law.
Coroners and Medical Examiners ; Disclosure ; Hand Strength ; Humans ; Jurisprudence ; Korea* ; Mandatory Reporting ; Patient Safety* ; Risk Management

The hospital readmission rate has been widely used as an indicator of the quality of hospital care in many countries. However, the transferrability of this indicator that has been developed in a different health care system can be questioned. We reviewed what should be considered when using the risk-standardized readmission rate (RSRR) as a generic quality indicator in the Korean setting. We addressed the relationship between RSRR and the quality of hospital care, methodological aspects of RSRR, and use of RSRR for external purposes. These issues can influence the validity of the readmission rate as a generic quality indicator. Therefore RSRR should be used with care and further studies are needed to enhance the validity of the readmission rate indicator.
Delivery of Health Care ; Patient Readmission ; Quality Indicators, Health Care

Paraneoplastic pemphigus is a rare, life-threatening disorder associated with an underlying neoplasm, which presents with painful stomatitis and polymorphous skin lesions. Successful diagnosis of paraneoplastic pemphigus can lead to the diagnosis and treatment of the underlying malignancy.However, involvement of the respiratory system is typically unresponsive to treatment. Herein, we report the case of a 44-year-old female diagnosed with paraneoplastic pemphigus with underlying follicular lymphoma treated with a chemotherapy regimen including rituximab. Her skin lesions and underlying lymphoma responded to treatment, but bronchiolitis obliterans continued to progress and resulted in fatal respiratory failure.

Paraneoplastic pemphigus is a rare, life-threatening disorder associated with an underlying neoplasm, which presents with painful stomatitis and polymorphous skin lesions. Successful diagnosis of paraneoplastic pemphigus can lead to the diagnosis and treatment of the underlying malignancy.However, involvement of the respiratory system is typically unresponsive to treatment. Herein, we report the case of a 44-year-old female diagnosed with paraneoplastic pemphigus with underlying follicular lymphoma treated with a chemotherapy regimen including rituximab. Her skin lesions and underlying lymphoma responded to treatment, but bronchiolitis obliterans continued to progress and resulted in fatal respiratory failure.

PURPOSE: The purpose of this study was to determine nurses' perceptions of the disclosure of patient safety incidents (DPSI), which is known to be effective in reducing medical litigation and improving the credibility of medical professionals. METHODS: Three focus group discussions were conducted with 20 nurses using semistructured guidelines. Transcribed content including a record of the progress of the focus group discussions and researchers' notes were analyzed using directed content analysis. RESULTS: Most participants thought that DPSI is necessary because of its effectiveness and for ethical justification. However, participants held varied opinions regarding the primary responsibility of DPSI. Participants agreed on the necessity of explaining the incident and expressing sympathy, apologizing, and promising appropriate compensation that are chief components of DPSI. However, they were concerned that it implies a definitive medical error. A closed organizational culture, fear of deteriorating relationships with patients, and concerns about additional work burdens were suggested as barriers to DPSI. However, the establishment of DPSI guidelines and improving the hospital organization culture were raised as facilitators of DPSI. CONCLUSION: Most nurse participants acknowledged the need for DPSI. To promote DPSI, it is necessary to develop guidelines for DPSI and provide the appropriate training. Improving the hospital organization culture is also critical to facilitate DPSI.
Compensation and Redress ; Disclosure ; Focus Groups ; Humans ; Jurisprudence ; Korea ; Medical Errors ; Organizational Culture ; Patient Rights ; Patient Safety

Background: The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during the endemic phase may vary from that during the previous pandemic phase. We evaluated the risk of infection in a general population with laboratory-confirmed coronavirus disease 2019 (COVID-19) in a community setting in Korea. Materials and Methods: This study included 1,286 individuals who had been in contact with an index COVID-19 case between January 24, 2020, and June 30, 2022. Variables such as age, sex, nationality, place of contact, level of contact, the status of exposed cases, period, and level of mask-wearing were assessed. Results: Among 1,286 participants, 132 (10.30%) were confirmed to have COVID-19. With increasing age, the risk of the exposed persons contracting COVID-19 from index cases tended to increase (P <0.001), especially for people in their 70s (odds ratio, 1.24; 95% confidence interval, 1.11–1.40; P <0.001). We found an increasing trend in the risk of a COVID-19 exposed case becoming a secondary infection case (P <0.001) in long-term care facilities where the attack rate was high. Conclusion The risk of COVID-19 transmission is high in long-term care facilities where many older adults reside. Intensive management of facilities at risk of infection and strict mask-wearing of confirmed COVID-19 cases are necessary to prevent the risk of COVID-19 infection.

OBJECTIVES: The purpose of this study was to assess the inter-rater reliability and intra-rater reliability of medical record review for the detection of hospital adverse events. METHODS: We conducted two stages retrospective medical records review of a random sample of 96 patients from one acute-care general hospital. The first stage was an explicit patient record review by two nurses to detect the presence of 41 screening criteria (SC). The second stage was an implicit structured review by two physicians to identify the occurrence of adverse events from the positive cases on the SC. The inter-rater reliability of two nurses and that of two physicians were assessed. The intra-rater reliability was also evaluated by using test-retest method at approximately two weeks later. RESULTS: In 84.2% of the patient medical records, the nurses agreed as to the necessity for the second stage review (kappa, 0.68; 95% confidence interval [CI], 0.54 to 0.83). In 93.0% of the patient medical records screened by nurses, the physicians agreed about the absence or presence of adverse events (kappa, 0.71; 95% CI, 0.44 to 0.97). When assessing intra-rater reliability, the kappa indices of two nurses were 0.54 (95% CI, 0.31 to 0.77) and 0.67 (95% CI, 0.47 to 0.87), whereas those of two physicians were 0.87 (95% CI, 0.62 to 1.00) and 0.37 (95% CI, -0.16 to 0.89). CONCLUSIONS: In this study, the medical record review for detecting adverse events showed intermediate to good level of inter-rater and intra-rater reliability. Well organized training program for reviewers and clearly defining SC are required to get more reliable results in the hospital adverse event study.
Drug-Related Side Effects and Adverse Reactions/classification/*pathology ; Hospitals, General ; Humans ; Medical Records ; Nurses/psychology ; Physicians/psychology ; Retrospective Studies