The purpose of the present study is to develop a CRM system for patients with diabetes mellitus. The subjects were outpatients who visited a university hospital from March, 1997 thru February, 2003. The distributions of outpatients, types of disease, revenues, exemption of designated doctor's fee, and no-show rate were obtained for each department by utilizing the OCS database. Quantitative and Qualitative data were collected from the diabetes patients chosen based on the distribution. The goals of applying the CRM are not to provide diabetes patients with general medical services, but to provide individually-tailored medical services by utilizing the information obtained from the departments of moment of truth(MOT) effectively and integrating the management of work process and human resources. For an effective application of the CRM, it needs to be performed to support the strategic objectives and incorporate management strategies that are appropriate for internal and external environments. That modeling for diabetes patients includes campaign activities, customer management process, and the functions of predicting and diagnosing the patients and managing the medical services of MOT departments and referral system.
Diabetes Mellitus ; Fees and Charges ; Humans ; Internet* ; Outpatients ; Referral and Consultation

This study developed, and applied, a portable emergency medical information system, enabling patient-related information to be efficiently shared with the hospital information system, via a PDA, while an emergency patient was being taken to the emergency room. The system consisted of an emergency patient`s server for monitoring the condition of the emergency patients registered in an emergency room, in real time, and a PDA terminal that delivers patient and emergency ac tivity information to a se rver through a wireless connection. Within the emergency room of G hospital a DB server was in charge of the stored information to de liver information the patients' conditions, emergency treatments, and activities, with 119 emergency medical system personnel being responsible for the information storage space, via a PDA. In addition, the member of personnel in charge of an emergency room can check the registrations of the 119 EMS personnel through a user's application, that enablings real-time checks of the fir st-aid patients being registerted in the information storage space. In conclusion, the development and experimental application of the emergency patient information delivery system demonstrated that a PDA can be used in an emergency medical environment. Modification to the interface, for a convenient input into a PDA, and an increase in its usability, through the training and continuous studies of the users, will help to make qualitative improvements to this emergency medical service.
Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Emergency Treatment ; Hospital Information Systems ; Humans ; Information Storage and Retrieval ; Information Systems ; Liver

To establish an appropriate policy for robotic surgery in Korea, the National Evidence-based Collaborating Agency (NECA) and the Korean Society of Health Policy and Administration held a round-table conference (RTC) to gather opinions through a comprehensive discussion of scientific information in gastric cancer. The NECA RTC is a public discussion forum wherein experts from diverse fields and members of the lay public conduct in-depth discussions on a selected social issue in the health and medical field. For this study, representatives from the medical field, patient groups, industry, the press, and policy makers participated in a discussion focused on the medical and scientific evidence for the use of robotic surgery in gastric cancer. According to the RTC results, robotic surgery showed more favorable results in safety and efficacy than open surgery and it is similar to laparoscopy. When the cost-effectiveness of robotic surgery and laparoscopy is compared, robotic surgery costs are higher but there was no difference between the two of them in terms of effectiveness (pain, quality of life, complications, etc.). In order to resolve the high cost issue of the robotic surgery, a proper policy should be implemented to facilitate the development of a cost-effective model of the robotic surgery equipment. The higher cost of robotic surgery require more evidence of its safety and efficacy as well as the cost-effectiveness issues of this method. Discussions on the national insurance coverage of robotic surgery seems to be necessary in the near future.
Adenosine-5'-(N-ethylcarboxamide) ; Administrative Personnel ; Consensus* ; Health Policy ; Humans ; Insurance Coverage ; Korea ; Laparoscopy ; Quality of Life ; Stomach Neoplasms*

Abstract: Diarrhea is the most common cause of death in calves, and remains a major health challenge. Although there are many studies on the related pathogens, the understanding of the clinicopathological changes is limited. This study aimed to identify the pathogens and observe the clinicopathological changes in electrolytes and acute phase proteins (APPs) associated with diarrhea.Blood samples and fecal samples were collected from 141 calves for the determination of APPs, electrolyte and acid-base status and identification of enteropathogens, respectively. Single or co-infections with enteropathogens, including virus (bovine viral diarrhea virus, coronavirus, and rotavirus), Eimeria, Cryptosporidium, and Escherichia coliK99 were detected in both non-diarrheic and diarrheic calves. Levels of APPs such as serum amyloid A, haptoglobin and fibrinogen were comparable between diarrheic and nondiarrheic calves. Hypoglycemia, high blood urea, electrolytes and acid-base imbalance (hyponatremia, hypochloremia, and decreased bicarbonate), and strong ion difference (SID) acidosis showed a significant association in diarrheic calves (p < 0.01). Particularly, significant hyponatremia, bicarbonate loss, SID acidosis, hypoglycemia, and elevated blood urea nitrogen were found in rotavirusinfected calves. Monitoring the clinicopathological parameters of APPs and electrolyte levels could be vital in the clinical management of diarrheic calves.

OBJECTIVE: To evaluate the influence of weight-bearing on foot shape measured by 3-D foot scanner. METHOD: Forty-two feet of twenty-one normal subjects were studied. The foot length, width, girth and arch parameters under non weight-bearing and weight-bearing conditions were measured by 3-D foot scanner (Nexcan(R), K & I, Korea), analysis software (EnFOOT(r), K & I, Korea) and 3-D foot arch measurement program. RESULTS: The foot length, ball width, ball girth, waist girth, instep girth, short heel girth, long heel girth and length from heel point to proximal arch point significantly increased under weight-bearing condition (p<0.01). However, vamp height, waist height, instep height, length of arch, height of arch, width of arch, length from heel point to distal arch point, maximal arch height and volume of arch were significantly decreased under 50% weight-bearing condition (p<0.01). CONCLUSION: Foot parameters associated with length, width and girth increased but volume, width, length, and height of medial longitudinal arch decreased under weight bearing condition. We suggest that these findings under weight- bearing condition result from the pronation of subtalar joint and the decrement of heights of transverse and longitudinal arch heights.
Foot* ; Heel ; Pronation ; Subtalar Joint ; Weight-Bearing*

To develop the occupational cancer surveillance system in Korea, data linkage analysis was performed on the subjects of Health-monitoring-pocketbook (the list of subjects who were exposed to selected occupational carcinogens) and the retired workers of a cokes manufacturing factory using the Korean medical insurance data, Korean death certificate data and Korean cancer registry data. Study subjects comprised the 822 retired subjects and the 3101 present-post subjects of Health-monitoring-pocketbook and the 182 retired workers of a cokes manufacturing factory. The incidence of cancer of these study subjects was ascertained by linkage of Korean medical insurance data of year 1995-6, Korean death certificate data of year 1992-8 and Korean cancer registry data of year 1993-5. In the study subjects, Eighty seven percent were males and mean age was 39.3+/-8.9 year-old, Average work duration was 8.0+/-5.5 years. Chrome, asbestos and cokes were the most frequent exposed agents. In the study subjects, total 13 cancer cases were ascertained by data linkage analysis. In the ascertained cancer cases, 8 cases were male and 5 cases were female, and 7 cases were aged 40-49 yr, 5 cases were aged 50-59 yr and 1 cases were aged 30-39 yr. The commonest exposure agent in the ascertained cancer cases was asbestos and cokes. By the site of cancer, 3 stomach cancer cases, 2 hematopoietic cancer cases and 2 biliary tract cancer cases were ascertained. The occupational cancer surveillance system using data linkage analysis on the workers exposed to hazardous agents was the most feasible and efficient method in Korea. And to do this, establishment of occupational history information in several disease registry database is needed with the effort of estimating the proper size of workers exposed hazardous agents.
Asbestos ; Biliary Tract Neoplasms ; Coke ; Information Storage and Retrieval* ; Death Certificates ; Female ; Humans ; Incidence ; Insurance ; Korea* ; Male ; Stomach Neoplasms

Background: There is growing evidence that abnormal liver function tests (LFTs) are common in patients with coronavirus disease 2019 (COVID-19). However, it is not known whether viral involvement in the liver differs according to the strain. We investigated the impact on liver injury in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta (B.1.617.2) variants. Materials and Methods: We conducted a single-center, retrospective cohort study, including 372 patients admitted during the pre-Delta period (PDP: between February 1 and November 30, 2020) and 137 patients admitted during the Delta period (DP: between August 1 and August 31, 2021). Initial liver injury was defined as alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels ≥3 × the upper limit of normal (ULN) or alkaline phosphatase (ALP) or total bilirubin ≥2 × the ULN within 3 days from admission. Results: Of 509 patients with COVID-19 included in our study, 38 (7.5%) patients had initial liver injury. The DP group had a significantly higher rate of initial liver injury than the PDP group (PDP: 5.9% vs. DP: 11.7%, P = 0.028). The DP group (adjusted odds ratio [aOR]: 2.737, 95% confidence interval [CI]: 1.322 – 5.666) was independently associated with initial liver injury. During hospitalization, 160 (31.4%) patients had severe COVID-19. The DP group and initial liver injury had higher odds of progressing to severe COVID-19 (aOR: 2.664, 95% CI: 1.526 - 4.648, and aOR: 4.409, 95% CI: 1.816 - 10.707, respectively). The mediation analysis suggested that initial liver injury mediates the relationship between SARS-CoV-2 Delta variant infection and severe COVID-19 (unstandardized beta coefficient = 0.980, Standard error = 0.284, P = 0.001). Conclusion Initial liver injury is more common in COVID-19 patients with Delta variants. Also, Delta variants and initial liver injury are associated with poor clinical outcomes.

Background: Because of the very low incidence of human immunodeficiency virus (HIV) coinfection in Korea, data on hepatitis C virus (HCV)/HIV coinfection are limited. This study aimed to investigate the clinical characteristics and treatment outcomes of patients with HCV/HIV coinfection in Korea. Methods: We performed a retrospective cohort study of all HCV-monoinfected and HCV/ HIV-coinfected patients treated with antivirals at National Medical Center in Seoul, Korea, between January 2009 and March 2020. Results: We enrolled 220 HCV-monoinfected and 23 HCV/HIV-coinfected patients treated with antivirals. The HCV/HIV-coinfected patients were younger (HCV vs. HCV/HIV: 57.3 ± 11.3 vs. 40.7 ± 10.1 years, P < 0.001) and had a higher proportion of men (HCV vs. HCV/ HIV: 54.5% [n = 120] vs. 91.3% [n = 21], P < 0.001) than the HCV-monoinfected patients.Genotype 1b and 2 were most common in both HCV monoinfection and HCV/HIV coinfection groups. HCV-monoinfected patients had a higher incidence of genotype 1b and 2 than HCV/HIV-coinfected patients (HCV vs. HCV/HIV: 95.4% [n = 210] vs. 73.9% [n = 17], P < 0.001), while the HCV/HIV-coinfected patients had genotype 1a (HCV vs. HCV/HIV: 1.8% [n = 4] vs. 21.7% [n = 5], P < 0.001). The fibrosis-4 index was significantly lower in the HCV/ HIV-coinfected patients than in the HCV-monoinfected patients (HCV vs. HCV/HIV: 3.81 ± 3.38 vs. 1.66 ± 1.10, P < 0.001). Among the direct-acting antivirals (DAA)-treated patients, the sustained viral response (SVR) rate did not differ significantly between both groups (HCV vs.HCV/HIV: 94.9% [93/99] vs. 90.9% [10/11], P = 0.480). Conclusion In Korea, the HCV/HIV-coinfected patients who received antiviral treatment were younger, had higher proportion of men and incidence of genotype 1a, and had less advanced fibrosis than the HCV-monoinfected patients. In actual clinical settings, HCV/HIV-coinfected patients show excellent SVR to DAA treatment, similar to HCVmonoinfected patients.

OBJECTIVE: In 2007, the American College of Obstetricians and Gynecologists (ACOG) recommended that all pregnant women be offered screening or diagnostic tests for chromosomal abnormalities regardless of their age. Noninvasive prenatal testing (NIPT) for common chromosomal aneuploidies was introduced as a screening test in case of high-risk pregnancies. We assessed the rates of prenatal tests in women aged 35 years and older. METHODS: A retrospective study was conducted to compare the rates of amniocentesis, chorionic villus sampling (CVS), serum screening, and NIPT from January 2005 through March 2017 in women aged 35 years and older. We divided the initial 12 months after NIPT introduction into 4-month intervals, beginning in April 2016 through March 2017. RESULTS: The rates of amniocentesis were 56% before the ACOG statement, 38% between the ACOG statement and NIPT introduction, and 10% after NIPT introduction (P=0.001). The rates of CVS during the same periods were 0.5%, 2.1%, and 4.3% (P=0.016), respectively. The rates of serum screening were 44.2%, 61.3%, and 55.1% (P=0.049), respectively. During the 3 quarters after NIPT introduction, the rates of amniocentesis were 16.2%, 12.3%, and 7.3% (P=0.002), respectively; the rates of serum screening were 62%, 54%, and 46% (P=0.03), respectively; and the rates of NIPT were 19.9%, 30.3%, and 39.5% (P=0.007), respectively. The rates of CVS over the same periods were not significantly different. CONCLUSION: The ACOG statement and NIPT introduction significantly decreased the rate of amniocentesis in women of advanced maternal age. NIPT also reduced the rate of serum screening.
Amniocentesis ; Aneuploidy ; Chorionic Villi Sampling ; Chromosome Aberrations* ; Diagnostic Tests, Routine ; Female ; Humans ; Mass Screening ; Maternal Age* ; Pregnancy ; Pregnancy, High-Risk ; Pregnant Women ; Prenatal Diagnosis ; Retrospective Studies

Purpose: Fetal well-being is usually assessed via fetal heart rate (FHR) monitoring during the antepartum period. However, the interpretation of FHR is a complex and subjective process with low reliability. This study developed a machine learning model that can classify fetal cardiotocography results as normal or abnormal. Materials and Methods: In total, 17492 fetal cardiotocography results were obtained from Ajou University Hospital and 100 fetal cardiotocography results from Czech Technical University and University Hospital in Brno. Board-certified physicians then reviewed the fetal cardiotocography results and labeled 1456 of them as gold-standard; these results were used to train and validate the model. The remaining results were used to validate the clinical effectiveness of the model with the actual outcome. Results: In a test dataset, our model achieved an area under the receiver operating characteristic curve (AUROC) of 0.89 and area under the precision-recall curve (AUPRC) of 0.73 in an internal validation dataset. An average AUROC of 0.73 and average AUPRC of 0.40 were achieved in the external validation dataset. Fetus abnormality score, as calculated from the continuous fetal cardiotocography results, was significantly associated with actual clinical outcomes [intrauterine growth restriction: odds ratio, 3.626 (p=0.031); Apgar score 1 min: odds ratio, 9.523 (p<0.001), Apgar score 5 min: odds ratio, 11.49 (p=0.001), and fetal distress: odds ratio, 23.09 (p<0.001)]. Conclusion The machine learning model developed in this study showed precision in classifying FHR signals. This suggests that the model can be applied to medical devices as a screening tool for monitoring fetal status.