BACKGROUND: This study aims to analyze quality of and satisfaction with Korea medical services and identify factors affecting medical service satisfaction, revisit, and recommendation intention among international patients. METHODS: Secondary analysis of survey data conducted by Korea Health Industry Development Institute from June 10th to July 17th in 2013 was done using multiple regression and logistic regression analysis. The 191 international patients from 9 medical institutions in Seoul were enrolled. RESULTS: The results showed that international patients were satisfied with 85.6 points out of 100.0 points. International patients appraised higher in staff service rather than other services. Factors influencing medical service satisfaction were gender, religion, medical specialty, length of stay, and quality of medical services. Quality of medical service explained 29.8% of medical service satisfaction and especially, ‘doctor's care’ and ‘communication and patient respect‘ were significantly related to medical service satisfaction. Medical specialty had a significant influence on revisit intention. There were no statistically significant influencing factors of recommendation intention. Additionally, more satisfied patients were associated with higher revisit and recommendation intention. CONCLUSION: This study implies that quality of medical services is a critical factor for patient satisfaction and that satisfaction with medical services is an important factor for increasing revisit and recommendation intention among international patients. In addition, health care providers should consider cultural differences to enhance satisfaction with medical services for international patients. Therefore, multidimensional strategy is required to strengthen the cultural competency of healthcare providers.
Cultural Competency ; Health Personnel ; Health Services ; Humans ; Intention* ; Korea* ; Length of Stay ; Logistic Models ; Patient Satisfaction ; Seoul

Meta-analysis is the statistieal analysis of a collection of analytic result for the purpose of integrating the findings across studies. Such a systematic quantitative procedure through combination of statistic offers accumulation of evidence in terms of the effect size. Furthermore, the combination of data from several studies increases generalibility and statistical power with some criticisms. Schmidt-Hunter procedure is appropriate method for measuring d(the difference between the group mean divided by the standard deviation) statistics. In this paper we present the cumulation formulas for effect sizes and analyzed mean d statistics. Twenty-five research reports of clinical trials for prevention of hemodynamie changes after tracheal intubation were gathered. Three drugs(lidocaine, fentanyl, esmolol) were reported in detail sufficient to get for analyzing variables(systolic, diastolic and heart rate). Means of each variable were summarized and calculated by each drug between control and treatment group. Nine meta-analysis were performed. Lidocaine, fentanyl and esmolol all effectively decreased hemodynamic changes compared to control group(placebo group). Fentanyl provided reliable protection in systolic blood pressure as esmolol in heart rate. Range variation.of mean effect size was smallest and consistent in esmolol group. Variance of the effect size corrected for sampling error was large in all drugs and there should be a search for moderator variables(covariate) with need for stratification.
Blood Pressure ; Fentanyl ; Heart ; Heart Rate ; Hemodynamics* ; Intubation* ; Lidocaine ; Research Report ; Selection Bias

BACKGROUND: The single-breath carbon monoxide diffusion capacity (DLCO) and the per unit alveolar volume (KCO; DLCO/VA) gave discordant values when there was an abnormal alveolar volume (VA). However, the clinical significance of the discordant values in patients with airflow limitation has not been examined. This study investigated the DLCO and KCO changes after improving the airflow limitation. METHOD: The baseline DLCO and KCO with lung volume were measured in patients with an airflow obstruction. The effective alveolar volume was measured using the single-breath CH4 dilution method. The patients divided into two groups according to the baseline values: (1) increased KCO in comparison with the DLCO (high discordance) (2) decreased or not increased KCO in comparison with the DLCO (low discordance). The diffusion capacity and lung volume were measured after treatment. RESULTS: There was no significant difference in the baseline lung volumes including the FEV1 and FVC between the two groups. The FEV1 and FVC were significantly increased in the high discordance group compared with the low discordance group after treating the airflow limitation. The DLCO and alveolar volume were significant higher in the high discordance group compared with the low discordance group while the TLC was not. CONCLUSION: The discordance between the DLCO and KCO could be translated into an airflow reversibility in patients with an airflow limitation
Carbon Monoxide* ; Carbon* ; Diffusion ; Humans ; Lung ; Lung Diseases, Obstructive ; Respiratory Function Tests

Behcet? disease is a recurring illness characterized by the triple symptom complex of aphthous stomatitis, genital ulceration, and uveitis. The disease is multisystemic disorder with involvement of skin, gastrointestinal tract, blood vessels, central nervous system, joints, and epididymis. Vascular involvement of Behcet? disease affects both arteries and veins and blood vessels of all sizes. Periosteal new bone formation is one feature of hypertrophic osteoarthropathy. Other features are clubbing and arthritis. Periosteal new bone formation on the bones of the lower extremities without other features of hypertrophic osteoarthropathy has been reported in patients with varicose veins, vitamin A intoxication, infantile cortical hyperostosis, tuberous sclerosis, congenital syphilis and chronic renal failure with hyperparathyroidism, and chronic venous insufficiency. However, periosteal new bone formation has not, to our knowledge, been described in patients with Behcet? disease yet although similar findings are occasionally noted in polyarteritis nodosa. We report a case of Behcet? disease complicated by leg swelling with periosteal new bone formation of right lower leg.
Arteries ; Arthritis ; Behcet Syndrome ; Blood Vessels ; Central Nervous System ; Epididymis ; Gastrointestinal Tract ; Humans ; Hyperostosis, Cortical, Congenital ; Hyperparathyroidism ; Joints ; Kidney Failure, Chronic ; Leg ; Lower Extremity ; Male ; Osteogenesis* ; Polyarteritis Nodosa ; Skin ; Stomatitis, Aphthous ; Syphilis, Congenital ; Tuberous Sclerosis ; Ulcer ; Uveitis ; Varicose Veins ; Veins ; Venous Insufficiency ; Vitamin A

Although many hepatitis B virus (HBV) mutants have been found in all open reading frames since the precore defective mutant was initially reported, systematic investigations of diverse HBV mutant populations in hepatitis B patients have not been performed. Therefore, we examined whether heterogeneous mutant populations simultaneously exist in Korean hepatitis B patients. In order to detect hepatitis B virus mutants, we amplified a conserved core region and a surface antigen region of HBV DNA by PCR from sera of 27 Korean chronic hepatitis B patients, and then performed single strand conformational polymorphism analysis followed by DNA sequencing analysis. The results showed that heterogeneous HBV mutants in both regions were present in a single as well as in various hepatitis B patients. Sequence analysis revealed a defective interfering particle with missense mutation in the core region. We also found that two subtypes of adr and adw coexisted in a single patient. In addition, a point mutation causing a stop codon in the surface antigen region was observed. We are further analyzing the clinical implications of HBV mutants to identify their roles in the pathogenesis of chronic hepatic disorders induced by HBV.
Adult ; Base Sequence ; Conserved Sequence ; Female ; Genetic Heterogeneity ; Hepatitis B Surface Antigens/genetics ; Hepatitis B Virus/genetics* ; Hepatitis B, Chronic/virology* ; Human ; Male ; Middle Age ; Molecular Sequence Data ; Mutation* ; Polymerase Chain Reaction ; Polymorphism, Single-Stranded Conformational ; Sequence Analysis, DNA

Large bladder masses in children are extremely rare pathological lesions. They can present as a gross hematuria, with irritable or obstructive voiding symptoms and a urinary tract infection. Their differential diagnosis must include for genitourinary malignancies, such as rhabdomyosarcoma, as well as benign inflammatory lesions. A case of a bladder mass in a three-year-old girl is reported, which was finally diagnosed as localized perforated appendicitis.
Appendicitis* ; Child ; Child, Preschool* ; Diagnosis, Differential ; Female* ; Hematuria ; Humans ; Rhabdomyosarcoma ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Tract Infections

PURPOSE: To evaluate the usefulness and complications of ultrasonography (US)-guided vacuum assisted biopsy (VAB) for the removal of benign breast lesions, and the short- and long-term changes after VAB as shown on follow-up US. MATERIALS AND METHODS: From January 2007 to May 2008, 110 sonographically benign lesions in 62 patients were sampled via US-guided VAB. We prospectively evaluated the sonographic findings 1 week and 6 months after VAB in all patients to determine the presence of residual tumors, hematomas and scarring. We evaluated the prevalence of hematoma, pain, skin dimpling, fibrotic scarring and residual tumors after US-guided VAB, and determined if correlation existed between complications, size of the lesions and lesion pathology. RESULTS: The age of the patients was 15-65 years, with a mean age of 36.5 years. The pathologic diagnoses were fibroadenomas (41.8%, n = 46), fibrocystic changes (30.9%, n = 34), fibroadenomatoid hyperplasias (13.6%, n = 15), fibroadenomatoid mastopathies (6.3%, n = 7), adenoses (3.6%, n = 4), hamartomas (1.8%, n = 2) and phyllodes tumors (1.8%, n = 2). Complications 1 week after the US-guided VAB included hematomas (n = 39, 35.4%), pain (n = 23, 20.9%), fibrotic scars (n = 26, 23.68%), residual tumors (n = 4, 3.6%) and skin dimplings (n = 4, 3.6%). Complications 6 months after the US-guided VAB included hematomas (n = 12, 10.9%), pain (n = 3 2.7%), fibrotic scars (n = 14, 12.7%), and residual tumors (n = 17, 15.4%). Residual tumor after US-guided VAB existed in association with 15.2% of fibroadenomas (7/46), 14.7% of fibrocystic changes (5/34), 13.3% of fibroadenomatoid hyperplasias (2/15), 25% of adenoses (1/4), and 100% of phyllodes tumors (2/2). CONCLUSION: US-guided VAB is an effective procedure for removal of benign breast lesion. Periodic follow up studies at 1week and 6months after the VAB are useful to assess Post-VAB complications.
Biopsy ; Breast ; Cicatrix ; Fibroadenoma ; Follow-Up Studies ; Hamartoma ; Hematoma ; Humans ; Hyperplasia ; Neoplasm, Residual ; Phyllodes Tumor ; Prevalence ; Prospective Studies ; Skin ; Vacuum

Purpose: Glyphosate herbicide (GH) is a widely used herbicide and has been associated with significant mortality as poisoned cases increases. One of the reasons for high toxicity is thought to be toxic effect of its ingredient with glyphosate. This study was designed to determine differences in the clinical course with the salt-type contained in GH. Methods: This was a retrospective study conducted at a single hospital between January 2013 and December 2017. We enrolled GH-poisoned patients visited the emergency department. According to salt-type, patients were divided into 4 groups: isopropylamine (IPA), ammonium (Am), potassium (Po), and mixed salts (Mi) groups. The demographics, laboratory variables, complications, and their mortality were analyzed to determine clinical differences associated with each salt-type. Addtionally, we subdivided patients into survivor and non-survivor groups for investigating predictive factors for the mortality. Results: Total of 348 GH-poisoned patients were divided as follows: IPA 248, Am 41, Po 10, and Mi 49 patients. There was no difference in demographic or underlying disease history, but systolic blood pressure (SBP) was low in Po group. The ratio of intentional ingestion was higher in Po and Mi groups. Metabolic acidosis and relatively high lactate level were presented in Po group.As the primary outcome, the mortality rates were as follows: IPA, 26 (10.5%); Am, 2 (4.9%); Po, 1 (10%); and Mi, 1 (2%). There was no statistically significant difference in the mortality and the incidence of complications. Additionally, age, low SBP, low pH, corrected QT (QTc) prolongation, and respiratory failure requiring mechanical ventilation were analyzed as independent predictors for mortality in a regression analysis. Conclusion There was no statistical difference in their complications and the mortality across the GH-salt groups in this study.

OBJECTIVES: This study developed an algorithm for identifying pregnancy episodes and estimating the last menstrual period (LMP) in an administrative claims database and applied it to investigate the use of pregnancy-incompatible immunosuppressants among pregnant women with systemic lupus erythematosus (SLE). METHODS: An algorithm was developed and applied to a nationwide claims database in Korea. Pregnancy episodes were identified using a hierarchy of pregnancy outcomes and clinically plausible periods for subsequent episodes. The LMP was estimated using preterm delivery, sonography, and abortion procedure codes. Otherwise, outcome-specific estimates were applied, assigning a fixed gestational age to the corresponding pregnancy outcome. The algorithm was used to examine the prevalence of pregnancies and utilization of pregnancy-incompatible immunosuppressants (cyclophosphamide [CYC]/mycophenolate mofetil [MMF]/methotrexate [MTX]) and non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy in SLE patients. RESULTS: The pregnancy outcomes identified in SLE patients included live births (67%), stillbirths (2%), and abortions (31%). The LMP was mostly estimated with outcome-specific estimates for full-term births (92.3%) and using sonography procedure codes (54.7%) and preterm delivery diagnosis codes (37.9%) for preterm births. The use of CYC/MMF/MTX decreased from 7.6% during preconception to 0.2% at the end of pregnancy. CYC/MMF/MTX use was observed in 3.6% of women within 3 months preconception and 2.5% during 0-7 weeks of pregnancy. CONCLUSIONS This study presents the first pregnancy algorithm using a Korean administrative claims database. Although further validation is necessary, this study provides a foundation for evaluating the safety of medications during pregnancy using secondary databases in Korea, especially for rare diseases.

PURPOSE: This study was designed to investigate differences in ultrasonographic findings between malignant and benign mammary duct ectasia. METHODS: From January 2003 to June 2005, 54 surgically proven mammary duct ectasia lesions depicted on sonograms were included in this study. We evaluated the ultrasonographic (US) findings in terms of involved ductal location, size, margin, intraductal echogenicity, presence of an intraductal nodule, calcification, ductal wall thickening and echo changes of the surrounding breast parenchyma. The US findings were correlated with the pathological features. RESULTS: Of the 54 lesions, 46 lesions were benign and eight lesions were malignant. Benign lesions included an inflammatory change (n=7), ductal epithelial hyperplasia (n=7), fibrocystic change (n=18), intraductal papilloma (n=11), atypical ductal hyperplasia (n=2) and sclerosing adenosis (n=1). Malignant lesions included ductal carcinoma in situ (DCIS) (n=6), infiltrating ductal carcinoma (n=1) and mucinous carcinoma (n=1). On US images, the peripheral ductal location, an ill-defined margin, ductal wall thickening and a hypoechoic change of the surrounding parenchyma were features significantly associated with malignant duct ectasia. CONCLUSION: For ill-defined peripheral duct ectasia with ductal wall thickening and surrounding hypoechogenicity as depicted on US, the possibility of malignancy should be considered and radiologists should not hesitate to recommend a prompt biopsy.
Adenocarcinoma, Mucinous ; Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Dilatation, Pathologic ; Hyperplasia ; Papilloma, Intraductal ; Ultrasonography, Mammary