Several bills were proposed during the 20th and 21st National Assemblies to grant special judicial police powers to employees of the National Health Insurance Corporation (NHIC) to improve the low recovery rate of unfair profits collected by non-medical practitioner hospitals. The Ministry of Health and Welfare made a pre-announcement of legislation regarding the revision of the Enforcement Decree of the Medical Law, aiming to delegate certain enforcement responsibilities, including investigations into illegally established hospitals. This study discusses the contents and issues related to the bill, focusing on the revision of the Enforcement Decree of Medical Law and the bill proposed by the 21st National Assembly. Furthermore, it proposes improvements to address the challenges posed by non-medical practitioner hospitals.Current Concepts: We pointed out concerns regarding the bill to grant special judicial police powers to NHIC employees, such as the potential infringement of basic rights due to a lack of expertise among these special judicial police, a reversal of procedural thinking, challenges in identifying illegal hospitals, the appropriateness of granting investigative rights to NHIC employees, and the risk of abuse of these rights.Discussion and Conclusion: We propose strengthening the establishment, operations, and supervision of medical corporations; introducing a preliminary monitoring system for the establishment of medical institutions through branches of medical personnel organizations; and implementing a leniency program.

Background: Patients with hematologic cancers have a risk of drug-related problems (DRPs) from medications associated with chemotherapy and supportive care. Although the role of oncology pharmacists has been widely documented in the literature, few studies have reported its impact on cost reduction. This study aimed to describe the activities of oncology pharmacists with respect to hematologic diseases and evaluate the associated cost avoidance. Methods: From January to July 2021, patients admitted to the department of hemato-oncology at Seoul National University, Bundang Hospital were studied. The activities of oncology pharmacists were reported by DRP type following the Pharmaceutical Care Network version 9.1 guidelines, and the acceptance rate was calculated. The avoided cost was estimated based on the cost of the pharmacy intervention, pharmacist manpower, and prescriptions associated with the intervention. Results: Pharmacists intervened in 584 prescriptions from 208 patients during the study period. The most prevalent DRP was “adverse drug event (possibly) occurring” (32.4%), followed by “effect of drug treatment not optimal” (28.6%). “Drug selection” (42.5%) and “dose selection” (30.3%) were the most common causes of DRPs. The acceptance rate of the interventions was 97.1%. The total avoidance cost was KRW 149,468,321; the net profit of the avoidance cost, excluding labor costs, was KRW 121,051,690; and the estimated cost saving was KRW 37,223,748. Conclusion Oncology pharmacists identified and resolved various types of DRPs from prescriptions for patients with hematologic disease, by reviewing the prescriptions. Their clinical service contributed to enhanced patient safety and the avoidance of associated costs.

Purpose: A meta-analysis was conducted to determine the proportion of contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System category M (LR-M) in hepatocellular carcinomas (HCCs) and non-HCC malignancies and to investigate the frequency of individual CEUS LR-M imaging features. Methods: The MEDLINE and Embase databases were searched from January 1, 2016 to July 23, 2020 for studies reporting the proportion of CEUS LR-M in HCC and non-HCC malignancies. The meta-analytic pooled proportions of HCC and non-HCC malignancies in the CEUS LR-M category were calculated. The meta-analytic frequencies of CEUS LR-M imaging features in nonHCC malignancies were also determined. Risk of bias and applicability were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results: Twelve studies reporting the diagnostic performance of the CEUS LR-M category were identified, as well as seven studies reporting the frequencies of individual CEUS LR-M imaging features. The pooled proportions of HCC and non-HCC malignancies in the CEUS LR-M category were 54% (95% confidence interval [CI], 44% to 65%) and 40% (95% CI, 28% to 53%), respectively. The pooled frequencies of individual CEUS LR-M imaging features in non-HCC malignancies were 30% (95% CI, 17% to 45%) for rim arterial phase hyperenhancement, 79% (95% CI, 66% to 90%) for early (<60 s) washout, and 42% (95% CI, 21% to 64%) for marked washout. Conclusion In total, 94% of CEUS LR-M lesions were malignancies, with HCCs representing 54% and non-HCC malignancies representing 40%. The frequencies of individual CEUS LR-M imaging features varied; early washout showed the highest frequency for non-HCC malignancies.

Background/Aims: There have been few multicenter studies on colonic polyps conducted by primary medical institutions. This study examined the detection rate of colonic polyps in primary health care institutions and the related factors while following the guidelines. Methods: The medical records of 14,029 patients who underwent colonoscopy between January-June 2020 at 40 primary medical institutions in Korea were analyzed. High-risk adenoma was defined as advanced adenoma, carcinoma, or ≥3 adenomas. Results: Most patients (71.2%) aged ≥50 years underwent re-colonoscopy within 5 years (51.3%) for diagnostic purposes (61.3%) in Korean primary medical institutions. The detection rates of colon polyps, adenoma, advanced adenoma, high-risk adenoma, and carcinoma was 59.9%, 38.9%, 5.9%, 11.4%, and 0.3% in all subjects and 59.8%, 37.5%, 8.5%, 12.9%, and 0.3% in average-risk patients, respectively. The incidences of adenoma in average-risk patients increased significantly with age (30s/40s/50s: 20.1%/29.4%/43% for adenoma, 4.4%/6.7%/10.3% for advanced adenoma, and 5.6%/9.5%/14.6% for high-risk adenoma; p<0.05). Before 50 years of age, high-risk adenoma was detected in 9.1% of patients in the first-time screening group, and the significant risk factors were being male and ≥40 years of age. The detection rate of high-risk adenoma in the normal index colonoscopy group within 5 years was 9.0%. The significant risk factors included older age, male sex, positive fecal occult blood test, stool form changes, and nonspecific symptoms (gas and indigestion). Conclusions More colonic adenoma studies targeting real-world clinical practice will be needed to revise the Korean guidelines for colorectal cancer screening and surveillance.

This study aims to suggest practical strategies for improving the governance system of the Korean Medical Association (KMA). To this end, we used survey studies, statistical analysis, and literature reviews. The statistical analysis was performed using an analytic hierarchy process and frequency analysis. In our previous study, we proposed some measures to improve the governance system of the KMA. These measures included the organization of top decisionmakers’ meetings, recruitment of non-member officers, new qualification requirements for representatives and officers, commitment of functional roles to six vice-presidents, and organization of professional committees supporting the roles of six vice-presidents. In this study, we proposed practical strategies for the improvement measures and an implementation organization to achieve the suggested practical strategies. For the implementation of the practical strategies, the members of the KMA should understand the issue and the importance of the KMA’s governance. Additionally, the strong support of the members should be required to solve the internal problems of the KMA and to improve its governance system.

Background: Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. Methods: Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. Results: Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. Conclusions In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.

This study aims to suggest practical strategies for improving the governance system of the Korean Medical Association (KMA). To this end, we used survey studies, statistical analysis, and literature reviews. The statistical analysis was performed using an analytic hierarchy process and frequency analysis. In our previous study, we proposed some measures to improve the governance system of the KMA. These measures included the organization of top decisionmakers’ meetings, recruitment of non-member officers, new qualification requirements for representatives and officers, commitment of functional roles to six vice-presidents, and organization of professional committees supporting the roles of six vice-presidents. In this study, we proposed practical strategies for the improvement measures and an implementation organization to achieve the suggested practical strategies. For the implementation of the practical strategies, the members of the KMA should understand the issue and the importance of the KMA’s governance. Additionally, the strong support of the members should be required to solve the internal problems of the KMA and to improve its governance system.

Background: Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. Methods: Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. Results: Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. Conclusions In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.

The purpose of this study is to suggest improvement measures to solve the problems of governance within the Korean Medical Association (KMA), and to outline future tasks to implement these measures. The following measures are proposed to improve the governance of the KMA: a new representative system, the revision of the term of officers, new qualification requirements for representatives and officers, a clear business division for vice presidents, the organization and operation of councils by professional fields, and an organization of a top decision making committee. Future tasks to apply these measures in practice include the establishment of the direction of improvement of the KMA‘s governance, organization and operation of the presidential committee, and active participation and support of the KMA members. In order to improve the KMA‘s governance, the bodies of the KMA must avoid conflicts and criticisms; taking collective decisions about all tasks and policies should be made an essential principle. In conclusion, the bodies of the KMA must cooperate with each other while constantly considering and discussing the purpose of the establishment of the KMA. These measures will ensure the improvement of KMA’s governance.

The year 2020 marks the 112th year of the Korean Medical Association (KMA), which is a historic organization of medical experts. Since its foundation the KMA has contributed to the promotion of the health and medical care environment as well as the establishment and development of related policies. In times of health and medical care crises in the country, the KMA has always fought at the front lines. However, recent internal conflicts in the medical community have caused a lack of consistency and persistence in responding to or pursuing various health and medical policies. It weakens the KMA’s social status and influence, raising demands for its improvement. The first step for the betterment of the KMA is to analyze its critical situation. This study assumes that the internal conflicts are caused by the KMA’s governance. Through an analysis of how the KMA is currently governed, this study highlights the problems and suggests a direction for improvement.