Developing national level high alert medication lists for acute care setting in Korea

Background@#High-alert medications (HAMs) are medications that bear a heightened risk of causing significant patient harm if used in error. To facilitate safe use of HAMs, identifying specific HAM lists for clinical setting is necessary. We aimed to develop the national level HAM list for acute care setting. @*Methods@#We used three-step process. First, we compiled the pre-existing lists referring HAMs. Second, we analyzed medication related incidents reported from national patient safety incident report data and adverse events indicating medication errors from the Korea Adverse Event Reporting System (KAERS).We also surveyed the assistant staffs to support patient safety tasks and pharmacist in charge of medication safety in acute care hospital. From findings from analysis and survey results we created additional candidate list of HAMs. Third, we derived the final list for HAMs in acute care settings through expert panel surveys. @*Results@#From pre-existing HAM list, preliminary list consisting of 42 medication class/ingredients was derived. Eight assistant staff to support patient safety tasks and 39 pharmacists in charge of medication safety responded to the survey. Additional 44 medication were listed from national patient safety incident report data, KAERS data and common medications involved in prescribing errors and dispensing errors from survey data. A list of mandatory and optional HAMs consisting of 10 and 6 medication classes, respectively, was developed by consensus of the expert group. @*Conclusion@#We developed national level HAM list for Korean acute care setting from pre-existing lists, analyzing medication error data, survey and expert panel consensus.

Influenza Vaccination Coverage and Its Associated Factors among North Korean Defectors Living in the Republic of Korea

This study aimed to examine influenza vaccination coverage of North Korean defectors (NKD) in the Republic of Korea (Korea) and explore the factors affected the vaccination coverage. Total 378 NKD were analyzed. Four Korean control subjects were randomly matched by age and gender from the Korea National Health and Nutrition Examination Survey V (n = 1,500). The adjusted vaccination coverage revealed no statistical difference between the defectors group and indigenous group (29.1% vs. 29.5%, P = 0.915). In the aged under 50 group, the vaccination coverage of NKD was higher than that of Korean natives (37.8% vs. 25.8%, P = 0.016). However in the aged 50 yr and over group, the vaccination coverage of North Korean defectors was lower than that of the natives (28.0% vs. 37.6%, P = 0.189). Even the gap was wider in the aged 65 yr and over group (36.4% vs. 77.8%, P = 0.007). Gender and medical check-up experience within 2 yr showed association with the vaccination coverage of NKD. Influenza vaccination coverage of aged defectors' group (aged 50 yr and over) was lower than indigenous people though overall vaccination coverage was similar. Further efforts to increase influenza vaccination coverage of this group are needed.

Effect of Preoperative Flow Rate on Postoperative Retention and Voiding Difficulty After Transobturator Tape Operation

PURPOSE: Controversy exists over the preoperative risk factors for postoperative urinary retention after the midurethral sling procedure for stress urinary incontinence (SUI). We intended to analyze the effect of preoperative flow rate on postoperative urinary retention after the transobturator tape (TOT) operation. MATERIALS AND METHODS: A total of 322 patients who underwent TOT from June 2006 to May 2012 were included in this retrospective study. All patients were preoperatively investigated for urinary symptoms and underwent preoperative urodynamic studies including urine flow rate. Postoperative urinary retention, voiding difficulty, and uroflowmetry were checked. Urinary retention was defined as the need for additional catheterization longer than 1 day. Patients were divided by preoperative peak flow rate (Qmax) of 15 mL/s (low Qmax group and normal Qmax group). RESULTS: There were 3 cases of postoperative urinary retention (0.9%) and 52 cases of voiding difficulty (16.1%). The low Qmax group included 40 patients (12.4%) and the normal Qmax group included 282 patients (87.5%). Between the two groups, there were no significant differences in age, previous pelvic surgery history, or past medical history. The low Qmax group had higher scores for voided volume and detrusor pressure at Qmax. However, there was no significant difference in postoperative voiding difficulty between the two groups. Furthermore, three patients who experienced postoperative retention showed high flow rates preoperatively. CONCLUSIONS: Our results suggest that voiding difficulty in the group with low preoperative flow was tolerable and the treatment success rate was comparable to that in patients in the normal flow group. According to our analysis, patients with a low flow rate preoperatively can be safely treated with TOT for SUI.

The Role of Major Donors in Health Aid to the Democratic People's Republic of Korea / 예방의학회지

We investigated the major trends in health aid financing in the Democratic People's Republic of Korea (DPRK) by identifying the primary donor organizations and examining several data sources to track overall health aid trends. We collected gross disbursements from bilateral donor countries and international organizations toward the DPRK according to specific health sectors by using the Organization for Economic Cooperation and Development creditor reporting system database and the United Nations Office for the Coordination of Humanitarian Affairs financial tracking service database. We analyzed sources of health aid to the DPRK from the Republic of Korea (ROK) using the official records from the ROK's Ministry of Unification. We identified the ROK, United Nations Children's Fund (UNICEF), World Health Organization (WHO), United Nations Population Fund (UNFPA), and The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) as the major donor entities not only according to their level of health aid expenditures but also their growing roles within the health sector of the DPRK. We found that health aid from the ROK is comprised of funding from the Inter-Korean Cooperation Fund, private organizations, local governments, and South Korean branches of international organizations such as WHO and UNICEF. We also distinguished medical equipment aid from developmental aid to show that the majority of health aid from the ROK was developmental aid. This study highlights the valuable role of the ROK in the flow of health aid to the DPRK, especially in light of the DPRK's precarious international status. Although global health aid from many international organizations has decreased, organizations such as GFATM and UNFPA continue to maintain their focus on reproductive health and infectious diseases.

Trends in Cardiovascular Health Metrics among Korean Adults / 가정의학회지

BACKGROUND: American Heart Association (AHA) defined 7 cardiovascular health metrics for the general population to improve cardiovascular health in 2010: not smoking; having normal blood pressure; being physically active; normal body mass index, blood glucose, and total cholesterol levels; and eating a healthy diet. To investigate trends in cardiovascular health metrics in Korea, we used data from the third and fourth Korean National Health and Nutrition Examination Surveys. METHODS: We defined seven cardiovascular health metrics similar to the one defined by AHA but physical activity, body mass index, and healthy diet were properly redefined to be suited for the Korean population. We compared each cardiovascular health metric and calculated the sum of cardiovascular health metrics after dichotomizing each health metric to ideal (scored 1) and poor (scored 0). RESULTS: Health metric scores of smoking in males (P value for trend < 0.001), physical activity both in males and females (P-value for trend < 0.001 both), body mass index in females (P-value for trend = 0.030), and blood pressure both in males and females (P-value for trend < 0.001, both) were improved. On the other hand, health metric scores of healthy diet in males (P-value for trend = 0.002), and fasting blood glucose both in males and females (P-value for trend < 0.001 both) got worse. The total scores of seven health metrics were stationary. CONCLUSION: Total scores were not changed but each metric showed various trends. A long-term study is necessary for analyzing exact trends.

Current Situation of Psychiatry in North Korean : From the Viewpoint of North Korean Medical Doctors / 정신신체의학

OBJECTIVES: Psychiatry in North Korea is believed to seem very different from psychiatry in South Korea. However, there is nearly no information regarding psychiatry in North Korea until now. Our study aimed to get information about North Korean psychiatry. METHODS: Three North Korean defectors in South Korea, whose clinical experience as medical doctors in North Korea was over 10 years, were recruited. They underwent the semi-structured interview, content of which included the clinical experience with psychiatric patients, the details of psychiatry, the treatment of psychiatric patients, the stigma of mental illness, and the suicide, in North Korea. RESULTS: In North Korea, psychiatric department was called as 49th(pronounced as Sahsip-gu-ho in Korean). Only patients with vivid psychotic symptoms came to psychiatric department. Non-psychotic depression or anxiety disorders usually were not dealt in psychiatry. The etiology of mental illness seemed to be confined to biological factors including genetic predisposition. Psychosocial or psychodynamic factors as etiology of mental illness appeared to be ignored. Psychiatry was apparently separated from political or ideological issues. The mainstay of psychiatric treatment is the inpatient admission and out-of-date therapy such as insulin coma therapy. Stigma over mental illness was common in North Korea. Suicide is considered as a betrayal to his/her nation, and has been reported to be very rare. CONCLUSION: The situation of psychiatry in North Korea is largely different from that of South Korea. Although some aspects of North Korean psychiatry are similar to psychiatry in former socialist countries, North Korean psychiatry is considered to have also its unique characteristics.

Effect of Horizontal Eye Movements on the Heart Rate Variability after Exposure to a Fear-Inducing Film Clip

OBJECTIVES: There has been a continued debate regarding the role of eye movements in Eye Movement Desensitization and Reprocessing(EMDR). This study examined the possible autonomic effect of horizontal eye movements after being exposed to fearful stimuli. METHODS: Fifty two healthy adult women were randomly allocated to eye movement or eye fixed groups after watching a five minute fear-inducing film clip. ECG was recorded during the resting state, after watching the clip, and the treatment. A spectral power analysis of the heart rate variability was performed. As the variables violated the rule of normal distribution and the number in each group is small the non-parametric test was used. RESULTS: Overall, we did not find the differences between the groups in both time and frequency domains. Some minor differences found were not consistent with results from previous studies. CONCLUSIONS: Effect of eye movement on autonomic nervous system during fear desensitization was not supported in this experiment. Further study with other psychophysiological measures is needed to understand the role of eye movements in treatment of traumatic memory.

Psychosocial Correlates of Duration of Untreated Psychosis in the First-Episode Schizophrenia / 신경정신의학

OBJECTIVES: This study investigated the psychosocial factors and clinical symptoms related to the duration of untreated psychosis (DUP) in 35 consecutive first-episode inpatients with schizophrenia. METHODS: Data from 35 schizophrenic patients were obtained from two general psychiatric inpatient units at a university medical center. These data included scores from Index of Social Position (ISP), Positive and Negative Syndrome Scale (PANSS) and Symptom Checklist-90-Revised (SCL-90-R) as well as socio-demographic informations. RESULTS: Among socio-demographic variables, lower social position (r=.610, p<.001), male sex (r=.407, p=.015), and grew up in rural area (r=.335, p=.045) were significantly correlated with DUP. The interpersonal sensitivity of SCL-90-R was the only symptomatic variable significantly correlated with DUP (r=.379, p=.027). However, after controlling interactive effects of the variables, only lower social position and interpersonal sensitivity remained significant. Lower social position was more influential on DUP than interpersonal sensitivity in the multiple regression model. CONCLUSION: Both social and symptomatic factors independently influenced DUP in schizophrenic patients. Lower social position defined by education and occupation of patients or caretakers may reflect barriers to psychiatric services or poor identification of mental illness. This together with patients' subjective distress in interpersonal interactions may delay the intervention of psychiatric services.

Factor Structure of the Korean Version of Illness Intrusiveness Rating Scale: Cross-cultural Implications

The Illness Intrusiveness Rating Scale (IIRS) measures illness-induced disruptions to 13 domains of lifestyles, activities, and interests. A stable three-factor structure has been well documented; however, the cross-cultural validity of this scale needs to be tested. This study investigated the factor structure of the Korean version of IIRS in 712 outpatients at a university medical center. A predominant diagnosis of the patients was rheumatoid arthritis (47%). The Center for Epidemiological Studies-Depression Scale (CES-D), and Health Assessment Questionnaire (HAQ) were also administered. Exploratory Principal Component Analysis identified a two-factor structure, "Relationships and Personal Development (RPD)" and "Instrumen-tal", accounting for 57% of the variance. Confirmatory analyses extracted an identical factor structure. However, a goodness-of-the fit test failed to support two-factor solution (X2 =138.2, df=43, p<.001). Two factors had high internal consistency (RPD, alpha=.89; Instrumental, alpha=.75) and significantly correlated with scores of HAQ (RPD, r=.53, p<.001; Instrumental, .r=44, p<.001) and CES-D (RPD, .r=55, p<.001; Instrumental, .r=43, p<.001). These findings supported construct validity of the Korean version of IIRS, but did not support cross-cultural equivalence of the factor structure.

Physical Violence Reported by Han and Korean Chinese School Children(I): Ethnic Difference in the Prevalence / 신경정신의학

OBJECTIVES: This study sought to determine ethnic difference in physical violence and to see if ethnicity is an independent predictor of violence by surveying eight Korean or Han ethnic elementary schools in Yanji city, China. A total of 2,316 school children from fourth through sixth grade participated the study. METHODS: Participants completed a questionnaire on sociodemographic background and experiences of physical violence during the previous year using the Conflict Tactics Scale. The history of physical violence was categorized as within the family, by peers, or by teachers. RESULTS: Han children reported significantly higher rates of physical abuse compared with Koreans (76.2% vs. 54.9%, chi2=116.12, df=1, p=<.001). Binary logistic regression analysis identified five risk factors for physical violence:(1) ethnic Han (odds ratio [OR]=3.01, 95% confidence interval [CI]=2.47-3.66), (2) boys (OR=2.76, 95% CI=2.28-3.36), (3) poor economic status (OR=1.69, 95% CI=1.17-2.42), (4) single or absent parents (OR=1.42, 95% CI=1.09-1.86), (5) interaction of fourth-graders with promotive or neutral opinions of corporal punishment (OR=2.41, 95% CI=1.86-3.13). Ethnicity remained an independent risk factor after other sociodemographic variables were controlled. CONCLUSION: These findings showed cross-cultural risk factors of child physical abuse, including ethnicity which previously identified as a factor in literature. This study particularly reports lower prevalence of physical violence in ethnic minority, Korean-Chinese, compared with the Han ethnic group. This result explained a special environment of Korean self-government district and the successful adaptation of the ethnic minority to the mainstream culture.

Prevalence and Correlates of Sexual Assault in Psychiatric Patients / 신경정신의학

OBJECTIVES: The direct causal relationship between the experience of sexual assault and development of psychiatric disorder remains uncertain. However, studies consistently show that those with history of this horrendous event report a wide range of symptoms, higher level of distress, and various social and psychological problems. This study investigated the prevalence and associated risk factors in a cohort sample of 340 Korean psychiatric patients. METHODS: Data from consecutive 340 new patients were gathered at a psychiatric department of a university affiliated hospital. Participants completed Life Events Scale, Symptom Checklist-90-R, State-Trait Anxiety Inventory, Beck Depression Inventory, and Dissociative Experiences Scale. RESULTS: History of sexual assault was reported by 11.5% of respondents (women 18.6%;men 2.1%). Bivariate analysis revealed that women (p<.001), divorced or widowed and never been married (p<.05), unemployed and students or housewives (p<.05), monthly income more than 2 million Won (p<.05) were associated significantly with experience of sexual assault. All the scores from the scales but Beck Depression Inventory were significantly higher for the sexually assaulted. Multiple logistic regression analysis revealed that women were 12 times more likely to be sexually assaulted (Odds ratio=12.24, 95% CI=3.51-42.64). Other risk factors included younger age and interaction of post-traumatic stress disorder (PTSD) and Global Severity Index. CONCLUSION: This study supported the risk factors of sexual assaults identified in western literature. Clinicians can be alert for any history of sexual assault when younger women with PTSD present higher level of symptomatology.

Effect of Transduced Tumor Necrosis Factor-alpha Gene Expression on Growth of Human Bladder Tumor Cell Lines / 대한비뇨기과학회지

OBJECTIVE: To evaluate the effect of transduced tumor necrosis factor-a(TNF-a) gene expression on growth of human bladder tumor cell lines in vitro. MATERIALS AND METHODS: The complete cDNA of TNF-a was introduced to three human bladder tumor cell lines(F-24, J-82, HT-1197) using a retroviral vector, a recombinant form of Molony murine leukemia virus with TNF-a and Neo gene and transfected cells were selected by exposure to neomycin analog G418. Gene transfer and expression were confirmed by polymerase chain reaction(PCR) and reverse transcription polymerase chain reaction(RT-PCR)-Southern blotting. Cell growth was measured by MTT assay Result is Successful gene transfer and expression were confirmed in all three cell bladder tumor lines. Growth of transfected cells were compared with parental cell lines and no differences were found in all three cell lines(p>0.05). CONCLUSION: Expression of transduced TNF-t gene could not show any effect on growth of human bladder tumor cells in vitro.

Evaluation of the Augmentation Cystoplasty in the Pediatric Neurogenic Bladder / 대한비뇨기과학회지

From 1985 to 1995, 13 children with neurogenic bladder underwent augmentation cystoplasty. Diagnosis in these 13 children included Meningomyelocele in 11 and unknown origin in 2. Indications for augmentation cystoplasty were persists incontinence in 6 patients and progressive upper urinary tract deterioration in Bowel segments were used for augmentation included sigmoid colon in 1 patient, ileocecal segments incontinence in 6 patients stomach in 3. Dilated ureter also was used in 1 patient. Postoperatively, all the patients have stable upper tracts radiographically and stable or improved renal function. Of 13 patients 12 require clean intermittent catheterization to empty bladder and 10 are completely continent. After operation, bladder capacity increased from 155 ml to 305 ml and there were significant increases in bladder compliance. Hypereflexia was present in 5 patients before operation and in 3 patients after operation. There has been no surgical mortality. Postoperative complications occurred in 4 patients included mild ileus in 2 patients, mucus obstruction in 1, mild hematuria in 1, metabolic alkalosis in 1 and superficial wound infection in All complications were transient and managed medically. the kind of bowel segments did not seem to influence results. We think that augmentation cystoplasty is a therapeutic modality that should be considered as a viable treatment option in selected patients with neurogenic bladder dysfunction.