Korean Journal of Family Medicine

A Case of Painful Diplopia after COVID-19 Vaccination: Could It Be Tolosa-Hunt Syndrome?: Wafa Ammari, Alyssa Kammoun, Asma Zaghdoudi, Olfa Berriche, Samia Younes, Riadh Messaoud; Korean J Fam Med 2023;44(4):240-243. Published online July 18, 2023; DOI: https://doi.org/10.4082/kjfm.22.0201

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Herein, we report a rare case of Tolosa-Hunt syndrome (THS) following coronavirus disease 2019 (COVID-19) vaccine administration. A 64-year-old patient presented with recurrent horizontal diplopia and ipsilateral orbital pain, 2 weeks after being administered the COVID-19 vaccination. A diagnosis of THS was based on the relevant criteria after ruling out the differential diagnoses. The clinical presentation improved with corticosteroid administration. THS must be recognized as a complication of COVID-19 vaccination. This association can be explained by an autoimmune response.

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A Novel Scale for Assessing the Burden of Caregiving for Functionally Compromised Patients: Proposal and Validation: Arun-Kumar Kaliya-Perumal, Anupama Korlakunta, Jacquilyne Kharlukhi, Sarada Devireddy; Korean J Fam Med 2021;42(1):31-37. Published online January 3, 2020; DOI: https://doi.org/10.4082/kjfm.19.0063

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Background
Disability not only burdens the patient, but also the caregiver. To quantify this caregiving burden, we propose a simple four-part questionnaire tool. Our objective is to validate this questionnaire by administering it to caregivers who oversee patients with low back pain and are functionally compromised.
Methods
Twenty-five spouse caregivers who were taking care of in-patients awaiting surgery for various lumbar spine pathologies were shortlisted. The content-validated questionnaire was administered on different occasions during the care recipient’s treatment. Cronbach’s α was calculated to assess internal consistency. Interrelationships between the care recipient’s pain score, extent of functional compromise, and caregiver burden were calculated. The questionnaire’s ability to track changes in the caregivers’ attitudes over time was assessed.
Results
The percentage of caregiver burden before the surgery of the care recipient was 52.5. This increased significantly to 61.1% (P=0.001) 3 days after surgery, but was found to decrease to 32.5% (P<0.001) a month after the surgery; demonstrating the questionnaire’s efficacy to track changes. Cronbach’s alpha of 0.948 signifies the questionnaire’s excellent internal consistency. Pearson’s correlation coefficient (r) between the care recipient’s pain score and caregiver’s burden score was 0.41 (P=0.04), and between the care recipient’s disability score and caregiver’s burden score was 0.9 (P<0.001).
Conclusion
The proposed questionnaire is consistent and can track changes in a caregiver’s attitude over time. It can be adopted for clinical use to assess the burden of caregiving for functionally compromised patients.

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Family functioning and caregiver's perceptions of burden among chronic kidney disease patients
C Vasantha Kalyani, Priyanka Malhotra, Kusum Kumari
Journal of Kidney Care.2025; 10(5): 227. CrossRef

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Medical Student Debt: What Perspective Should We Take?: Kieran Walsh; Korean J Fam Med 2015;36(4):159-161. Published online July 17, 2015; DOI: https://doi.org/10.4082/kjfm.2015.36.4.159

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Since medical education is expensive, healthcare professional students in many countries must take out loans to pay for their studies. The resultant levels of debt have created concerns at both the beginning and the end of undergraduate education. How should medical educators respond to these concerns? If educators are to look at medical education from the perspective of their students who are most in need, then they should think about this. Educators should think about their response when current or prospective students ask them about mitigating the costs of medical education. This may include questions about working during undergraduate studies, the costs of living in different locations, and the availability of bursaries that offer financial aid to students. Medical students should be encouraged to "think like an investor" when making decisions related to their medical education. Senior medical educators should be well placed to advise them in this regard.

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The Cost of Postgraduate Medical Education and Continuing Medical Education: Re-Examining the Status Fifty Years Back: Kieran Walsh; Korean J Fam Med 2015;36(2):46-49. Published online March 23, 2015; DOI: https://doi.org/10.4082/kjfm.2015.36.2.46

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The subject of the cost and value of medical education is becoming increasingly important. However, this subject is not a new one. Fifty years ago, Mr. DH Patey, Dr. OF Davies, and Dr. John Ellis published a report on the state of postgraduate medical education in the UK. The report was wide-ranging, but it made a considerable mention of cost. In this short article, I have presented the documentary research that I conducted on their report. I have analyzed it from a positivist perspective and have concentrated on the subject of cost, as it appears in their report. The authors describe reforms within postgraduate medical education; however, they are clear from the start that the issue of cost can often be a barrier to such reforms. They state the need for basic facilities for medical education, but then outline the financial barriers to their development. The authors then discuss the costs of library services for education. They state that the "annual spending on libraries varies considerably throughout the country." The authors also describe the educational experiences of newly graduated doctors. According to them, the main problem is that these doctors do not have time to attend formal educational events, and that this will not be possible until there is "a more graduated approach to responsible clinical work," something which is not possible without financial investment. While concluding their report, the authors state that the limited money invested in postgraduate medical education and continuing medical education has been well spent, and that this has had a dual effect on improving medical education as well as the standards of medical care.

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Investigation flipped classroom effectiveness in teaching anatomy: A systematic review
Mohsen Kazeminia, Leili Salehi, Masoud Khosravipour, Fatemeh Rajati
Journal of Professional Nursing.2022; 42: 15. CrossRef
Costs and Cost-Effectiveness of mCME Version 2.0: An SMS-Based Continuing Medical Education Program for HIV Clinicians in Vietnam
Lora L. Sabin, Aldina Mesic, Bao Ngoc Le, Nafisa Halim, Chi Thi Hue Cao, Rachael Bonawitz, Ha Viet Nguyen, Anna Larson, Tam Thi Thanh Nguyen, Anh Ngoc Le, Christopher J. Gill
Global Health: Science and Practice.2022; 10(4): e2200008. CrossRef

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Health Economics and Outcomes Research.: Chul Min Kim; Korean J Fam Med 2009;30(8):577-587. Published online August 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.8.577

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Health conomics refers to the scientific discipline that compares the value of one healthcare program to another. It is a sub-discipline of Micro-economics. A health economic study evaluates the cost (expressed in monetary terms) and effects (expressed in terms of monetary value, effi cacy or enhanced quality of life) of a healthcare program or product. We can distinguish several types of health economic evaluation: cost-minimization analysis, cost-benefi t analysis, cost-effectiveness analysis and cost-utility analysis. Health economics studies serve to guide optimal healthcare resource allocation, in a standardized and scientifi cally grounded manner. Health economics research facilitates the translation of health technology assessment into useful information for healthcare decision-makers to ensure that society allocates scarce health care resources wisely, fairly and effi ciently. Health economics usually evaluate the outcomes like clinical, economics and humanistic outcomes per costs. Health economics research include pharmacoeconomics, clinical epidemiology, decision analysis, modeling, risk assessment, patient-reported outcomes (quality of life), database analyses, observational studies, and patients registries.

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Chong Yeob Kim, Jung-Hyun Kim
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Cost-Benefit Analysis of Occupational Therapy in Center for Dementia Based on Public Data
Seung-Hyun Cho, Kyung-Yoon Kam, Sung-Yoon Bae, Nam-Hoon Cho, Hye-Won Oh, Young-Ae Yang
Journal of Korean Society of Occupational Therapy.2018; 26(2): 99. CrossRef
A Review of Economic Evaluations in Acupuncture for Allergic Rhinitis
Dong-Hyo Lee
The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology.2016; 29(2): 1. CrossRef
Association between research topics and disease burden in health technology assessment
Hee Sun Kim, Jisu Lee, Bit-Na Yoo
Journal of the Korean Medical Association.2016; 59(7): 536. CrossRef
Economic Impact of Atopic Dermatitis in Korean Patients
Chulmin Kim, Kui Young Park, Seohee Ahn, Dong Ha Kim, Kapsok Li, Do Won Kim, Moon-Beom Kim, Sun-Jin Jo, Hyeon Woo Yim, Seong Jun Seo
Annals of Dermatology.2015; 27(3): 298. CrossRef
Cost-effectiveness analysis of low density lipoprotein cholesterol-lowering therapy in hypertensive patients with type 2 diabetes in Korea: single-pill regimen (amlodipine/atorvastatin) versus double-pill regimen (amlodipine+atorvastatin)
Ji-Hyun Park, Yong-Ho Lee, Su-Kyoung Ko, Bong-Soo Cha
Epidemiology and Health.2015; 37: e2015010. CrossRef
Value-based medicine: concepts and application
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Epidemiology and Health.2015; 37: e2015014. CrossRef

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Socioeconomic Costs of Alcohol Drinking in Korea.: Sunmi Lee, Woojin Chung, Il Soon Kim, Han Joong Kim, Woohyun Cho, Euichul Shin, Sang Hoon Ahn, Kwang Hyub Han, Jae Il Myoung; J Korean Acad Fam Med 2008;29(3):201-212. Published online March 10, 2008

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Background
The purpose of this study was to estimate socioeconomic costs caused by alcohol drinking in Korea as of 2004 in an effort to raise the awareness of the gravity of problems associated with alcohol drinking and the necessity of active intervention by family physicians. Methods: The costs were classified as direct costs, indirect costs and other costs. The direct costs consisted of direct medical costs and direct non-medical costs. The indirect costs were computed by the reduction and loss of productivity and the loss of workforce. Other costs consisted of property loss, administration costs and costs of alcohol beverage. Results: The annual costs, which seemed to be attributable to alcohol drinking, were estimated to be 200,990 hundred million won (2.9% of GDP). In the case of the former, the amount included 38.83% for reduction of productivity, 26.92% for loss of the workforce, 22.24% for alcoholic beverage, 5.34% for direct medical costs, 2.29% for loss of productivity, 1.87% for direct non- medical costs, 1.54% for administration costs and 0.97% for loss of property. Conclusion: Our study confirms that compared with the cases of Japan (1.9% of GNP), Canada (1.09% of GDP), France (1.42% of GDP) and Scotland (1.19% of GDP), alcohol drinking incurs substantial socioeconomic costs to Koreans. An active intervention by family physicians is suggested. (J Korean Acad Fam Med 2008;29:201-212)

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Cost-effectiveness Analysis of Colorectal Cancer Screening in Korean General Population.: Sang Min Park, Yoon Jung Chang, Young Ho Yun, Tai Woo Yoo, Bong Yul Huh, Soonman Kwon; J Korean Acad Fam Med 2004;25(4):297-306. Published online April 10, 2004

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Background
: CRC is an ideal target for population screening because it is a prevalent disease with an identifiable precursor lesion. This study was performed for the purpose of comparing cost-effectiveness of CRC screening strategies.

Methods : The natural history of a simulated cohort of 50- year-old Koreans in the general population was modeled with and without CRC screening until age 80 years. We evaluated 16 different screening strategies with Markov model. Cases of positive screening test results were worked up with a colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Our main outcome measurements were discounted lifetime costs, life expectancy and incremental cost-effectiveness (CE) ratio, comparing 16 different CRC screening strategies.

Results : In base-case analysis, compliance was assumed to be 60% with the initial screen and 80% with follow-up or surveillance colonoscopy. The non-dominated strategies were colonoscopy every 10 years (COL10), colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). Strategies that only included sigmoidoscopy were generally not regarded as non-dominated strategies, but sigmoidoscopy every 5 years (SIG5) showed similar cost and effects as COL10 while sigmoidoscopy every 3 years (SIG3) had similar results as COL5. Other strategies recommended by the expert panel, such as sigmoidocopy plus colon study every 5 years were less cost-effective than the alternatives.

Conclusion : Colonoscopy is the most cost-effective strategy in Korea for colorectal cancer screening. Unfortunately, the number of physicians skilled enough to perform colonoscopy is not enough to meet the demands of screening for colorectal cancer in average-risk adults. Therefore, we consider alternative strategies such as SIG5 or SIG3.

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Use of complementary therapies for rheumatologic conditions among patients of rheumatologists.: Eun Suk Jun, Kyung Ho Park, Hoon Ki Park, Jung Kwon Lee, Dae Hyun Yoo, Seong Yoon Kim; J Korean Acad Fam Med 2001;22(3):371-385. Published online March 1, 2001

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Background
: Use of Complementary and Alternative Medicine(CAM) is common among patients with chronic conditions such as rheumatic disorder. This study was conducted to know rate and behavior of using CAM and to improve doctor-patient relationship in rheumatic patients.

Methods : Among patients visiting a tertiary hospital rheumatology clinic, 867 persons (15.8% of total) were selected conveniently and interviewed by a trained nurse according to structured questionnaire from July 1st through July 31st 1999. Three hundred and sixty two CAM users completed the interview.

Results : Among 867 persons interviewed, 372 persons had used CAM (use rate 44%). Use rate of Chinese medicine was 26%, CAM except Chinese medicine 21%. Herb medicine(49.4%) was the commonest single category of all CAM. Twenty four percents of users had used two or more types of CAM, 6.8% had experienced adverse effects. The average yearly cost for CAM was 704,000 won/person, 64% of the one for hospital use, 1,100,000 won/person. The subjectively rated degree of effectiveness was 6.3 points which was significantly higher when compared with 5.9 points for hospital services. The degree of satisfaction with CAM was 5.6 points which was higher than that of hospital services, 4.8 points. The most frequently reported reason for using CAM was the hope for synergistic treatment effect(32%). The proportion of experiencing adverse effects from CAM was 7% of all users. Only one fourth of the users had discussed on the CAM use with the western doctors. The commonest reason for not discussing CAM was that the respondents had no need to discuss about it (40%). Among doctor's attitudes when discussing CAM with patient, limited aproval was most common(40%).

Conclusion : Among patients with rheumatic conditions, 44% use CAM. Herb medicine was most commonly used CAM. Comparing with hospital services, cost for CAM is 2/3 but its subjective effectiveness and satisfaction are higher. Western doctors must consider appropriately the need from users of alternative medicine.

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The comparison of the medical costs and quality of life in terminal cancer patients by the types of medical facilities.: Chang Hwan Yeom, Youn Seon Choi, Hye Ree Lee, Jae Yong Shim, Young Seon Hong, Wha Sook Choe, Young Ran Park; J Korean Acad Fam Med 2000;21(3):332-343. Published online March 1, 2000

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Background
: Life expectancy is ever increasing due to medical advancements, but cancer death rate is also increased. Quality of life is an important issue in cancer patients. Despite developments of early diagnosis and treatments for cancer, the medical costs is increasing due to extended survival against cancer and the absolute numbers of terminal cancer patients. We assessed the medical costs and quality of life in terminal cancer patients by the types of medical facilities, which would contribute to effective management.
Method: A total 159 patients (males 70, females 89) with terminal cancer patients who were treated and died in various types of medical facilities(home hospice, charity hospital hospice unit, university hospital hospice unit, university hospital non-hospice unit) between November 1, 1997 and January 31, 1999 were included in the study. After the confirmation that the demographic factors correlated with factors of quality of life, the differences in the medical costs and quality of life(pain, depression, ADLs, family APGAR score) during the last 1 week of life in the various types of medical facilities analyzed by multi-way ANOVA with interaction of the significant demographic factors.

Results : The mean cost of types of medical facilities during the last week of patients as 65,332.5 won in charity hospital hospice unit, 105,165.5 won in home hospice, 702,083.4 won in university hospital hospice unit, and 1,037,358.6 won in university hospital non-hospice unit. The difference between free hospital hospice unit and home hospice in medical costs as not statistically significant, but the difference among charity hospital hospice unit and home hospice, university hospital hospice unit, and university hospital non-hospice unit as significant (p<0.001). The demographical factors of quality of life in terms of pain, depression, ADLs, and family APGAR score were compared among various facilities. The ADL score of home hospice was 8.2±3.3, which was lower than free hospital hospice unit and university hospital hospice unit(p<0.05). The mean pain score of home hospice as 1.7±1.7 and that of university hospital hospice as 1.2±1.2, and pain scores of home hospice were lower than free hospital hospice unit, and pain scores of university hospital hospice were lower than free hospital hospice unit and university hospital non-hospice unit(p<0.05). In depressions categorical scale of home hospice the score was 4.8±1.3, which was higher than those of free hospital hospice unit and university hospital non-hispice unit(p<0.05), signifying less depression. The family APGAR score was statistically insignificant among various types of medical facilities.

Conclusion : The cost of hospice care is less than the non-hospice care. We found that the patients of home hospice experienced less pain and depression even with low ADLs, and increased the quality of life in both psychological and physical aspects.