• Title/Summary/Keyword: 질분만 경험

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A Study on Patients' Satisfaction and Service Utilization in the DRG Based Payment System - Patients who Experienced Cesarean Section Before and After the Demonstration Program - (DRG 지불제도에서 환자의 의료서비스 만족도와 제공량에 관한 연구 - 시범사업 전.후 제왕절개 분만 경험 산모를 대상으로 -)

  • Kim, Ji Sook;Park, Hayoung
    • Quality Improvement in Health Care
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    • v.7 no.2
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    • pp.190-202
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    • 2000
  • Background : The objectives of this study were to examine patients' satisfaction with the DRG based payment method and its association with their awareness of the method, to examine patient reported changes in doctors' caring attitude, level of their out-of-pocket payments, providers' acceptance of patients' request for additional services after the program, and to examine changes in service utilization recorded in medical records. Method : One hundred-four patients who had cesarean sections before and after the demonstration program at two hospitals located in Seoul participated in the study. Patients were surveyed before discharges when their charges were finalized. Their medical records were reviewed as well to collect data for service utilization during hospital stays. The association between patients' satisfaction with the payment method and their awareness of the method was analyzed by ${\chi}^2$-test, and the significance of changes in providers' acceptance of patients' request for additional services and service utilization after the program were examined by ${\chi}^2$-test and t-test, respectively. Results : A large proportion of patients did not know of the DRG based payment method at the time of survey and a significantly larger proportion of patients who came to the hospitals with the knowledge satisfied with the method. About the same proportion of patients reported improvement and deterioration in doctors' caring attitude compare to the previous hospitalizations and a similar result was found concerning out-of-pocket payments. Providers' acceptance of patients' request for medication, PCA and painless delivery decreased significantly after the program whereas the acceptance for additional hospital days and laboratory and radiology tests did not. Length of stay, the numbers of days on antibiotics and antianemic medication, and the number of blood tests decreased significantly after the program, however, decreases in the rate of antianemic medication and the number of urine analyses were not statistically significant. Re-operation, in-hospital death, and complications were not observed before and after the program. Conclusion : The study findings indicated a need for better patient education and publicity about the newly introduced payment method to improve their satisfaction with the system. Other study findings concerning service utilization and quality of care indicators were consistent with the government funded evaluation studies.

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SURGICAL REPAIR OF COMPLETE BONY BILATERAL CHOANAL ATRESIA VIA TRANSPALATAL APPROACH (완전 골성 양측성 후비공 폐쇄 환자의 구개부를 통한 외과적 치험례)

  • Kim, Kyoung-Won;Cho, Yong-Seok;Yang, Soo-Nam
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.20 no.2
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    • pp.133-138
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    • 1998
  • Choanal atresia may be membrane or bony, unilateral or bilateral. Approximately 90% of the choanal atresia are bony type. Unilateral choanal atresia often eludes the diagnosis because of the absence of subjective symptoms in the neonatal period. However, bilateral choanal atresia presents at birth with cyclic respiratory distress aggravated by feedings. So complete bilateral choanal atresia is considered as a neonatal emergency. Examinations for the diagnosis of chonal atresia include 1) attempt at passing a rubber catheter or probe through the patient s nose, 2) mirror examination of the nasopharynx, 3) digital examination of the nasopharynx, 4) X-ray examination after installation of radiopaque materal into the nasal cavity. But, computed tomography has become accepted method for evaluation of choanal atresia. Surgical repair of choanal atresia is accomplished via transnasal or transpalatal approach. Advantages of the transpalatal approach are improved exposure and the preservation of mucosal flap along the newly formed apertures. On the other hand, the transpalatal approach carries the risk of injury to the greater palatine neurovascular complex, and requires longer operative time. After careful physical and radiographic examinations, we accomplished the surgical repair of the complete bony bilateral choanal atresia via transpalatal approach without complications.

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A Clinical Study of 20 Uterine Sarcomas (자궁육종 20례에 대한 임상적 고찰)

  • Lee, Young-Gi;Park, Yoon-Ki;Lee, Doo-Jin
    • Journal of Yeungnam Medical Science
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    • v.15 no.2
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    • pp.275-285
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    • 1998
  • Sarcoma of the uterus is very rare malignant tumor originating from uterine muscle or connective tissue. We have experienced 20 cases of uterine sarcoma from January 1991 to June 1998. The results were as follows: 1. The pathologic types were 13 cases(65.0%) of leiomyosarcoma, 5 cases(25.0%) of malignant mixed Mullerian tumor, 1 case of rhabdomyosarcoma, and 1 case of angiosarcoma. 2. The average age and parity was 50.2 and 3.7. The chief complaints were irregular vaginal bleeding(35.0%), lower abdominal pain(25.0%), and abdominal mass(25.0%). 3. Nine cases(45.0%) were FIGO stage I, 1 case(5.0%) was stage II, 6 cases(30.0%) were stage III, and 4 cases(20.0%) were stage IV. 4. The survival was from 1.5 months to over 130 months(median 16.5 months), and there was no correlation between survival and FIGO stage or pathologic type. The correlation between survival and number of mitotic figure was incalcurable. 5. CA 125 levels were serially measured as a tumor marker in monitoring patients and the positive rate was 40%. Further study was needed to make a conclusion for usefulness of CA 125 as a tumor marker.

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Studies on Dairy Farming Status, Reproductive Efficiencies and Disorders in New Zealand (I) A Survey on Dairy Farming Status and Milk Yield in Palmerston North Area (뉴질랜드 (Palmerston North) 의 낙농 현황과 번식 및 번식장해에 관한 연구(I) Palmerston North 지역의 낙농 현황과 우유 생산량에 관한 조사 연구)

  • 김중계;맥도날드
    • Korean Journal of Animal Reproduction
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    • v.24 no.1
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    • pp.1-18
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    • 2000
  • Eighty dairy farms in Palmers ton North area in New Zealand were surveyed on 1) general characteristics (10 Questions), 2) milk yield and feed supplementary (7 questions), 3) reproductive efficiencies (12 questions) and 4) reproductive disorders (12 questions) by mail questions from February to July, 1998. Among those 4 items from 38 dairy farms (47.5%), especially in items 1) and 2), overall dairy farming situation, supplementary feeding and milk yields were surveyed and analyzed for Korean dairy farmers (especially in Cheju island) to have better understanding or higher economical gains. The results were as follows. 1. In dairy experience, 21 (45%) among 38 dairy farms surveyed were answered that farming less than 15 years, 15~19 year, 20~25 years and over 26 years experience were 3 (7.9%), 7 (18.4%), 6 (15.8%) and 5 (13.2%) which generally showed longer experience compare to Korean dairy farming situation. In survey of labour input and business goal of dairy farming, self-managing farms, sharemilkers, unpaid family manpowering farms, manager running farms, farms with hired worker, farms with part time helper and other type was 21 (55.3%), 10 (26.3%), 2 (3.5%), 3 (5.3%), 18 (31.6%), 2 (3.5%), and 1 (1.8%), respectively. 2. Analyzing pasture and tillable land, pasture according to feeding scale (200, 300 and 400 heads) were 56, 90 and 165.3 ha, and tillable lands were 51, 78 and 165 ha which showed some differences among feeding scale. In recording methods in 38 farms replied, 36 (95%) dairy handbook and 23 (70%) dual methods taking farms were higher than that of 10 (26.3%) computer and 15(39.5%) well-recorder methods. 3. Dairy waste processing facilities in environmental field were almost perfect except of metropolitan area, and so no problem was developed in its control so far. Hence, 26 farm (68.4%) of pond system was higher rather than those in 8 (21.2%) of using as organic manure after storing feces of dairy cattle, 1(2.6%) bunker system and 3 (7.9%) other type farms. 4. In milking facilities, 33 farms (86.9%) of Harringbone types were higher than those in 3 (7.9%) of Walkthrough types, 1 (2.6%) of Rotary system and other types. Although the construction facilities was not enough, this system show the world-leveled dairy country to attempted to elevate economic gains using the advantage of climatic condition. 5. In milking day and yearly yield per head, average 275 milking days and 87 drying days were longer than that of 228 average milking days in New Zealand. Annual total milk yield per head and milk solid (ms) was 3,990 kg and approximately 319 kg. Dairy milk solid (ms) per head, milk yield, fat percentage was 1.2 kg, 15.5 kg and average 4.83% which was much higher than in other country, and milk protein was average 3.75%. 6. In coclusion, Palmerstone North has been a center of dairy farming in New Zealand for the last 21 years. Their dairy farming history is 6~9 year longer than ours and the average number of milking cows per farm is 355, which is much greater than that (35) of Korea. They do not have dairy barn, but only milking parlors. Cows are taken care of by family 0.5 persons), are on a planned calving schedule in spring (93%) and milked for 240~280 days a year, avoiding winter. Cows are dried according to milk yield and body condition score. This management system is quite different from that of Korean dairy farms. Cows are not fed concentrates, relying entirely on pasture forages and the average milk yield per cow is 3,500 kg, which is about 1/2 milk yield of Korean dairy farms. They were bred to produce high fat milk with an average of 4.5%. Their milk production cost is the lowest in the world and the country's economy relies heavily on milk production. We Korean farmers may try to increase farming size, decreasing labor and management costs.

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