• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.5
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• pp.357-367
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• 2022

Background: Low-dose dexmedetomidine may be a suitable alternative to opioids for pediatric ambulatory procedures under general anesthesia (GA). However, the recovery profile remains unclear. Herein, we aimed to evaluate the effects of low-dose dexmedetomidine on the recovery profile of children. Methods: Seventy-two children undergoing ambulatory oral rehabilitation under GA were randomly and equally distributed into two groups (D and F). Group D received an infusion of dexmedetomidine 0.25 ㎍/kg for 4 min for induction, followed by maintenance of 0.4 ㎍/kg/h. Group F received an infusion of fentanyl 1 ㎍/kg over 4 min for induction, followed by maintenance at 1 ㎍/kg/h. The primary outcome was the extubation time. The secondary outcomes were awakening time, end-tidal sevoflurane (ET-Sevo) requirement, change in hemodynamic parameters, Richmond Agitation-Sedation Scale (RASS), Children's Hospital of Eastern Ontario pain scale (CHEOPS) score, length of PACU stay, and incidence of adverse events. Results: Statistically significant differences were observed in the recovery profile between the groups: the median time for extubation was 3.65 (3.44-6.2) vs. 6.25 (4.21-7) minutes in groups D vs. F (P=0.001), respectively, while the corresponding awakening times were 19 (18.75-21) and 22.5 (22-24) minutes, respectively (P < 0.001). The mean ET-Sevo was low in group D (1.1 vs. 1.2; P < 0.001). The heart rate was significantly low across all time points in group D, without resulting in bradycardia. The median RASS and CHEOPS scores were also significantly lower in group D. No significant differences were observed in the mean arterial pressure, incidence of adverse events, or length of PACU stay. Conclusion: Low-dose dexmedetomidine was more effective than fentanyl as an opioid substitute at providing a better recovery profile in pediatric ambulatory oral rehabilitation under GA. Dexmedetomidine also significantly reduced sevoflurane consumption without causing adverse events or prolonging hospital stay.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.5
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• pp.2611-2617
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• 2016

Background: Medication errors are common but most often preventable events in any health care setup. Studies on medication errors involving chemotherapeutic drugs are limited. Objective: We studied three aspects of medication errors - prescription, transcription and administration errors in 500 cancer patients who received ambulatory cancer chemotherapy at a resource limited setting government hospital attached cancer centre in South India. The frequency of medication errors, their types and the possible reasons for their occurrence were analysed. Design and Methods: Cross-sectional study using direct observation and chart review in anmbulatory day care unit of a Regional Cancer Centre in South India. Prescription charts of 500 patients during a three month time period were studied and errors analysed. Transcription errors were estimated from the nurses records for these 500 patients who were prescribed anticancer medications or premedication to be administered in the day care centre, direct observations were made during drug administration and administration errors analysed. Medical oncologists prescribing anticancer medications and nurses administering medications also participated. Results: A total of 500 patient observations were made and 41.6% medication errors were detected. Among the total observed errors, 114 (54.8%) were prescription errors, 51(24.5%) were transcribing errors and 43 (20.7%) were administration errors. The majority of the prescription errors were due to missing information (45.5%) and administration errors were mainly due to errors in drug reconstitution (55.8%). There were no life threatening events during the observation period since most of the errors were either intercepted before reaching the patient or were trivial. Conclusions: A high rate of potentially harmful medication errors were intercepted at the ambulatory day care unit of our regional cancer centre. Suggestions have been made to reduce errors in the future by adoption of computerised prescriptions and periodic sensitisation of the responsible health personnel.

• Health Policy and Management
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• v.24 no.1
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• pp.47-55
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• 2014

Background: Korea is considered to have an integrative health system where both western medicine and Korean (traditional) medicine are officially recognized and provided. Although Korean medicine has been covered by National Health Insurance over 20 years, equity in the utilization of Korean medical care has rarely been examined. Methods: We examined medical care utilization and expenditure of outpatient Korean medicine using panel fixed effects model to remove selection bias. Then we compared it with pooled ordinary least square (OLS) model. This study used Korea Health Panel data, which provides accurate information on out-of-pocket health care payment, including non-covered medical services. Results: Principal findings indicate that the frequency of the utilization of Korean medicine is related with unobservable individual choices different from western medicine, so the panel fixed effect model is appropriate. But pooled OLS model is better fitted for the expenditure of Korean medicine, after controlling for western medical care expenditure. After adjusting for the selection bias, socioeconomic status (income, education) was significantly associated with the expenditure of Korean medicine, but not with the frequency of the utilization of Korean medicine. Conclusion: This study shows that expenditure of Korean medicine utilization is inequitable across socioeconomic groups, which implies that health insurance coverage of Korean medicine is not sufficient.

• Journal of Korean Academy of Nursing Administration
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• v.13 no.1
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• pp.109-117
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• 2007

Purpose: This study focused on analysing the performance and the perception of importance about workload of ambulatory nurses and nurse-aides for quality of nursing. Method: The subjects of this study were 126 ambulatory nurses and 117 nurse-aides in 6 secondary and 4 tertiary hospitals. The method of data collection was used the questionnaire. Result: As a result, First, nurses' activities that the performance score is above 3.0 are reception, guidance, reservation, confirm, checking medical record, operating report, explanation of disease, explanation of examination discuss with medical part, discuss with supporting part, solving patient problem environment management, and paper work. And the other side, those of nurse-aides are reception, guidance, reservation, preparation for clinic, assistant for clinic, preparation for examination, material transfer & receipt, confirm, checking medical record, and arrangement. Second, nurses-aids perceive above 3.0 performance score activities to be important for themselves. Finally, nurses perceive three categories of patient education/counselling, patient advocacy and quality improvement to be more important and higher performance when compared with nurse-aides. Conclusions: Ambulatory nurse's important nursing activities are therapeutic care, patient education/counselling, patient advocacy, communication, personal management, quality improvement.

• Health Policy and Management
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• v.3 no.2
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• pp.100-129
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• 1993

This study is designed to find out some intra-clinic factors affecting the content of practice provided by primary care physicians in Korea, and proposed factors in this study are characteristcs of each private clinc --- physician-related variables(age, sex, specialty), bfed-related variables for inpatient care, laboratory-related variables for precise diagnosis. We have tried to estimate the difference of disease entities cared by each primary care physician according to above factors by analyzin gdisease data claimed during one month(April, 1992) to National Federation of Medical Insurance. The diagnosis codes by ICD-9 in the research disease data were reclassified to 'diagnosis clusters' by virtue of clinical similarities for effective analyses. We have converted frequent-tsing ICD-9 codes to 86 diagnosis clusters, which incorporated 97.4 percents of all ambulatory visits to private clinics. This result means proposed diagnosis-cluster method is effective tool for analysis of the content of ambulatory medical care carried out by primary care physicians. Comparisons and analyses of multiple diagnosis-clusters made on the basis of presented factors were done and the results were as follows; - Major factors affecting the difference between diagnosis-cluster pattern by each variables were phyusician's age, sex, specialty and bed counts of each private clinic for inpatient care and the size of laboratories of each clinic. - Middle aged(30th to 40th) group physicians are providing more comprehensive care than 20th or above 50th aged groups. Male physicians are more adequate for comprehensive care than female physicians, because woman-doctors are providing narrow-spectrum care. The content of practice of obstetricians and gynecologists shows much difference from primary medical practice, and they cannot be included in primary care physician, this study suggested. Pediatricians are also providing short-spectum acre, and nearly all visits to pediatricians were incorporated only 2-3 diagnosis-clusters. General surgeons' practices are very similar to general practioners' or family physicians' practices, the means they are providing primary care rather than special surgical care. And small number of beds(under 5 beds) and only basic(2-3 sorts of)diagnostic apparatuses are sufficient for primary physicians' clinic to carry out primary care. In conclusion, to reinforce primary care department in Korea, there must be support with health policy to expand office-based primary care practice-- with small number of beds for inpatient care and only basic laboratories-- provided by general practitioner of family physician.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.5 no.2
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• pp.313-323
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• 1998

This study was a descriptive research on the level of self-care available to continous ambulatory peritoneal dialysis patients (hereinafter referred to as 'CAPD patient') related to the specific area of infection management. The method employed for the collection of data was a modified instrument of the self-care survey essentially based on Young Sook Choi's instrument. The relevant data was collected from september 1, 1996 to september 30, 1996. The subjects were provided with an open-ended question regarding the reasons behind why they did not seek self-care. The answers provided about self-care compliance were analyzed by SPSS for frequency, percentage, mean, t-test, ANOVA. Reasons for non-compliance were analyzed by content analysis. The results of the study were as follows : 1. The percentage of patients engaging in self-care were according to the following self performed tasks : preparation of dialysis : 30.58 points Dialysate exchange procedures : 49.40 points - Two bag type : 50.50 points - Spike type : 48.80 points - Neo type : 48.90 points Catheter exit site care : 25.13 points More specifically, in relation to the preparation of dialysis as referred to above, those patients engaging in self care was relatively high with respect to the cleaning of the dialysis before use and for the preservation of peritosol. However, in dialysate exchange procedures, data revealed that those patients engaging in self-care are relatively low with respect to putting on a mask during the performance of peritosol exchange. Similary in peritosol exchange procedure and catheter exit care, low levels of self-care performance were found in the area of putting on a mask during the peritosol exchange procedures and catheter line testing procedures, respectively. 2. In general characteristics, there appeared to be no distinction in self-care compliance among CAPD patients. 3. The main reasons for non-compliance were based in the following factor : intellectual, attitude, enviromental surrounding and physical. As a result of the foregoing finding, nurses should provide adequate assistance to promote self-care compliance by CAPD patients by checking the preparation of dialysis, dialysate exchange procedure, and catheter exit site care which recieved low point in this research.

• Journal of the Korean Association of Geographic Information Studies
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• v.15 no.4
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• pp.138-150
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• 2012

The purpose of this study was to examine the regional disparity of ambulatory health care utilization considering spatio-temporal variation in South Korea during 1996-2008(precisely, in 1996, 1999, 2002, 2005, and 2008) using bayesian hierarchial spatio-temporal model. The spatial pattern uses an intrinsic gaussian conditional autoregressive (CAR) error component. Ornstein-Uhlenbeck method was applied to detect the temporal patterns. The results showed that substantial temporal-geographical variation depending on diseases exists in Korea. On the Contrary to the pattern of total outpatient utilizations, for example, the areas that chronic diseases distributed relatively high were most in rural where the proportion of elderly population was higher than in the urban. Chungcheongnam-do, Junlabuk-do, and Kyeongsangbuk-do had higher risks in hypertension, whereas arthritis was higher risk in the Kyeonggi-do, Chungcheongbuk-do, Junlanam-do, and Junlabuk-do. The results of this study suggested that the effective health intervention programmes needed to alleviate the regional variation of health care utilization. These outcomes also provided the foundation for further investigation of risk factors and interventions in these high-risk areas.

• Health Policy and Management
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• v.10 no.4
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• pp.20-56
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• 2000

The purpose of this article was to evaluate the effects of reimbursement system on the basis of diagnosis-related groups(DRGs). We searched articles which was published from 1970 to 2000 using MEDLINE ； Key words "diagnosis-related groups, DRGs, prospective payment system, PPS. Then we reviewed 97 articles on classifying them into several categories of contents. It seems that the effects of DRGs in controlling hospitals cost in the U.S. was not clear cut. The U.S. Medicare PPS using DRGs remains vulnerable to compensatory increases in ambulatory care and long-term care facilities utilization despite cost per case and cost per admission being reduced. Also some research indicated the possibilities of deterioration in health care service quality. So putting theses results together, much more consideration is needed before the application of DRGs reimbursement system in Korea. Particularly there is the crucial difference between U.S. health care system and Korean, we must be aware of the limitations of DRGs and revise the DRG system to applicable in Korea.orea.

• Asian Oncology Nursing
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• v.9 no.2
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• pp.136-144
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• 2009

Purpose: This study was to compare the differences in self-care behaviors between the group with fighting spirit and the group with helplessness. Methods: This study utilized a cross-sectional descriptive design. A total of 97 ambulatory cancer patients completed the Mental Adjustment to Cancer (MAC) scale by Watson et al. (1988) and Self Care Behaviors Scale by Oh et al. (1997). The data was analysed using frequency, percentage, t-test, ANOVA, Pearson's correlation and stepwise multiple regression. Results: Fighting spirit group were found to conduct self-care behaviors more compared to the helplessness group (t=3.346, p<.0001). The score of the self-care behaviors in fighting spirit group was 4.42 out of a total score of 7 and that of helplessness group was 3.85. There was a significant difference (p<.0001) in self-care behaviors according to the level of faith and performance status. Fighting spirit ($R^2$=0.120, p<.0001), performance status ($R^2$=0.078, p=.001) were predictive of self-care behaviors. Conclusion: Cancer patients' mental adjustment is correlated with the degree of self-care behaviors. Having fighting spirit is one of the most adaptive techniques that cancer patients could use in adjustment to the life with cancer.

• Journal of Korean Public Health Nursing
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• v.17 no.2
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• pp.287-298
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• 2003

This study was conducted to identify the health care utilization, health care costs, and potential health care demands of the disabled in the Medicaid Aid beneficiaries. This study focused on the heath care costs not included in the medical aid allowance such as transportation, informal nursing costs, and ambulatory aids etc. Participants were the 864 subjects who were beneficiaries of the National Medical Aid program living in 10 district of Korea. A questionnaires were distributed to the disabled in the Medical Aid beneficiaries during August to September, 2001 through public offices. Data were collected through a home visiting by social workers working in public offices. Direct and indirect medical costs expended for one month by the participating disabled were examined. They expended 110.748 won $({\$}100)$ for heath care costs, which was not included in the medical aid allowance during the month. The disabled with cerebral diseases or who have level 4 disability expended more health care costs compare to those with other diseases. Gradual expansion of medical aid allowance for the disabled is recommended to alleviate economic burden of the disabled and their family.