• 보건행정학회지
• /
• 제3권1호
• /
• pp.1-24
• /
• 1993

This study is designed to find clues to make a plan for efficient hospital bed utilization. Author has tried to estimate the level of appropriateness and to find out factors affecting intra-hospital variation of inappropriate bed utilization using modified Appropriateness Evaluation Protocol of which criteria are based on service intensity and patients' conditions. Systematic random sampling was done from the population of inpatients during one month in on university hospital. Data were collected by concurrent and retrospective medical record review and analysed by multiple logistic regression. In medical services, 83.5% of admission reveals appropriate and the level of inappropriate admission shows significant differences by patients' residence, type of department admitted to, admission 개\ulcorner, and length of stay. In surgical services, 97.3% and 34.7% are appropriate in location and timing of surgery respectively. Inappropriate timing of surgery differs significantly depending on patients' age, type of department admitted to, admission route, and length of stay. Sixty two percent of hospital days shows appropriate and the level of inappropriateness show marked differences by patients'age, type of services, admission routes, part of the month, part of the stay, and length of stay. Inappropriate hospital days are due to inappropriate level of care, premature admission, improper scheduling of diagnostic or therapeutic procedures, and problems in scheduling surgery in sequence. In conclusion, substantially high proportion of inappropriate hospital bed utilization was confirmed. To reduce it, it is necessary to develop alternative services with which can replace inpatient services, and to introduce utilization management system which may include internal peer review.

• 한국전문물리치료학회지
• /
• 제17권3호
• /
• pp.59-67
• /
• 2010

Mortality rates from stroke have been declining. Because of this, more people are living with residual disability. Rehabilitation plays an important role in functional recovery of stroke survivors. In stroke rehabilitation, early prediction of the obtainable level of functional recovery is desirable to deliver efficient care, set realistic goals, and provide appropriate discharge planning. The purpose of this study was to identify predictors of functional outcome after stroke using inpatient rehabilitation as measured by Functional Independence Measure (FIM) total scores. Correlation and stepwise multiple regression analyses were performed on data collected retrospectively from two-hundred thirty-five patients. More than moderate correlation was found between FIM total scores at the time of hospital admission and FIM total scores at the time of discharge from the hospital. Significant predictors of FIM at the time of discharge were FIM total scores at the time of hospital admission, age, and onset-admission interval. The equation was as follows: expected discharge FIM total score = $76.12+.62{\times}$(admission FIM total score)-$.38{\times}(age)-.15{\times}$(onset-admission interval). These findings suggest that FIM total scores at the time of hospital admission, age, and onset-admission interval are important determinants of functional outcome.

• 지역사회간호학회지
• /
• 제10권1호
• /
• pp.80-92
• /
• 1999

The purpose of this study was to survey appropriateness of admission and days of care for the cerebral ischemia patients as a basis to provide an effectiveness of hospitalization. The authors retrospectively reviewed the medical records of cerebral ischemia patients in two hospitals from November 1997 to February 1998. Of 194 medical records reviewed, there were 2108 medical days. I t is used a 'Appropriateness Evaluation Protocol' previously developed by Gertman and Restuccia (1981) and translated by Department of Health Management, Seoul National University and Korea Institute for Health Services Management (1993), It was found that the 'Appropriateness Evaluation Protocol' had a high inter-rater reliability(k=.92), Statistical significant was tested by using the percentage, mean, and logistic regression by SAS 6.12. The results were as follows; 1. The appropriate admissions were 87.6%, days of care 63.4%, and the average length of stay $10.9{\pm}6.7$ days. 2. The reasons of inappropriate admissions were for work-up(75.0%) and conservative care (25.0%). Major reasons of inappropriate days of care were 'cases in which the medical purpose of hospitalization has been accomplish or can be addressed in a less setting(45.0%)', and 'cases in which there is a delay in performing the work-up or treatment which required patients is hospitalized (44.4%)'. 3. Appropriate days of care were higher as ageing. Appropriate days of care were higher in patients with lower accademic back ground than those of upper college graduates, and in the patients who enter a hospital via emergency room than out-patients department. Appropriate days of care were higher in the patient with MCA infarction, and lower in the patient with cerebellar infarction than the patient with lacunar infarction. Appropriate days of care were higher in attack first than attack above second, in nomortension patients than hypertensive, and lower in groups who engaged in semi-private room and public room than private room in hospital. Appropriate days of care were higher in shorter length of stay than longer length of stay. 4. Diagnosis, admission path, and appropriate days of care explained appropriate admissions. Diagnosis, appropriate admissions, hypertension explained appropriate days of care. According to the above results, author confirms the substantial amount of inappropriate hospital bed utilization. To reduce inappropriateness, it is necessary to develop some alternative services such as home care services or nursing home with which can be replaced inpatient services and to introduce policy such as case management which includes Critical Pathway for consistent management. And, it should be followed the further study for the effectiveness.

• 한국통신학회논문지
• /
• 제23권9A호
• /
• pp.2184-2196
• /
• 1998

Admission control is one of the most important congestion control mechanism to be executed at the call set up phase by regulating traffic into a network in a preventive way. An efficient QOS evaluation or bandwidth estimation method is required for call admission to be decided in real time. In this paper, we spropose a computtionally simple approximation method of estimating cell loss probability and mean cell delay for admission control of both delay sensitive and loss sensitive calls. Mixed input queueing system, where a new call combines with the existing traffic, is used as a queueing model for QOS estimation. Also traffic parameters are suggested to characterize both a new call and existing traffic. Aggregate traffic is approximated by a renewal process with these traffic parameters and then mean delay and cell loss probability are detemined using appropriate approximation formulas. The accuracy of this approximation approach is examined by comparing their results with exact analysis or simulation results of vrious mixed unput queueing systems. Based on this QOS estimation method, call admission control scheme which is traffic independent and computable in yeal time are proposed.

• 한국추진공학회:학술대회논문집
• /
• 한국추진공학회 2004년도 제22회 춘계학술대회논문집
• /
• pp.861-866
• /
• 2004

A numerical flow analysis has been performed on the partial admission turbine of KARI turbopump to support the aerodynamic and structural dynamic assessments. The flow-field in a partial admission turbine is essentially three dimensional and unsteady because of a tip clearance and a finite number of nozzles. Therefore the mixing plane method is generally not appropriate. To avoid heavy computational load due to an unsteady three dimensional calculation, a frozen rotor method was implemented in steady calculation. It adopted a rotating frame in the grid block of a rotor blade by adding some source terms in governing equations. Its results were compared with a mixing plane method. The frozen rotor method can detect the variation of flow-field dependent upon the blade's circumferential position relative to the nozzle. It gives a idea of wake loss mechanism starting from the lip of a nozzle. This wake loss was assumed to be one of the most difficult issues in turbine designers. Thus, the frozen rotor approach has proven to be an efficient and robust tool in design of a partial admission turbine.

• 한국콘텐츠학회논문지
• /
• 제21권9호
• /
• pp.51-62
• /
• 2021

본 연구는 H 대학의 입학전형계획 수립을 위한 정책 제안을 목적으로 대학입학전형에 따른 학업성취도 및 대학생활의 경향성을 비교해보았다. 연구대상은 H 대학교 재학생 3,025명이다. 연구결과는 다음과 같다. 첫째, 입학전형별로 H 대학 선택영향 요인들은 동일하게 나타났다. 둘째, 입학전형별로 GPA에는 차이가 나지 않았으나, 학년이 올라갈수록 학생부 종합전형 학생들이 상승하는 경향으로 나타났다. 셋째, 학생부 종합전형 학생들의 대학만족도와 전공만족도가 가장 높게 나타났다. 넷째, 학생부 종합전형 학생들은 대학교육 성과에 대해서도 가장 높게 평가하고 있었다. 결론적으로 H 대학은 학생부 종합전형에서 학생들의 미래 학업적 성장 가능성을 잘 평가하고 있음을 알 수 있다. 그러므로 H 대학에서는 정시보다는 학생부 종합전형 위주의 수시전형 확대가 적합한 정책이라고 볼 수 있다.

• 성인간호학회지
• /
• 제13권2호
• /
• pp.291-304
• /
• 2001

The purpose of this study was to develop Intensive Care Unit (ICU) admission and discharge criteria that would lead to the appropriate utilization of ICU resources and nursing services. For this study, a conceptual framework was developed through a review of the literature. Then in order to identify the overall health condition of patients in the ICU, and to draw up preliminary criteria, the medical records of 58 patients who were admitted to the ICU of Y Medical Center in Seoul between March, 1999 to February, 2000 of were analyzed. Two expert validity tests were done for the preliminary criteria for admission and discharge with 21 patients over 18 years of age who were admitted patients and for 12 patients who were discharged between May 30, 2000 and June 5, 2000 a clinical validity test was also done. After this process, the final admission and discharge criteria were developed. The results of this study are summarized as follows: 1. After a review of the literature, there were 9 categories for admission criteria cardiologic, gastrointestinal, neurologic, endocrine, post-op care of major surgery, vital signs, laboratory values, and a category of miscellaneous items. Discharge criteria had 3 categories which were vital signs, laboratory values, and a category of miscellaneous items. 2. From the medical records of the 58 patients who were admitted to the ICU, 45 items for preliminary criteria for admission and 17 for discharge were identified. 3. The two expert validity tests showed that of the 45 items 29 admission items received over 75 percent agreement. The 16 admission items which received less than 75 percent agreement were revised or deleted from the admission criteria. Of the 17 discharge items, 11 had over 75 percent agreement and 6 less then 75 percent agreement. These were revised or deleted from the discharge criteria. 4. In the clinical validity test, 14 admission items showed more than 75 percent agreement and 11 discharge items more than 83 percent agreement. 5. The final criteria consisted of 29 items for admission and 11 items for discharge. Since patients being considered for admission to the ICU have complex problems, there is a need to make the decision based on more than a single issue. This tool will insure that the ICU nursing care and treatment resources are appropriately used by allowing a multi-professional health team to make admission and discharge decisions.

• Nutrition Research and Practice
• /
• 제9권3호
• /
• pp.268-277
• /
• 2015

BACKGROUND/OBJECTIVES: Although it is crucial to identify those children likely to be treated in an appropriate nutrition rehabilitation programme and discharge them at the appropriate time, there is no golden standard for such identification. The current study examined the appropriateness of using Mid-Upper Arm Circumference for the identification, follow-up and discharge of malnourished children. We also assessed its discrepancy with the Weight-for-Height based diagnosis, the rate of recovery, and the discharge criteria of the children during nutrition rehabilitation. SUBJECTS/METHODS: The study present findings from 156 children (aged 6-59 months) attending a supplementary feeding programme at Makadara and Jericho Health Centres, Eastern District of Nairobi, Kenya. Records of age, weight, height and mid-upper arm circumference were selected at three stages of nutrition rehabilitation: admission, follow-up and discharge. The values obtained were then used to calculate z-scores as defined by WHO Anthro while estimating different diagnostic indices. RESULTS: Mid-upper arm circumference single cut-off (< 12.5 cm) was found to exhibit high values of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio at both admission and discharge. Besides, children recorded higher rate of recovery at 86 days, an average increment of 0.98 cm at the rate of 0.14mm/day, and a weight gain of 13.49gm/day, albeit higher in female than their male counterparts. Nevertheless, children admitted on basis of low MUAC had a significantly higher MUAC gain than WH at 0.19mm/day and 0.13mm/day respectively. CONCLUSIONS: Mid-upper arm circumference can be an appropriate tool for identifying malnourished children for admission to nutrition rehabilitation programs. Our results confirm the appropriateness of this tool for monitoring recovery trends and discharging the children thereafter. In principle the tool has potential to minimize nutrition rehabilitation costs, particularly in community therapeutic centres in developing countries.

• 임상간호연구
• /
• 제21권3호
• /
• pp.293-308
• /
• 2015

Purpose: This study aimed to develop nursing practice standards of hemodialysis care according to admission types. Methods: The standards were developed in four phases. Phase 1: The preliminary standards of hemodialysis care were developed based on literature review and evaluation of professional experts. Phase 2: Content validity was evaluated by 34 professional experts and the standards were modified and revised. Phase 3: Clinical validity was evaluated by 212 hemodialysis nurses. Expert group validated and verified the final outcome. Phase 4: Final standards of hemodialysis care according to admission types were developed. Results: The standard of hemodialysis care for out-patients included 5 standards, 9 contents, 43 nursing activities. The standard for in-patients included 6 standards, 10 contents, 50 nursing activities. The standards for critical patients included 4 standards, 10 contents, 43 nursing activities. There were differences in nursing activities according to admission type. Time required to meet the standards were different according to admission types. Conclusion: The findings of this research demonstrated that the time required for hemodialysis care and appropriate number of nurse would be different according to admission types. Different nursing workload according to admission type of hemodialysis patients need to be considered in allocating nursing manpower.

• Journal of Communications and Networks
• /
• 제4권3호
• /
• pp.230-245
• /
• 2002

Usually the network-throughput maximization problem for constant-bit-rate (CBR) circuit-switched traffic is posed for a fixed offered load profile. Then choices of routes and of admission control policies are sought to achieve maximum throughput (usually under QoS constraints). However, similarly to the notion of channel “capacity,” it is also of interest to determine the “network capacity;” i.e., for a given network we would like to know the maximum throughput it can deliver (again subject to specified QoS constraints) if the appropriate traffic load is supplied. Thus, in addition to determining routes and admission controls, we would like to specify the vector of offered loads between each source/destination pair that “achieves capacity.” Since the combined problem of choosing all three parameters (i.e., offered load, admission control, and routing) is too complex to address, we consider here only the optimal determination of offered load for given routing and admission control policies. We provide an off-line algorithm, which is based on Lagrangian techniques that perform robustly in this rigorously formulated nonlinear optimization problem with nonlinear constraints. We demonstrate that significant improvement is obtained, as compared with simple uniform loading schemes, and that fairness mechanisms can be incorporated with little loss in overall throughput.