• Health Policy and Management
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• v.11 no.3
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• pp.121-150
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• 2001

This study was conducted to investigate provider's behavior change after releasing the information on the Cesarean section rate. Claims data filed at the National Health Insurance Corporation was used for this analysis and the focus of this study was the change of cesarean rate after the public disclosure of information. Average rates of the year 1999 and 2000 were compared, on the institutional basis, and range and coefficient of variation were estimated. For the last decade, Cesarean section rate has been increased dramatically. Clinical or demographic factors could not adequately explain the increase. Instead, nonclinical factors, such as financial incentive, physician's convenience, practice characteristics, etc., were more significant in explaining the increasing rate. Providers' behavior was significantly affected by the public release of information: after the release, average rate was decreased by 10.2%, and variations were also decreased. In particular, the extent of decrease was explained mainly by nonclinical factor rather than clinical ones. The results suggest that disseminating practice information to providers and consumers could contribute to reducing unnecessary medical service.

• Quality Improvement in Health Care
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• v.4 no.1
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• pp.82-103
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• 1997

Background : With increased concerns about variation among physician's practice pattern and their impact on the quality of care, clinical practice guidelines have been developed by many different organizations, with differing aims and incentives. From the same point of view, there is growing interest in the development of clinical practice guidelines in Korea, but with only a few examples. As a result, there is not much exploration on the incentive and barrier to develop guidelines as well as description on the development process. The purposes of this study are to describe the process of the four different clinical practice guidelines in a hospital setting, and to identify incentives and barriers in the development of guidelines. Methods : For this research, a clinical practice guideline development committee and four clinical practice guideline development teams were organized in a university hospital which has more than 1,200 bead. Twenty eight doctors, three nurses, and one technician participated as members of development teams for eight months. Four to six meetings were held, and three to seven departments in the hospital were involved. Results : The topics which developed into clinical practice guidelines were cardiopulmonary resuscitation(CPR), blood transfusion, anticoagulation, and angiography. The main goals set by teams were education(CPR, angiography), risk management(blood transfusion), and to enhance quality of care(anticoagulation). Among four teams, only in the team for anticoagulation guideline medical record review and pilot-testing were performed. Also literature review was not carried out systematically. However, all the guidelines were developed by multidisciplinary be used as standard protocols in the practice. Conclusion : Experience and skill in developing process has to be improved to have a more valid and useful practice guideline. In particular, literature review and problem identification by examining medical record should be emphasized. Also further studies on the clinical outcomes of the guidelines application and changes in physicians' behaviors would be required.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.3
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• pp.225-232
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• 2019

Purpose: To evaluate intra- and inter-observer variability and guideline adherence amongst pediatricians in treating children aged between 4 and 18 years referred with recurrent abdominal pain (RAP) without red flags. Methods: The first part of the study is a retrospective single-center cohort study. The diagnostic work-ups of eight pediatricians were compared to the national guidelines. Intra- and inter-observer variability were examined by Cramer's V test. Intra-observer variability was defined as the amount of variation within a pediatrician and inter-observer variability as the amount of variation between pediatricians in the application of diagnostic work-up in children with RAP. Prospectively, the same pediatricians were requested to provide a report on their management strategy with a fictitious case to prove similarities in retrospective diagnostic work-up. Results: A total of 10 patients per pediatrician were analyzed. Retrospectively, a (very) weak association between pediatricians' diagnostic work-ups was found (0.22), which implies high inter-observer variability. The association between intra-observer diagnostic was moderate (range, 0.35-0.46). The Cramer's V of 0.60 in diagnostic work-up between pediatricians in the fictitious case implied the presence of a moderately strong association and lower inter-observer variability than in the retrospective study. Adherence to the guideline was 66.8%. Conclusion: We found a high intra- and inter-observer variability and moderate guideline adherence in daily clinical practice amongst pediatricians in treating children with RAP in a teaching hospital.

• Journal of Acupuncture Research
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• v.24 no.2
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• pp.169-185
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• 2007

Objectives : The studies on variation in diagnosis on the neck and nuchal pain has not been done thoroughly as we can use it in clinical practice of these days. For this reason, I examined the variation in diagnosis mentioned in the classics of Oriental Medicine as the preceding study on standardization of variation in diagnosis on neck and nuchal pain. Methods : I gathered the twenty kinds of classics of Oriental Medicine that were computerized, the textbooks on Oriental Medicine which are being used these days, and the theses on current clinical research. After gathering these data, I analyzed these according to the variation in diagnosis. Results : The classics of Oriental Medicine on the neck and nuchal pain mentioned very much about the neck and nuchal pain occurred by the pathogenic factor of Wind, Cold, and Dampness, disharmony created by deficiency of Liver and Kidney, and pathogenic state of Meridians of Taiyang. According to the texts of these days, the differentiation of syndromes can be divided into four kinds of items such as Wind-Cold pathogen, Wind-Dampness pathogen, Phelgm-Heat, and disharmony between Qi and Blood. The theses of these days rarely mentioned about variation in diagnosis on the neck and nuchal pain. Conclusions : The differentiation of syndromes on the neck and nuchal pain can be divided into four kinds items as affection by exopathogen like Wind, Cold, Dampness, Heat, and so on, stagnation of Qi and the coagulation blood, deficient syndrome of Liver and Kidney, and deficient syndrome of Qi and Blood.

• Journal of Korean Neurosurgical Society
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• v.61 no.2
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• pp.127-166
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• 2018

Despite advancements in treating ruptured cerebral aneurysms, an aneurysmal subarachnoid hemorrhage (aSAH) is still a grave cerebrovascular disease associated with a high rate of morbidity and mortality. Based on the literature published to date, world-wide academic and governmental committees have developed clinical practice guidelines (CPGs) to propose standards for disease management in order to achieve the best treatment outcomes for aSAHs. In 2013, the Korean Society of Cerebrovascular Surgeons issued a Korean version of the CPGs for aSAHs. The group researched all articles and major foreign CPGs published in English until December 2015 using several search engines. Based on these articles, levels of evidence and grades of recommendations were determined by our society as well as by other related Quality Control Committees from neurointervention, neurology and rehabilitation medicine. The Korean version of the CPGs for aSAHs includes risk factors, diagnosis, initial management, medical and surgical management to prevent rebleeding, management of delayed cerebral ischemia and vasospasm, treatment of hydrocephalus, treatment of medical complications and early rehabilitation. The CPGs are not the absolute standard but are the present reference as the evidence is still incomplete, each environment of clinical practice is different, and there is a high probability of variation in the current recommendations. The CPGs will be useful in the fields of clinical practice and research.

• Clinics in Shoulder and Elbow
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• v.26 no.2
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• pp.156-161
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• 2023

Background: We analyzed association between viewing two-dimensional computed tomography (2D CT) images in addition to radiographs with radial head treatment recommendations after accounting for patient and surgeon factors in a survey-based experiment. Methods: One hundred and fifty-four surgeons reviewed 15 patient scenarios with terrible triad fracture dislocations of the elbow. Surgeons were randomized to view either radiographs only or radiographs and 2D CT images. The scenarios randomized patient age, hand dominance, and occupation. For each scenario, surgeons were asked if they would recommend fixation or arthroplasty of the radial head. Multi-level logistic regression analysis identified variables associated with radial head treatment recommendations. Results: Reviewing 2D CT images in addition to radiographs had no statistical association with treatment recommendations. A higher likelihood of recommending prosthetic arthroplasty was associated with older patient age, patient occupation not requiring manual labor, surgeon practice location in the United States, practicing for five years or less, and the subspecialties "trauma" and "shoulder and elbow." Conclusions: The results of this study suggest that in terrible triad injuries, the imaging appearance of radial head fractures has no measurable influence on treatment recommendations. Personal surgeon factors and patient demographic characteristics may have a larger role in surgical decision making. Level of evidence: Level III, therapeutic case-control study.

• The Journal of Korean Academic Society of Nursing Education
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• v.21 no.2
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• pp.237-245
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• 2015

Purpose: The purpose of the study was to explore the levels of self-awareness, assertiveness, life stress, and empathy in nursing students and identify influential factors on empathy. Methods: A predictive correlational design was used. The data was collected by questionnaires from a convenience sample of 319 nursing students in 2014 in Korea. The data was analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and stepwise multiple regression. Results: The mean items scores of self-awareness, assertiveness, life stress, and empathy were 3.49, 3.02, 2.20 and 3.58, respectively, of a possible score ranging from 1 to 5. Empathy significantly differed by gender, grade, satisfaction with nursing as a major, and clinical practice experience. Empathy was correlated with self-awareness and interpersonal relationship stress. As a result of multiple regression analysis, empathy accounted for 20.1% of the variance by self-awareness, gender, clinical practice experience and interpersonal relationship stress. The most important factor was self-awareness, which explained 11.6% of the variation. Conclusion: The results of the study reveal that strengthening self-awareness and relieving interpersonal relationship stress ought to be integrated in developing effective educational intervention for enhancing empathy in nursing students.

• YAKHAK HOEJI
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• v.53 no.4
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• pp.165-172
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• 2009

Pharmacy residency program in Korea was first implemented in Seoul National University Hospital in 1983 to train hospital pharmacists regarding theories and practice which were not appropriately educated in the colleges of pharmacy. There are currently seven hospitals operating the program in Korea, and all of those are located in Metropolitan Seoul area. Most hospitals administer examination and interview to select competent pharmacists while some other hospitals select those based on paperwork and interview tests. Although the program contents are mostly similar, some variation were identified between the programs. Title conferred after accomplishment of the program has not been officially accredited by educational authority. In June of 2008, Korean Society of Health-System Pharmacists promulgated an internal regulation as an attempt to standardize the program contents and to encourage efficient management of the program. Since the regulation has now been effective, it is expected that the regulation may help clinical pharmacy education in Korea move toward advanced level.

• Quality Improvement in Health Care
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• v.10 no.2
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• pp.176-189
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• 2003

Background : Gastric cancer is the most common malignant tumor in Korea. Surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for reducing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and the unplanned readmission rate between the pre-pathway group (n=67) and the post-pathway group (n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days (p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was not statistically significant (p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group and 0% in the post-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korean hospital settings.

• Journal of Computing Science and Engineering
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• v.6 no.1
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• pp.51-59
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• 2012

We describe the framework of a data-fuelled, interdisciplinary team-led learning system. The idea is to build models using patients from one's own institution whose features are similar to an index patient as regards an outcome of interest, in order to predict the utility of diagnostic tests and interventions, as well as inform prognosis. The Laboratory of Computational Physiology at the Massachusetts Institute of Technology developed and maintains MIMIC-II, a public deidentified high- resolution database of patients admitted to Beth Israel Deaconess Medical Center. It hosts teams of clinicians (nurses, doctors, pharmacists) and scientists (database engineers, modelers, epidemiologists) who translate the day-to-day questions during rounds that have no clear answers in the current medical literature into study designs, perform the modeling and the analysis and publish their findings. The studies fall into the following broad categories: identification and interrogation of practice variation, predictive modeling of clinical outcomes within patient subsets and comparative effectiveness research on diagnostic tests and therapeutic interventions. Clinical databases such as MIMIC-II, where recorded health care transactions - clinical decisions linked with patient outcomes - are constantly uploaded, become the centerpiece of a learning system.