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A Study on the cost allocation method of the operating room in the hospital (수술실의 원가배부기준 설정연구)

  • Kim, Hwi-Jung;Jung, Key-Sun;Choi, Sung-Woo
    • Korea Journal of Hospital Management
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    • v.8 no.1
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    • pp.135-164
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    • 2003
  • The operating room is the major facility that costs the highest investment per unit area in a hospital. It requires commitment of hospital resources such as manpower, equipments and material. The quantity of these resources committed actually differs from one type of operation to another. Because of this, it is not an easy task to allocate the operating cost to individual clinical departments that share the operating room. A practical way to do so may be to collect and add the operating costs incurred by each clinical department and charge the net cost to the account of the corresponding clinical department. It has been customary to allocate the cost of the operating room to the account of each individual department on the basis of the ratio of the number of operations of the department or the total revenue by each operating room. In an attempt to set up more rational cost allocation method than the customary method, this study proposes a new cost allocation method that calls for itemizing the operation cost into its constituent expenses in detail and adding them up for the operating cost incurred by each individual department. For comparison of the new method with the conventional method, the operating room in the main building of hospital A near Seoul is chosen as a study object. It is selected because it is the biggest operating room in hospital A and most of operations in this hospital are conducted in this room. For this study the one-month operation record performed in January 2001 in this operating room is analyzed to allocate the per-month operation cost to six clinical departments that used this operating room; the departments of general surgery, orthopedic surgery, neuro-surgery, dental surgery, urology, and obstetrics & gynecology. In the new method(or method 1), each operation cost is categorized into three major expenses; personnel expense, material expense, and overhead expense and is allocated into the account of the clinical department that used the operating room. The method 1 shows that, among the total one-month operating cost of 814,054 thousand wons in this hospital, 163,714 thousand won is allocated to GS, 335,084 thousand won to as, 202,772 thousand won to NS, 42,265 thousand won to uno, 33,423 thousand won to OB/GY, and 36.796 thousand won to DS. The allocation of the operating cost to six departments by the new method is quite different from that by the conventional method. According to one conventional allocation method based on the ratio of the number of operations of a department to the total number of operations in the operating room(method 2 hereafter), 329,692 thousand won are allocated to GS, 262,125 thousand won to as, 87,104 thousand won to NS, 59,426 thousand won to URO, 51.285 thousand won to OB/GY, and 24,422 thousand won to DS. According to the other conventional allocation method based on the ratio of the revenue of a department(method 3 hereafter), 148,158 thousand won are allocated to GS, 272,708 thousand won to as, 268.638 thousand won to NS, 45,587 thousand won to uno, 51.285 thousand won to OB/GY, and 27.678 thousand won to DS. As can be noted from these results, the cost allocation to six departments by method 1 is strikingly different from those by method 2 and method 3. The operating cost allocated to GS by method 2 is about twice by method 1. Method 3 makes allocations of the operating cost to individual departments very similarly as method 1. However, there are still discrepancies between the two methods. In particular the cost allocations to OB/GY by the two methods have roughly 53.4% discrepancy. The conventional methods 2 and 3 fail to take into account properly the fact that the average time spent for the operation is different and dependent on the clinical department, whether or not to use expensive clinical material dictate the operating cost, and there is difference between the official operating cost and the actual operating cost. This is why the conventional methods turn out to be inappropriate as the operating cost allocation methods. In conclusion, the new method here may be laborious and cause a complexity in bookkeeping because it requires detailed bookkeeping of the operation cost by its constituent expenses and also by individual clinical department, treating each department as an independent accounting unit. But the method is worth adopting because it will allow the concerned hospital to estimate the operating cost as accurately as practicable. The cost data used in this study such as personnel expense, material cost, overhead cost may not be correct ones. Therefore, the operating cost estimated in the main text may not be the same as the actual cost. Also, the study is focused on the case of only hospital A, which is hardly claimed to represent the hospitals across the nation. In spite of these deficiencies, this study is noteworthy from the standpoint that it proposes a practical allocation method of the operating cost to each individual clinical department.

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A Study on Prediction of Asian Dusts Using the WRF-Chem Model in 2010 in the Korean Peninsula (WRF-Chem 모델을 이용한 2010년 한반도의 황사 예측에 관한 연구)

  • Jung, Ok Jin;Moon, Yun Seob
    • Journal of the Korean earth science society
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    • v.36 no.1
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    • pp.90-108
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    • 2015
  • The WRF-Chem model was applied to simulate the Asian dust event affecting the Korean Peninsula from 11 to 13 November 2010. GOCART dust emission schemes, RADM2 chemical mechanism, and MADE/SORGAM aerosol scheme were adopted within the WRF-Chem model to predict dust aerosol concentrations. The results in the model simulations were identified by comparing with the weather maps, satellite images, monitoring data of $PM_{10}$ concentration, and LIDAR images. The model results showed a good agreement with the long-range transport from the dust source area such as Northeastern China and Mongolia to the Korean Peninsula. Comparison of the time series of $PM_{10}$ concentration measured at Backnungdo showed that the correlation coefficient was 0.736, and the root mean square error was $192.73{\mu}g/m^3$. The spatial distribution of $PM_{10}$ concentration using the WRF-Chem model was similar to that of the $PM_{2.5}$ which were about a half of $PM_{10}$. Also, they were much alike in those of the UM-ADAM model simulated by the Korean Meteorological Administration. Meanwhile, the spatial distributions of $PM_{10}$ concentrations during the Asian dust events had relevance to those of both the wind speed of u component ($ms^{-1}$) and the PBL height (m). We performed a regressive analysis between $PM_{10}$ concentrations and two meteorological variables (u component and PBL) in the strong dust event in autumn (CASE 1, on 11 to 23 March 2010) and the weak dust event in spring (CASE 2, on 19 to 20 March 2011), respectively.

The Patterns of Students' Conceptual Changes on Force by Age (나이에 따른 학생들의 힘에 관한 개념 변화 특성)

  • Kim, Yeoun-Soo;Kwon, Jae-Sool
    • Journal of The Korean Association For Science Education
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    • v.20 no.2
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    • pp.221-233
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    • 2000
  • Many investigators have reported difficulties in changing the high school students' misconceptions on mechanics. By one possible solution to this problem, some researchers suggested that the students should be taught mechanics at a younger age to make conceptual changes possible. because as they get older they become less willing to change their ideas. The purpose of this study was to compare the patterns of students' conceptual changes on force by age, to find out whether older students were less ready to change their conceptions than younger students. Individual interviews were carried out with 35 students (average ages 13) in middle school class and 50 students (average ages 17) in high school class near by the middle school. Those students who held the misconcetpion that "motion-implies-force (Impetus conception)" were asked to read a student-centered refutational text (anomalous data). In the immediate and delayed posttest, the types of responses of the students were analyzed to find out the patterns of student's conceptual changes on force by age. In result, first, most of students had impetus conception. Some of the students aged 13 understood the force as terminologies related with everyday experiences, while the students aged 17 understood the force as scientific terminologies. Second, there was no evidence to suggest that conceptual change is more difficult for the students aged 17 than aged 13. Third, the students aged 13 showed diverse responses (plain acceptance, critical acceptance, plain rejection, critical rejection) to the refutational text, while the students aged 17 showed restricted responses (critical acceptance, critical rejection). A month later those students who showed the plain acceptance retrogressed unscientific conceptions, while those students who showed critical acceptance maintained scientific conceptions. We did not find out any evidence to suggest that conceptual change is more difficult for older students. These results need deeper investigation on the nature of the loss of plasticity in comparison with other important variables.

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Retentive bond strength of fiber-reinforced composite posts cemented with different surface treatments (Fiber reinforced composite post의 표면 처리에 따른 접착 강도)

  • Roh, Hyunsik;Noh, Kwantae;Woo, Yi-Hyung;Pae, Ahran
    • The Journal of Korean Academy of Prosthodontics
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    • v.52 no.2
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    • pp.113-120
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    • 2014
  • This study will evaluate the effectiveness of various pretreatments when fiber-reinforced composite (FRC) post is bonded to endodontically treated tooth with resin cement. Materials and methods: Canal shaping of FRC post (DT Light post, Size 3, Bisco Inc., Schaumburg, IL, USA) was performed on endodontically treated premolars at 1.5 cm from CEJ. Samples were divided into 6 groups of surface treatment after conventional washing and drying to the canal. Total of 24 FRC posts were randomly divided into 6 groups of surface treatment as follows: Group C: control - no surface treatment, Group A: airborne-particle abrasion (Cojet sand, 3M ESPE), Group S: silanization (Bis-silane, Bisco Inc.), Group M: universal primer (Monobond-plus primer, Ivoclar Vivadent Inc.), Group AS: silanization after airborne-particle abrasion, Group AM: universal primer treatment after airborne-particle abrasion. Pretreated fiber posts were cemented with resin-based luting material and photo-polymerized and cut to the thickness of 1 mm. Push-out test using a universal testing machine was performed. Bonding failure strength of post dislodgement was measured and the type of bonding failure was classified. Data were analyzed with Kruskal-Wallis test and multiple comparison groups were performed using Tukey HSD value of rank test (${\alpha}=0.05$). Results: Group AS showed significantly highest bonding strength. Group S, group AM, group A, and group M showed lower bonding strength in order. The control group showed the lowest bonding strength. Conclusion: Surface treatment with silane showed to be the most effective of the surface pretreatment methods for cementation of FRC post. Surface treatment with universal primer showed no significant difference compared with no surface treatment group as for bonding strength.

Comparison of condylar guidance using ARCUSdigma 2 and Checkbite (ARCUSdigma 2와 Checkbite를 사용하여 측정한 과로경사각 비교)

  • Lee, Dong-In;Lee, Chang-Hee;Son, Mee-Kyoung;Chung, Chae-Heon;Kang, Dong-Wan
    • The Journal of Korean Academy of Prosthodontics
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    • v.51 no.3
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    • pp.153-159
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    • 2013
  • Purpose: Nowadays, checkbite methods and a digital sensor are used to analyze the movement of mandible. However, there are no study comparing two methods. Therefore, this study has compared measuring the condylar inclination methods by using the new ARCUSdigma 2 system and the checkbite method. Materials and methods: Young 20 adults without any orthodontic treatment experiences, missing teeth, and restorations with the change of occlusal plane were tested. Angles of condylar path were measured 3 times each, based on Camper's line, by using two methods. KaVo PROTAR Evo 7 semi-adjustable articulator was used and the data were statistically analyzed. Results: 1. The anterior sagittal condylar inclination by ARCUSdigma 2 system were measured as $26.97^{\circ}({\pm}7.38^{\circ})$ on the left side and $29.80^{\circ}({\pm}8.19^{\circ})$ on the right side. The lateral condylar inclination were measured as $5.75^{\circ}({\pm}3.47^{\circ})$ on the left side and $8.10^{\circ}({\pm}4.98^{\circ})$ on the right side. 2. The anterior sagittal condylar inclination by checkbite method were measured as $25.20^{\circ}({\pm}6.53^{\circ})$ on the left side and $28.18^{\circ}({\pm}7.38^{\circ})$ on the right side. The lateral condylar inclination were measured as $10.97^{\circ}({\pm}5.63^{\circ})$ on the left side and $12.03^{\circ}({\pm}5.22^{\circ})$ on the right side. There was no statistically significant difference between male and female (P>.05). 3. The lateral condylar inclinations of ARCUSdigma 2 were statistically significantly smaller than that of checkbite method (P<.05). Conclusion: In Both of 2 methods, there was no statistically significant difference between male and female (P>.05). However, the lateral condylar inclinations of ARCUSdigma 2 were statistically significantly smaller than that of checkbite method (P<.05).

Clinical Utility of Polymerase Chain Reaction for the Differentiation of Nontuberculous Mycobacteria in Patients with Acid-fast Bacilli Smear-positive Specimens (객담 항산균 도말 양성 환자에서 비결핵항산균과의 감별을 위한 결핵균 중합효소연쇄반응 검사의 유용성)

  • Lee, Jae Seung;Ji, Hyun Shuk;Hong, Sang Bum;Oh, Yeon-Mok;Lim, Chae-Man;Lee, Sang Do;Koh, Younsuck;Kim, Woo Sung;Kim, Dong Soon;Kim, Won Dong;Shim, Tae Sun
    • Tuberculosis and Respiratory Diseases
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    • v.58 no.5
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    • pp.452-458
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    • 2005
  • Background : In Korea, polymerase chain reaction (PCR) test for M. tuberculosis has been used for the diagnosis of acid-fast bacilli (AFB) smear-negative tuberculosis in order to increase diagnostic sensitivity. However, there have been no data dealing with the clinical utility of PCR in AFB smear-positive patients to differentiate between M. tuberculosis and nontuberculous mycobacteria. Method : We retrospectively analyzed the PCR test results which have been performed in patients who had AFB smear-positive sputum but had ambiguous clinical manifestations of active tuberculosis. PCR test was done using $AMPLICOR^{\hat{a}}$ M. tuberculosis kit. The sensitivity, specificity, and positive and negative predictive values of the PCR test were calculated based on culture and final clinical diagnosis result. Results : Fifty-six consecutive patients (62 PCR tests) were included in the study. Active tuberculosis was diagnosed in 23 patients (41.0%), while 9 patients had NTM infection (16.0%). The sensitivity, specificity, positive- and negative-predictive value of PCR test were 88.8%, 86.8%, 76.1% and 94.3%, respectively, according to the culture result. In comparison, they were 91.3%, 100%, 100%, 94.3%, respectively, according to the final clinical diagnosis. All 15 patients with NTM isolates, including 6 patients who had other lung diseases but expectorated NTM isolate, were negative for PCR test. Conclusion : Even though tuberculosis is still prevalent in Korea, PCR test is useful to differentiate between M. tuberculosis and NTM in patients with AFB-smear positive sputum but with ambiguous clinical manifestations of active tuberculosis.

The Propagation Behaviour of the Fatigue Crack in the Compact Tension Specimens of the Welded Structural Steels (On according to the difference of the welding direction, the input heat level, the strength of weld material and so on) (용접(鎔接)이음한 구조강(構造鋼)의 소인장시험편(小引張試驗片)에서의 피로구열진전거동(疲勞龜裂進展擧動) (용접방향(鎔接方向), 입열량(入熱量), 용접재료(鎔接材料)의 강도(强度) 등이 다를 때))

  • Chang, Dong Il;Chung, Yeong Wha
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.4 no.2
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    • pp.133-142
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    • 1984
  • With the weld-joined compact tension specimens compared with each other, that is, transverse and lengthwise about the crack propagation direction, high and low in the input heat level, same as and lower than the base metal in the strength of weld material, the fatigue test were performed. With these data, the log-log curves between the fatigue crack propagation rate ${\frac{da}{dN}}$ and the transition range of the stress intensity factor ${\Delta}K$ ahead the crack tip were drawed. These curves were compared and estimated among each compared specimens, among each zones, that is, the base metal, the heat-affected metal and the weld-mixed metal, and between this study and the past studies. Basically, Little difference in the slope of the $da/dN-{\Delta}K$ relation was showed in all the welded directions, all the input heat levels and all the zones. But, First, to comparison with in the past studies about the base metals, it was showed that da/dN started in the much later rate, increased faster and stoped in the little faster rate. Second, it was showed that, near the time the crack's going from the heat-affected zone to the weld-mixed metal da/dN decreased a little for a while. Third, in the lengthwise weld compared with the transverse weld, in the high input heat weld compared with the low input heat weld in the case used the weld material of the same strength as the base metal, in the opposite case in the case used the one of the lower strength than the base metal, in the case used the weld material of the same strength as compared with the lower strength than the base metal beside the high input heat and the lengthwise weld, it was showed that the crack occured earlier in lower ${\Delta}K$ and later da/dN, the curves went with the same slope. Forth, in the lengthwise weld compared with the transverse weld in the low input heat weld, in the low input heat weld compared with the high input heat weld, it was showed that da/dN went with the lower level.

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Evaluation of 3DVH Software for the Patient Dose Analysis in TomoTherapy (토모테라피 환자 치료 선량 분석을 위한 3DVH 프로그램 평가)

  • Song, Ju-Young;Kim, Yong-Hyeob;Jeong, Jae-Uk;Yoon, Mee Sun;Ahn, Sung-Ja;Chung, Woong-Ki;Nam, Taek-Keun
    • Progress in Medical Physics
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    • v.26 no.4
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    • pp.201-207
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    • 2015
  • The new function of 3DVH software for dose calculation inside the patient undergoing TomoTherapy treatment by applying the measured data obtained by ArcCHECK was recently released. In this study, the dosimetric accuracy of 3DVH for the TomoTherapy DQA process was evaluated by the comparison of measured dose distribution with the dose calculated using 3DVH. The 2D diode detector array MapCHECK phantom was used for the TomoTherapy planning of virtual patient and for the measurement of the compared dose. The average pass rate of gamma evaluation between the measured dose in the MapCHECK phantom and the recalculated dose in 3DVH was $92.6{\pm}3.5%$, and the error was greater than the average pass rate, $99.0{\pm}1.2%$, in the gamma evaluation results with the dose calculated in TomoTherapy planning system. The error was also greater than that in the gamma evaluation results in the RapidArc analysis, which showed the average pass rate of $99.3{\pm}0.9%$. The evaluated accuracy of 3DVH software for TomoTherapy DQA process in this study seemed to have some uncertainty for the clinical use. It is recommended to perform a proper analysis before using the 3DVH software for dose recalculation of the patient in the TomoTherapy DQA process considering the initial application stage in clinical use.

Comparison between Response AC/A and CA/C Ratio according to Additional Spherical Powers and Prism Powers (가입렌즈 도수와 프리즘 굴절력 변화에 따른 반응 AC/A비와 CA/C비 비교)

  • Roh, Byeong-Ho;Yu, Dong-Sik;Son, Jeong-Sik;Kwak, Ho-Weon
    • Journal of Korean Ophthalmic Optics Society
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    • v.20 no.3
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    • pp.341-347
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    • 2015
  • Purpose : This study was to examine a correlation of response AC/A ratio by additional spherical powers with PD(Pupilary distance) and relative accommodation, and was to investigate correlation of CA/C ratio by prism powers. The mean differences between a reciprocal response AC/A ratio and a CA/C ratio were compared, and were suggested to be used as data in the refractive power and prism prescriptions in the clinical. Methods: The open field autorefractometer (Nvision-K 5001, Shin nippon) and Howell target at 40 cm fixation distance to 62 persons with average $22.62{\pm}2.84$ ages were used to measure the response AC/A ratio according to additional Spherical powers. The CA/C ratios were measured using the DOG card at 40cm according to prism powers. Results: When the response accommodation according to Additional Spherical power changes and the response accommodation according to prism power changes were compared, it was larger than the response accommodation according prism power change. These were significant differences statistically. The correlation of response AC/A ratio and PD is showed as r = -0.158, the CA / C ratio is shown as r = 0.093. The correlation of response AC/A ratio and relative accommodation showed as r = -0.253, the CA/C ratio showed as r = 0.566 that is predictable correlation. The correlation of response AC/A ratio and CA/C ratio showed as r = -0.355 that is low minus correlation (p = 0.000). The difference between a reciprocal response AC/A ratio and a CA/C ratio showed $0.12{\pm}0.06D/{\Delta}$ with a significant difference statistically (p=0.000). Conclusions: The correlation of relative accommodation and CA/C ratio showed that depend on the individual, The more a relative accommodation is, the higher a response accommodation of convergence by convergence stimulus is. The reciprocal response AC/A and CA/C ratio showed significant differences statistically. This can have higher CA/C ratio in patients with low AC/A ratio in clinical as an independent variable. Thus when the abnormal binocular vision was prescribed in the clinical, it is necessary to consider the accommodative response even if the AC/A ratio is a normal range.

Comparison of Center Error or X-ray Field and Light Field Size of Diagnostic Digital X-ray Unit according to the Hospital Grade (병원 등급에 따른 X선조사야와 광조사야 간의 면적 및 중심점 오차 비교)

  • Lee, Won-Jeong;Song, Gyu-Ri;Shin, Hyun-yi
    • Journal of the Korean Society of Radiology
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    • v.14 no.3
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    • pp.245-252
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    • 2020
  • The purpose of this study was intended to recognize the importance of quality control (QC) in order to reduce exposure and improve image quality by comparing the center-point (CP) of according to hospital grade and the difference between X-ray field (XF) and light field (LF) in diagnostic digital X-ray devices. XF and LF size, CP were measured in 12 digital X-ray devices at 10 hospitals located in 00 metropolitan cities. Phantom was made in different width respectively, using 0.8 mm wire after attaching to the standardized graph paper on transparent plastic plate and marked as cross wire in the center of the phantom. After placing the phantom on the table of the digital X-ray device, the images were obtained by shooting it vertically each field of survey. All images were acquired under the same conditions of exposure at distance of 100cm between the focus-detector. XF and LF size, CP error were measured using the picture archiving communication system. data were expressed as mean with standard error and then analyzed using SPSS ver. 22.0. The difference in field between the XF and LF size was the smallest in clinic, followed by university hospitals, hospitals and general hospitals. Based on the university hospitals with the least CP error, there was a statistically significant difference in CP error between university hospitals and clinics (p=0.024). Group less than 36-month after QC had fewer statistical errors than 36-month group (0.26 vs. 0.88, p=0.036). The difference between the XF and LF size was the lowest in clinic and CP error was the lowest in university hospital. Moreover, hospitals with short period of time after QC have fewer CP error and it means that introduction of timely QC according to the QC items is essential.