• Journal of Preventive Medicine and Public Health
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• 제47권4호
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• pp.206-215
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• 2014

Objectives: The hospital standardized mortality ratio (HSMR) has been widely used because it allows for robust risk adjustment using administrative data and is important for improving the quality of patient care. Methods: All inpatients discharged from hospitals with more than 700 beds (66 hospitals) in 2008 were eligible for inclusion. Using the claims data, 29 most responsible diagnosis (MRDx), accounting for 80% of all inpatient deaths among these hospitals, were identified, and inpatients with those MRDx were selected. The final study population included 703 571 inpatients including 27 718 (3.9% of all inpatients) in-hospital deaths. Using logistic regression, risk-adjusted models for predicting in-hospital mortality were created for each MRDx. The HSMR of individual hospitals was calculated for each MRDx using the model coefficients. The models included age, gender, income level, urgency of admission, diagnosis codes, disease-specific risk factors, and comorbidities. The Elixhauser comorbidity index was used to adjust for comorbidities. Results: For 26 out of 29 MRDx, the c-statistics of these mortality prediction models were higher than 0.8 indicating excellent discriminative power. The HSMR greatly varied across hospitals and disease groups. The academic status of the hospital was the only factor significantly associated with the HSMR. Conclusions: We found a large variation in HSMR among hospitals; therefore, efforts to reduce these variations including continuous monitoring and regular disclosure of the HSMR are required.

• Journal of Trauma and Injury
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• 제29권3호
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• pp.68-75
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• 2016

Purpose: The purpose of this study was to analyze the effectiveness of regional trauma center's management. Methods: Data collected between January 2013 and December 2015 from a regional trauma center registry was retrospectively reviewed. The patients who had injury severity score (ISS) greater than 15 and over the age of 18 were included. We compared annual general characteristics, the injury mechanism, the pathway of transportation, the injury severity score, the length of stay in emergency department (ED) and hospital, the in-hospital mortality. Results: The annual numbers of enrolled patients were 337, 334 and 278, respectively. No significant differences were found in the annual patient's median ages, injury mechanism, ISS and in-hospital mortality. The annual proportions of coming from other hospital and the median length of stay in hospital were increased after establishment of regional trauma center. The annual median lengths of stay in ED were decreased remarkably. Conclusion: Through the establishment of regional trauma center, the length of stay in ED can be reduced but not in-hospital mortality. More multidisciplinary cooperation and well-organized study is needed to reduce mortality of major trauma patients and maximize effect of regional trauma center.

• Journal of Korean Neurosurgical Society
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• 제44권1호
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• pp.1-7
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• 2008

Objective : The purpose of this study was to investigate the factors affecting the surgical outcome and to compare the surgical results between transsylvian and transcortical approaches in patients with putaminal hematomas. Methods : Retrospective review of charts and CT scan images was conducted in 45 patients (20 transsylvian and 25 transcortical approaches) who underwent open surgical evacuation of putaminal hematomas. Mean Glasgow coma scale (GCS) score and hematoma volume were $7.5{\pm}3.2$ and $78.1{\pm}29.3\;cc$, respectively. The factors affecting the functional mortality were investigated using a multivariate logistic regression analysis. In addition, surgical results between transsylvian and transcortical approaches were compared. Results : None of the patients had a good recovery after the surgery. Overall functional survival rate and mortality were 37.7% and 31%, respectively. The only risk factor for functional mortality was GCS motor score after controlling age, history of hypertension, side of hematoma, hematoma amount midline shift, presence of intraventricular hemorrhage and surgical approach (p=0.005). Even though a transcortical approach was shorter in operative time (4.4 versus 5.1 hour) and showed a higher mortality rate (40% versus 20%) and lower functional survival (45% versus 35%) compared to the transsylvian approach, the differences were not statistically significant between the two groups. Conclusion : In patients who have large amounts of hematoma and require open surgical evacuation, the only significant risk factor for functional survival is the preoperative GCS score. Cortical incision methods such as transsylvian and transcortical approaches have no influence on the surgical outcome. To decompress the swollen brain rapidly, transcortical approach seems to be more suitable than transsylvian approach.

• Journal of Chest Surgery
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• 제50권1호
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• pp.14-21
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• 2017

Background: Off-pump coronary artery bypass (OPCAB) is performed worldwide, but significant risks are associated with conversion to on-pump surgery. Therefore, we evaluated the composite outcomes between an OPCAB group and a conversion group. Methods: From January 2008 to December 2012, 100 consecutive patients underwent OPCAB at Hallym University Sacred Heart Hospital, of whom 84 underwent OPCAB without adverse events (OPCAB group), and 16 were converted to on-pump surgery (conversion group). Early morbidity, early and long-term mortality, and major adverse cardiac and cerebrovascular events (MACCEs) were the primary and long-term composite endpoints. Results: The mean follow-up period was $55{\pm}26months$, with 93% of the patients completing follow-up. The composite outcomes in the OPCAB and conversion groups were as follows: early morbidity, 2.3% versus 12.5%; early mortality, 4.7% versus 0%; long-term mortality, 14.3% versus 25.0%; and MACCEs, 14.3% versus 18.8%, respectively. No composite endpoints showed statistically significant differences. Preoperative acute myocardial infarction (AMI) was identified as an independent risk factor for conversion (p=0.025). Conclusion: The conversion group showed no statistically significant differences in early mortality and morbidity, MACCEs, or long-term mortality compared with the OPCAB group. The preoperative diagnosis of AMI was associated with an increased number of conversions to on-pump surgery.

• Journal of Korean Medical Science
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• 제33권50호
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• pp.299.1-299.13
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• 2018

Background: Sarcopenia is associated with a poor prognosis in patients with liver cirrhosis. However, it is not known whether the rate of skeletal muscle depletion is also associated with a poor prognosis. We investigated the prognostic impact of the rate of skeletal muscle depletion in patients with liver cirrhosis. Methods: We included retrospectively all patients with liver cirrhosis who underwent both multiple computed tomography scans and hepatic venous pressure gradient (HVPG) measurements. Results: A total of 131 patients with liver cirrhosis were enrolled. The mean age of the patients was 53.7 years and alcoholic liver disease was the most common cause (61.8%). Sixty-four patients (48.9%) were diagnosed with sarcopenia. The median changes in skeletal muscle area per year (${\Delta}SMA/y$) were -0.89%. During a median follow-up period of 46.2 months (range, 3.4-87.6), 45 patients (34.4%) died. In multivariate analyses, age, Child-Pugh score, HVPG, presence of sarcopenia and ${\Delta}SMA/y$ were independently associated with mortality. Cumulative mortality was significantly higher in patients with ${\Delta}SMA/y$ < -2.4% than those with ${\Delta}SMA/y{\geq}-2.4%$ (log-rank test, P < 0.001). Conclusion: Both the presence and rate of change of sarcopenia are independently associated with long-term mortality in patients with liver cirrhosis.

• Journal of Chest Surgery
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• 제53권1호
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• pp.1-7
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• 2020

Background: The aim of this study was to evaluate the short-term and long-term results of surgical treatment for native valve endocarditis (NVE) and to investigate the risk factors associated with mortality. Methods: Data including patients' characteristics, operative findings, postoperative results, and survival indices were retrospectively obtained from Hallym University Sacred Heart Hospital. Results: A total of 29 patients underwent surgery for NVE (affecting the mitral valve in 20 patients and the aortic valve in 9) between 2003 and 2017. During the follow-up period (median, 46.9 months; interquartile range, 19.1-107.0 months), the 5-year survival rate was 77.2%. In logistic regression analysis, body mass index (p=0.031; odds ratio [OR], 0.574; 95% confidence interval [CI], 0.346-0.951), end-stage renal disease (ESRD) (p=0.026; OR, 24.0; 95% CI, 1.459-394.8), and urgent surgery (p=0.010; OR, 34.5; 95% CI, 2.353-505.7) were significantly associated with in-hospital mortality. Based on Cox proportional hazard regression analysis, the statistically significant predictors of long-term outcomes were hypertension, ESRD, and urgent surgery. Conclusion: Surgical treatment for NVE is associated with considerable mortality. The in-hospital mortality and 5-year survival rates of this study were 13.8% and 77.2%, respectively. Underlying conditions, including hypertension and ESRD, and urgent surgery were independent risk factors for unfavorable outcomes.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6413-6416
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• 2015

Colorectal cancer incidence and mortality in Kazakhstan are relatively high but exact statistics have hitherto been lacking and trends over time are unclear. The present study was therefore undertaken to retrospectively assess data for East Kazakhstan, accessed from the central registration office, for the period 2004-2013. Approximate age standardized data for incidence and mortality were generated and compared across age groups, gender and year. It was determined that during the studied period 3,417 new cases of colorectal cancer were registered and 2,259 died of this pathology. Average cancer cancer incidence and mortality over the ten years were $24.1/10^5$ and $15.9/10^5$ respectively, and the overall ratio of mortality/incidence (M/I) was 0.69:1 (range 0.58-0.73). Both incidence and mortality tended to remain constant in both males and females. The male to female ratios also did not significantly vary over time but a trend for improvement of the mortality to incidence ratio was observed, especially for rectum. Whether this might be related to screening remains unclear. These preliminary data indicate that whereas colorectal cancer continues to be important, change in environmental factors are not having a great impact on incidence in East Kazakhstan.

• Journal of Preventive Medicine and Public Health
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• 제38권1호
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• pp.38-44
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• 2005

Objective : To compare the mortality rate of Korean medical doctors to that of the general Korean population for the period 1992-2002. Methods : The membership records of the Korean Medical Association were linked to the 1992-2002 death certificate data of Korea s National Statistical Office using 13-digit unique personal identification numbers. The study population consisted of 61,164 medical doctors with a follow-up period of 473,932 person-years. Standardized mortality ratios(SMRs) were calculated to compare cause-specific mortality rates of medical doctors to those of the general population. Results : We confirmed 1,150 deaths at ages from 30 to 75 years from 1 January 1992 to 31 December 2002. The SMR for all-cause of death was 0.47(95% CI : $0.44{\sim}0.50$). The SMRs for smoking-related diseases such as cerebrovascular accidents and chronic obstructive pulmonary disease were smaller than the SMR of all-cause of death. However, the SMRs for colorectal and pancreatic cancers were not significantly lower than those of the general population. Transport accidents and suicides accounted for 72% (94 of 131) of external causes of death. The SMR for suicide was 0.51 (95% CI : $0.38{\sim}0.68$). Conclusions : The mortality rate of South Korean medical doctors was less than 50% that of the general population of South Korea. Cause-specific analysis showed that mortality rates in leading causes of death were lower among medical doctors although differences in mortality rates between medical doctors and the general population varied with the causes of death. These health benefits found among medical doctors may be attributable to the lower level of health damaging behaviors (e.g., lower smoking rates) and better working conditions.

• 대한영양사협회학술지
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• 제5권1호
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• pp.48-53
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• 1999

This study was prospectively conducted to investigate any relationship of nutritional status at the time of admission to length of hospital stay and mortality. All patients admitted to the Asan Medical Center between October 13 and November 12, 1997 who met the study criteria were included in the study. Patients were classified as Not-at-risk, At-risk Ⅰ or At-risk Ⅱ based on the levels of serum albumin and total lymphocyte count in a computerized nutrition screening program. Sixty three percent of the patients were classified as Not-at-risk Group, 29% as At-risk Group Ⅰ and 8% as At-risk Group Ⅱ. Significant correlation was observed between nutritional status and LOS (P＜0.01) as well as mortality rate (P＜0.05). The more the patient had the nutritional risk factors, the longer the LOS and the higher the mortality rate were. Further studies have to be done in order to demonstrate cost-effectiveness of medical therapy for the malnourished hospitalized patients.

• 한국인구학
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• 제26권2호
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• pp.33-62
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• 2003

이 연구의 목적은 사망수준의 저하에 영향을 미치는 세 요소-사회경제적 발전, 공공 보건의 발달, 사회경제적 발달의 균등상태-의 상대적 중요성을 분석하는 것이다. 종속변수인 사망 수준의 지표로는 영아사망률과 출생시 기대수명 등 두 변수가 사용되었다. 국민총생산(GNP)은 사회 경제적 발달지표로 여성의 초등학교 취학률과 기니계수(GINI index)는 사회경제적 균등상태 지표로 병원침대당 인구수는 공공보건 지표로 간주되었다. 변수들에 대한 자료는 두 시점에 걸쳐 수집되었다. 하나는 1970년 이전 53개국에서. 다른 하나는 1970-80년대 55개국에서 수집되었다. 탐색적 자료 분석 방법이 통계 분석 방법으로 사용되었다. 이 기법은 종속변수와 독립변수와의 관계가 선형인지 아닌지, 그리고 우리 모형에서 어느 것이 유력 사례인지를 파악할 수 있는 장점이 있다. 분석결과에 따르면, 첫째로 영아 사망률과 세 요소의 관계가 선형이 아니라 비선형임이 밝혀졌다. 영아 사망률 저하에 국민총생산이 가장 많이, 여성의 초등학교 취학률이 두 번째, 기니계수가 그 다음으로 영향을 미치는 것으로 나타났다. 반면 병원침대당 인구수는 통계적으로 유의미한 영향을 보여주지 않았다. 둘째, 출생시 기대수명은 여성의 취학률, 기니계수 등과 같은 변수와는 선형 관계를 가지는 반면 국민총생산 변수와는 비선형 관계를 가진다. 영아사망률 변수와는 달리 출생시 기대수명의 변이에는 여성의 초등학교 취학률이 국민총생산보다 더 커다란 영향을 미쳤다.