• 한국병원경영학회지
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• 제28권2호
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• pp.1-8
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• 2023

Purpose: This study was conducted to identify the impact of human rights sensitivity and patient rights awareness of first-year students in clinical practice on clinical practice adaptation and to prepare practical and systematic personality development program education alternatives to foster high-quality medical personnel. Method: As for the research method, an online survey of 155 medical and nursing students from two universities in G-do (76 medical students and 79 nursing students) was conducted, and the collected data were T-test, ANOVA, Scheffe test, Pearson's correlation coefficient and step-by-step multiple regression analysis using SPSS WIN/25.0. Findings: The results of the study are as follows. First, as a result of analyzing the differences in each variable according to general characteristics, human rights sensitivity had a significant impact on gender, patient rights recognition on personality type, and clinical practice adaptation had a significant impact on major selection motivation. Second, the factors affecting the adaptation of first-year college students to clinical practice had a significant impact on extroverted personality and patient rights perception among personality types (regression model results F=6.38 (p<).001), 24.2% explanatory power). Conclusion: This study suggests that education and policy efforts are needed to foster accurate awareness of human rights issues by developing flexible and flexible extracurricular activity programs in the operation of the curriculum to strengthen medical and nursing students' ability to adapt to clinical practice and improve awareness of human rights issues.

• Korean Circulation Journal
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• 제54권5호
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• pp.270-287
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• 2024

Background and Objectives: Blood pressure (BP) measurement using an auscultatory sphygmomanometer is recommended for diagnosing hypertension in children. As mercury sphygmomanometers (MSs) are banned owing to environmental concerns, it is crucial to determine the accuracy of mercury-free sphygmomanometers to replace them. We analyzed the accuracy of these devices to guide the National Survey selection. Methods: BP was measured thrice each with MS, auscultatory device (AD), and oscillometric device (OD) in 104 participants aged 10-18 using the National Survey data. The difference in BP was defined as the difference between MS and other devices. The BP differences, correlations, and influencing factors were analyzed. The frequencies of hypertension were also compared. Results: Systolic BP (SBP) and diastolic BP (DBP) differences between MS and AD were 0.88±3.36 mmHg and 0.63±3.95 mmHg, and those between MS and OD were 0.43±5.83 mmHg and 4.57±6.89 mmHg, respectively. The absolute error of <10 mmHg for DBP between MS and OD was 76%. The concordance correlation coefficient between MS and AD was 0.94 for SBP and 0.90 for DBP, and 0.81 and 0.67, respectively for MS and OD. Arm circumference negatively correlated with BP differences except for SBP between the MS and OD. The frequency of hypertension was not different between MS and AD but was underestimated by OD. Conclusions: AD correlated well with MS, while OD did not, especially for DBP. The superiority of AD over OD suggests AD as a possible alternative for MS in the National Survey.

• Journal of Preventive Medicine and Public Health
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• 제11권1호
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• pp.123-127
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• 1978

The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

• 한국학교보건학회지
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• 제13권1호
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• pp.147-160
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• 2000

The purpose of this study was to serve as a basis for better student practice in dental hygiene and for determining educational direction for dental hygiene clinical education by examining what students and clinical-practice instructors thought on clinical practice and what factors gave an impact to clinical education. For attaining the purpose, an investigation was made of 449 third-grade students in the department of dental hygiene at seven educational institutes in Seoul and Kyoung-gi province. 246 instructors in charge of the clinical practice of the students at dental hospital or clinics were also examined. The findings of this study were as follows: 1. The instructors and students had different opinions on the number of trainees, training time, beginning of training, and assessment(p<0.05). The instructors thought that a trainee was appropriate for an instructor(59.8%), and that training time was not sufficient(30.8%). They considered it proper for students to start practice during the summer vacation of second year(21.5%), and responded that assessment should be done by the dentist, dental hygienist or professor in charge(44.7%). However, the students had an idea that an instructor should take charge of 2 or 3 trainees(47.4%), and that there was a lot of training time(55.7%). They considered it appropriate to start practice in the first term of second grade(l9A%), and thought the assessment should be made by the dentist and dental hygienist in charge(44.8%). 2. The students' satisfaction was clinical practice was affected(p<0.05) by their own selection of training institutes(28.1%), the absence of trainee from other colleges(29.4%), ample practice time(28.3%), implementation of student assessment once a day(45.3%), diverse practice opportunities (45.5%), and easy traffic to the training institute(32.9%). 3. The achivement of clinical practice was influenced by practice opportunities, the degree of faithful treatment performance, the frequency of student assessment, the number of trainees, traffic to training institutes, assistance in understanding theoretical knowledge of clinical practice, and assessment methods(p<0.05).

• 대한간호학회지
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• 제52권1호
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• pp.52-65
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• 2022

Purpose: This study was conducted to develop a scale to measure spiritual distress in cancer patients. Methods: A total of 69 preliminary items for the spiritaul distress assessment tool (SDAT) were compiled, based on a literature review, selection of empirically relevant items through concept analysis of hybrid models, confirmation of content validity by experts, cognitive interviews, and a pretest. Self-administered questionnaires were collected between April 1 and July 31, 2018, from 225 cancer patients at four medical institutions and one nursing home. The data were analyzed using item analysis, exploratory factor analysis, convergent and discriminant validity, and Pearson correlation for criterion validity. Reliability was tested by Cronbash's α coefficient. Results: The final version of the SDAT consisted of 20 items. Five-factors, loss of peace, burden of family, avoidance of confronting death, guilt and remorse, regret for not being able to apololgize and forgive were extracted, and showed 62.8% of total variance. The factors were confirmed through convergent and discriminant validity. Criterion validity was confirmed by functional assessment chronic illness therapy spiritual well-being scale 12 (FACIT-Sp12). The overall Cronbach's α was .91, and the coefficients of each subscale ranged from .78~.83. Conclusion: The SDAT for cancer patients is valid and reliable. It is suggested that the tool can be used to measure spiritual distress in cancer patients.

• Childhood Kidney Diseases
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• 제8권2호
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• pp.214-222
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• 2004

목적: 소아 요로감염은 적절한 항생제 치료가 중요하며 항생제의 선택에는 E. coli에 대한 항생제 감수성이 기준이 된다. Extended-spectrum ${\beta}-lactamase(ESBL)$은 E. coli 등 그람음성균에서 분비되어 광범위 항생제 내성을 초래하는 효소로서 주로 병원 감염에서 발생하여 치료를 어렵게 하는 요인으로 알려져 있다 저자들은 지역사회 획득 소아 요로감염에서도 ESBL(+) E. coli가 분리되었기에 ESBL(+) E. coli 요로감염의 특성을 후향적으로 조사하고자 하였다. 방법: 2001년 3월부터 2003년 2월까지 이대목동병원 소아과에 입원한 지역사회 획득 E. coli 요로감염 소아(288명)를 대상으로 ESBL을 검사하였다. 검사 방법은 미량 액체배지 희석법을 이용한 자동화 기계(Vitek GNS 433 card)에서 ESBL이 의심되는 균주에 한해 National Committee for Clinical Laboratory Standard (NCCLS)의 기준에 따라 ESBL을 확인하였다. ESBL의 결과에 따라 ESBL(+) E. coli 요로감염의 발생률을 조사하였고 임상적 특징, 위험요인, 항생제 내성률 및 치료효과 등을 ESBL(-) E. coli 요로감염과 비교 분석하였다. 결과:지역사회 획득 소아 요로감염에서 ESBL(+) E. coli의 발생률은 10.8%(31명)이였고 93.5%(29/31)가 6개월 미만의 영아에서 발생하였다(P<0.01). 임상소견은 ESBL 양성군과 음성군 사이에 유의한 차이가 없었다. ESBL 밭생의 위험인자로 잘 알려진 항생제 사용력, 입원병력 및 요로계 기형과도 무관하였다. ESBL(+) E. coli의 항생제 내성률은 ESBL(-) E. coli 에 비하여 유의하게 높았다(P<0.05). Ceftriaxone 투여 48시간 후의 멸균률은 ceftriaxone에 대한 높은 내성률에도 불구하고 96.8%(30/31)로 높았다. 그러나 6개월 이내의 재발률이 25.8%(9/31)나 되었고 이는 ESBL 음성군의 재발률 6.6%(17/227)에 비하여 유의하게 높았다(P<0.05). 결론: 지역사회 획득 소아 요로감염에서 6개월 미만의 어린 영아는 ESBL(+) E. coli 발생의 새로운 위험요인이므로 이에 대한 역학적 연구가 요구된다. 소아 요로감염에서 경험적으로 사용하는 항생제의 선택에 대한 변화가 필요할 것으로 생각된다.

• Journal of Korean Dental Science
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• 제6권2호
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• pp.67-77
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• 2013

Purpose: The purpose of this study was to evaluate the survival and success rates of Korean Osstem implants US II Plus, GS II following loading period. Materials and Methods: Dental records were obtained in total 201 patients who were treated with Korean Osstem implants US II Plus, GS II on both maxillary and mandibular anterior and posterior areas in six different clinics for 2 years from January 2007 to December 2008. Total 430 implants were evaluated clinically and radiographically using predefined success criteria prospectively and following results were obtained. Result: US II Plus, GS II implants showed high survival rates of more than 99% and high success rates more than 90% independent of loading period. As a result of cross analysis to evaluate clinical significance between implant loading period and success rate, the P-value of US II Plus was 0.10 (P>0.05), and the P-value of GS II was 0.17 (P>0.05), which showed no statistical significance. Bone quality, smoking, and edentulous state are factors that can affect the survival and success rates following differently loaded implants, but did not significantly affect in this study. Conclusion: These results suggest that selection of loading period of Korean Osstem implants US II Plus, GS II would be done carefully considering implant install area, the quality alveolar bone, the state of edentulous ridge and experience of operator, though they showed clinically good results on both maxillary and mandibular anterior and posterior areas.

• Asian Pacific Journal of Cancer Prevention
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• 제15권11호
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• pp.4689-4695
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• 2014

Background: A great number of studies have shown that cytochrome P450 1A1 (CYP1A1) genetic polymorphisms, CYP1A1 Msp I and CYP1A1 Ile/Val, might be risk factors for digestive tract cancers, including esophageal cancer (EC), gastric cancer (GC), hepatic carcinoma (HC), as well as colorectal cancer (CC), but the results are controversial. In this study, a meta-analysis of this literature aimed to clarify associations of CYP1A1 genetic polymorphisms with digestive tract cancers susceptibility in Chinese populations. Materials and Methods: Eligible case-control studies published until December 2013 were retrieved by systematic literature searches from PubMed, Embase, CBM, CNKI and other Chinese databases by two investigators independently. The associated literature was acquired through deliberate search and selection based on established inclusion criteria. Fixed-effects or random-effects models were used to estimate odds ratios (ORs and 95%CIs). The meta-analysis was conducted using Review Manager 5.2 and Stata 12.0 softwares with stability evaluated by both stratified and sensitivity analyses. Moreover, sensitivity analysis and publication bias diagnostics confirmed the reliability and stability. Results: Eighteen case-control studies with 1,747 cases and 2,923 controls were selected for CYP1A1 MspI polymorphisms, and twenty case-control studies with 3, 790 cases and 4, 907 controls for the CYP1A1 Ile/Val polymorphisms. Correlation associations between CYP1A1 Ile/Val polymorphisms and digestive tract cancers susceptibility were observed in four genetic models in the meta-analysis (GG vs AA:OR= 2.03, 95%CI =1.52- 2.72; AG vs AA: OR=1.26, 95%CI =1.07-1.48; [GG+AG vs AA] :OR =1.42, 95%CI=1.20-1.68, [GG vs AA+AG]:OR=1.80, 95%CI =1.40-2.31). There was no association between CYP1A1 Msp I polymorphisms and digestive tract cancers risk. Subgroup analysis for tumor type showed a significant association of CYP1A1 Ile/Val genetic polymorphisms with EC in China. However, available data collected by the study failed to reveal remarkable associations of GC or HC with CYP1A1 Ile/Val genetic polymorphisms and EC, GC or CC with CYP1A1 MspI genetic polymorphisms. Conclusions: Our results indicated that CYP1A1 Ile/Val genetic polymorphisms, but not CYP1A1 Msp I polymorphisms, are associated with an increased digestive tract cancers risk in Chinese populations. Additional well-designed studies, with larger sample size, focusing on different ethnicities and cancer types are now warranted to validate this finding.

• Journal of Chest Surgery
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• 제51권5호
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• pp.312-321
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• 2018

Background: Treatment strategies for octogenarians with lung cancer remain controversial. The purpose of this study was to compare surgical outcomes and survival between octogenarians and younger patients with stage IA and IB lung cancer. Methods: We reviewed the medical records of 34 consecutive octogenarians and 457 younger patients (<70 years) with stage I lung cancer who underwent surgical resection from January 2007 to December 2015. We analyzed the survival and surgical outcomes of the 2 groups according to the lung cancer stage (IA and IB). Results: The only significant differences in the clinicopathological features between the groups were the higher proportion of sublobar resection (56.3% vs. 18.9%) and the smaller number of dissected lymph nodes (LNs) in octogenarians. There was no significant difference in hospital stay (11 days vs. 9 days), pneumonia (5.8% vs 1.9%), or operative mortality (0% vs 0.6%) between the 2 groups. Among patients with stage IA lung cancer, 5-year recurrence-free survival was not significantly different between the octogenarians (n=16) and younger patients (n=318) (86.2% vs. 89.1%, p=0.548). However, 5-year overall survival was significantly lower in octogenarians than in younger patients (79.4% vs. 93.4%, p=0.009). Among patients with stage IB lung cancer, there was no significant difference in 5-year recurrence-free survival (62.1% vs. 73.5%, p=0.55) or overall survival (77.0% vs 85.0%, p=0.75) between octogenarians (n=18) and younger patients (n=139). In multivariable analysis, male sex, the number of dissected LNs, and tumor size were factors related to survival (hazard ratio [HR], 5.795; p=0.017; HR, 0.346, p=0.025; and HR, 1.699; p=0.035, respectively). Conclusion: Surgical outcomes and survival after pulmonary resection for stage I lung cancer were comparable in octogenarians and younger patients. Continued careful selection of octogenarians for pulmonary resection is important to achieve good results.

• 대한족부족관절학회지
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• 제26권2호
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• pp.95-102
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• 2022

Purpose: This study was based on the Korean Foot and Ankle Society (KFAS) member survey and aimed to report the current trends in the management of syndesmotic injuries over the last few decades. Materials and Methods: A web-based questionnaire containing 36 questions was sent to all KFAS members in September 2021. The questions were mainly related to the preferred techniques and clinical experiences in the treatment of patients with syndesmotic injuries. Answers with a prevalence ≥50% of respondents were considered a tendency. Results: Seventy-six (13.8%) of the 550 members responded to the survey. The results showed that the most preferred method to diagnose a syndesmotic injury was magnetic resonance imaging (MRI). Intraoperatively, the external rotation stress test and the Cotton test were most frequently used to confirm syndesmotic diastasis. The reduction was usually done by a reduction clamp. One 3.5-mm screw was used most frequently over three cortices at 2~4 cm above the ankle joint. The preferred ankle position during fixation was 0° dorsiflexion. Removal of the syndesmotic screw was routinely done by most surgeons, mainly because of the limitation of movement and risk of screw breakage. Factors that affect suture button selection included non-rigid fixation which enables adequate fixation, early weight-bearing, and an infrequent need to remove the hardware. Inadequate reduction was considered the main factor that affects poor prognosis. Conclusion: This study proposes updated information about the current trends in the management of syndesmotic injuries in Korea. Consensuses in both the diagnostic and therapeutic approach to patients with syndesmotic injury were identified in this survey study. This study may raise the awareness of the various possible approaches toward the injury and should be used to further establish a standard protocol for the management of syndesmotic injuries.