• 대한족부족관절학회지
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• 제22권3호
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• pp.116-119
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• 2018

Gout occurs mainly in monoarthritis and is found in more than 50% of cases in hallux of the foot. In addition, symptoms sometimes begin in the hand, wrist, and elbow, but they are rarely observed in the spine. The patient was referred for tuberculous polyarthritis due to antituberculosis drug failure. Inflammatory findings were observed in the lumbar, elbow, wrist, hand and foot areas. Surgery was performed on the foot area and a pathology diagnosis revealed gouty arthritis. We report this case with a review of the relevant literature.

• 대한두개안면성형외과학회지
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• 제22권6호
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• pp.333-336
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• 2021

Verrucous carcinoma (VC) is a rare subtype of squamous cell carcinoma that commonly occurs in the oral cavity. However, VC of the facial skin is relatively rare. We report a case of a 91-year-old woman with VC of the facial skin in the left zygoma area. She was diagnosed with actinic keratosis (4×3 cm) of the same site approximately 12 years previously, but declined further treatment. The mass was excised with a minimum of 0.4 cm from gross margins with the result of free from tumor of all margins by frozen section, allowing for primary closure after skin undermining. Basal resection was performed in the preplatysmal plane. The diagnosis of VC was confirmed by histopathological examination. Postoperatively, the wound healed without incident and with no signs of facial nerve injury. To our knowledge, this is the first reported case of VC of facial skin arising from actinic keratosis.

• 한국병원경영학회지
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• 제19권2호
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• pp.73-88
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• 2014

Objective: This research investigates how to increase the quality of medical service and supply high quality of medical service to patients. By using Kano Model theory we examines what medical service attributes the hospital would be conducted preferentially for patient's satisfaction and provides informations of management strategies for hospitals. Method: To study patients' perception of medical service quality, first we performed pilot test to derive 30 medical service attributes. With 30 medical service attributes, we conducted survey of 300 subjects who have experienced medical services in 6 months. To examine patients' conception of medical services, a modified Kano's questionnaire using 5 scale is applied. Finally we calculated SI(Satisfaction index) and DI(Dissatisfaction index) and PCSI(Potential Customer Satisfaction Improvement) index with Kano's Model analysis results. Key Findings: We found that the quality of medical service categorized in 15 one-dimensional elements, 9 must-be elements and 6 indifferent elements. Moreover the attribute of gives prompt services and have patient's best interest at heart scored the highest SI, whereas the attributes of accurate and precise medical service, exact records, enough explanation and polite attitudes are the highest score of DI. And also good explanation of the bill scored the highest PCSI. In this study findings indicate that while medical service providers try to increase patients' satisfaction by improving hospital's environments, patients' perception of trust and good interpersonal relationships with medical service providers have strong and positive impact on patients' satisfaction.

• 보건의료산업학회지
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• 제3권2호
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• pp.29-43
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• 2009

The purpose of this study is to provide basic material about the improvement method of the hospital evaluation system by grasping recognition, corresponding behavior to evaluation, influence and problems about the hospital evaluation system with respect to the employee of mid sized hospitals having relatively poorer environment. In this study were used 518 questionnaires to hospital employee working at 20 general hospitals in Pusan, Kyungnam with less than 500 beds and having experience of the hospital evaluation during 2005~2007. As a result of the research, they felt the investigation tool used for the hospital evaluation has too many items and it could be difficult to reflect characteristics of each hospital. It appeared that utilization of the report result after the hospital evaluation was helpful for grasping a part necessary for hospital improvement and the present level of hospitals and increase of interest about medical service quality improvement of the a hospital director or hospital employee. They trusted the result of the hospital evaluation to some degree, and recognized it helps the patients to select a hospital and increase rights-to-know. Hospital employee recognized the necessity and showed high interest and participation, but they didn't sympathize in the propriety and the feasibility of the hospital evaluation items. High degree evaluated hospital employee receive hospital evaluation system positively and think hospital services to be improve after taking hospital evaluation. The hospital evaluation should make the hospital to effort to achieve medical quality improvement to its purpose. Also, systematic reformation will be necessary to reflect characteristics of the hospital that has relatively small scale or locates in poor environment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권1호
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• pp.51-54
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• 2016

The present case report describes an external auditory canal injury following extraction of the lower molar. The external auditory canal was torn in the same fashion that occurs in an anterior tympanic plate fracture. This case demonstrates one of the rare complications associated with dental extractions.

• 한국병원경영학회지
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• 제13권4호
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• pp.76-100
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• 2008

The purpose of this research is to identify causalities among service quality, service value, customer satisfaction and customer loyalty and to compare the causalities between in-patients and out-patients. A multi-group structural equation model was used to test the hypothesis of conceptual model. Empirical results indicate that two factors such as assurance and empathy have direct impact on service value and customer satisfaction in both the patients. In the results of multi-group comparison test, however, the path coefficients from service value to customer loyalty and from customer satisfaction to customer loyalty were different across the two groups. In out-patients, customer loyalty is more positively related with service value. In in-patients, customer loyalty is more positively related with customer satisfaction. It is proven that service quality influences customer loyalty. Therefore To compete successfully in today's volatile & competitive medical markets, the hospital needs to manage the service quality, considering the type of patients.

• 보건의료산업학회지
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• 제10권1호
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• pp.1-11
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• 2016

Objectives : Medical service specialization could have positive effects on their profits and medical service quality. This study was to examine the relationship between medical service specializations and operational performance in hospitals. Methods : We used the National Inpatient Sample data provided by the Health Insurance Review and Assessment Service from 2010 to 2013. The hospital operational performance was determined by measuring the specialization level of the hospital based on DRGs. Results : The information theory index was 2.38 in 2010, 2.38 in 2011, 2.37 in 2012, and 2.37 in 2013. A multiple regression model was constructed which showed that if the specialization level becomes higher, it decreases the length of stay per case with an increase in medical expense. Conclusions : Differentiation and concentrated medical service specialization strategy have had a positive effect on the operational performance of hospitals.

• 임상간호연구
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• 제23권3호
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• pp.302-311
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• 2017

Purpose: The purpose of this study was to examine nursing organizational culture and resilience and their effects on quality of nursing service. Methods: A cross-sectional study was conducted. A convenience sampling method was used to collect data from 199 participants who worked in a tertiary hospital in G city. Demographic and work related variables, quality of nursing service, resilience, and nursing organizational culture were measured using validated self-report questionnaires. Results: All of the participants were women and the majority were staff nurses and single. A statistically significant difference in quality of nursing service was found for age, marital status, educational level, clinical career, position and perceived health status. Age, educational level, clinical career, position, resilience, innovation-oriented culture, relation-oriented culture, and hierarchy-oriented culture were significant predictors of quality of nursing service, explaining 47% of total variance. Among the predictors, resilience was the strongest predictor, followed by innovation-oriented culture, and hierarchy-oriented culture. Conclusion: Findings indicate that quality of nursing service can be improved by raising individual nurse's resilience and advancing nursing organizational culture. Considering the identified factors, researchers and administrators need to develop and provide clinical nurses with a variety of programs to improve the quality of their nursing service.

• 보건행정학회지
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• 제5권2호
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• pp.35-69
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• 1995

The managerial environment of hospitals in Korea characterized by low levels of medical insurance fees is worsening by increasing government regulations as to the utilization of medical services, rising costs of labor, material, and medical equipments, growing patient expectations concerning the quality of services, and escalating competitions among large hospitals in the market. Hospitals should seek for their survival strategies in this harsh environment and they should have information about costs of their products in doing so. However, it has not been available due to the complexity of the production process of hospital services. The objectives of this study were to develop a service-based cost accounting model and to apply the developed model to a study hospital to obtain cost information of hospital services. A model commonly used for the job-order product cost accounting in the manufacturing industry was modified for the use in hospitals in Korea. Actual costs, instead of standard costs, incurred to produce a unit of services during a given period of time were estimated in the model. Data required to implement the model included financial information, statistics for the allocation of supportive cost center costs to final cost centers, statistics for the allocation of final cost center costs to services, and the volume of each services charged to patients during a study period. The model was executed using data of a university teaching hospital located in Seoul for the fiscal year 1992. Data for financial information, allocation statistics fo supportive service costs, and the volume of services, most of them in electronic form, were available to the study. Data for allocation statistics of final cost center costs were collected in the study. There were 15 types of evaluation and management service, 2, 923 types of technical service, and 2, 608 types of drug and material service charged to patients in the study hospital during the fiscal year 1992. Labor costs of each of seven types of pesonnel, material costs of 611 types of drugs and materials, and depreciation costs of 212 types of medical equipments, miscellaneous costs, and indirect costs incurred in producing a unit of each services were estimated. Medical insurance fees for basic services such as evaluation and management of inpatients and outpatients, injection, and filling prescriptions, and for operating procedures were found to be set lower than costs. Infrequent services which use expensive medical equipments showed negative revenuse as well. On the other hand, fees for services not covered by the insurance such as CT, MRI and Sonogram, and for laboratory tests were higher than costs. This study has a significance in making it possible for a hospital to obtain cost information for all types of services which produced income based on all types of expenses incurred during a given period of time. This information can assist the management of a hospital in finding an effective cost reduction strategy, an efficient service-mix strategy under a given fee structure, and an optimum strategy for within-hospital resource allocations.

• 간호행정학회지
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• 제7권1호
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• pp.25-40
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• 2001

As the medical market has gradually changed from supplier-centered market to consumer-centered one, it makes hospital managers seek the consumer's satisfaction and the various marketing strategies for survival. Under the these changes, this study was accomplished to measure the consumer's satisfaction about the medial services which a general hospital provided, to identify the marketing strategies that a general hospital could establish for survival. For these purposes, a questionnaire was developed and distributed to 200 patients in general units and 100 patients in oriental units of a general hospital in Seoul. Among them, 163 reponses in general units and 71 reponses in oriental units were turned out to be useful. they were used for final analysis. The results of the survey were as follows : First, among all items of medical services which the hospital provided, patients were most satisfied by nursing services. Second, to Improve the hospital's medical service quality, it was very important for hospital staffs to be courtesy and to explain about a process of treatment or care sufficiently. Third, to decrease cost of medical service, it was very important to develop the various items and premiums of medical insurance especially in field of oriental medicine. Fourth, to make people come to the hospital easy, it was very important of fully utilize the public transportation such as subway. Fifth, to make hospital's image good, it was very important to develop well-prepared public relationship and to continuously provide the diverse medical service in the community.