• Journal of Clinical Otolaryngology Head and Neck Surgery
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• v.29 no.2
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• pp.223-228
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• 2018

Background and Objectives : Necortizing fasciitis in the cervical region is a very rare disease with high mortality and morbidity rates. The purpose of this study was to analyze the clinical characteristics, treatment results, complication and prognosis of necrotizing fasciitis patients. Materials and Methods : We retrospectively reviewed the inpatient charts treated for cervical necrotizing fasciitis at our Otorhinolaryngology clinic. We diagnosed necrotizing fasciitis by the clinical findings such as swelling, redness and pain of infected area and necrosis of subcutaneous fat layer and fascia observed during surgery. Twenty such patients were identified and treated from January 2011 to December 2016. Results : 20 adults consisting of 14 male and 6 females with cervical necrotizing fasciitis were diagnosed and treated. The most commonly known associated preceding illness were dental abscess and tonsillitis. The most pathogen was Streptococcus species (12/20), followed by Klebsiella pneumonia (6/20), Staphylococcus species (2/20). The mean duration of hospitalization was 32.2 days (range,14-86). The mean Modified Laboroatory Risk Indicator for Necrotizing Fasciitis (M-LRINEC) score is 7.4 and more than 4 points was eighteen. All patients received parenteral antibiotics and surgical drainage after admission. Conclusions : The reason for the high survival rate in the study was the early diagnosis, as well as the early surgical procedure and antibiotics. After the operation, frequent betadine irrigation could improve the patient's condition and recover without severe complication.

• Archives of Plastic Surgery
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• v.49 no.3
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• pp.397-404
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• 2022

Background Excessive use of corticosteroids therapy along with gross immunocompromised conditions in the novel coronavirus disease 2019 (COVID-19) pandemic has raised the risks of contracting opportunistic fungal infections. Here, we describe our experience with the implementation of a surgical protocol to treat and reconstruct rhino-orbital-cerebral mucormycosis. Methods A retrospective review of our prospectively maintained database was conducted on consecutive patients diagnosed with mucormycosis undergoing immediate reconstruction utilizing our "Mucormycosis Management Protocol." All patients included in this study underwent reconstruction after recovering from COVID-19. Wide local excision was performed in all cases removing all suspected and edematous tissue. Reconstruction was done primarily after clear margins were achieved on clinical assessment under a cover of injectable liposomal amphotericin B. Results Fourteen patients were included. The average age was 43.6 years and follow-up was 24.3 days. Thirteen patients had been admitted for inpatient care of COVID-19. Steroid therapy was implemented for 2 weeks in 11 patients and for 3 weeks in 3 patients. Eight patients (57.1%) had a maxillectomy and mucosal lining resection with/without skin excision, and six patients (42.8%) underwent maxillectomy and wide tissue excision (maxillectomy and partial zygomatic resection, orbital exenteration, orbital floor resection, nose debridement, or skull base debridement). Anterolateral thigh (ALT) flaps were used to cover defects in all patients. All flaps survived. No major or minor complications occurred. No recurrence of mucormycosis was noted. Conclusion The approach presented in this study indicates that immediate reconstruction is safe and reliable in cases when appropriate tissue resection is accomplished. Further studies are required to verify the external validity of these findings.

• Journal of Korean Medicine Rehabilitation
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• v.32 no.3
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• pp.171-178
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• 2022

Meralgia paresthetica is a rare femoral disease and various symptoms appear such as pain, numbness, and paresthesia in the anterolateral thigh due to entrapment of the lateral femoral cutaneous nerve. We treated the meralgia paresthetica patients with Korean medicine treatment including herbal medicine, acupuncture, Chuna manual therapy and pharmacopuncture during 12 days. Numerical rating scale (NRS), Euroqol five dimension (EQ-5D) index, and the changes of symptoms were measured for assessment. After 12 days inpatient treatment, NRS decreased from 7 to 4, EQ-5D index and the symptoms of the patient also were improved. In conclusion, this case shows Korean medicine treatment might be an effective treatment for Meralgia paresthetica.

• Clinics in Shoulder and Elbow
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• v.25 no.1
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• pp.36-41
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• 2022

Background: Distal biceps rupture is a relatively uncommon injury that can significantly affect quality of life. Early complications following biceps tendon repair are not well described in the literature. This study utilizes a national surgical database to determine the incidence of and predictors for short-term complications following distal biceps tendon repair. Methods: The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify patients undergoing distal biceps repair between January 1, 2011, and December 31, 2017. Patient demographic variables of sex, age, body mass index, American Society of Anesthesiologists class, functional status, and several comorbidities were collected for each patient, along with 30-day postoperative complications. Binary logistic regression was used to calculate risk ratios for these complications using patient predictor variables. Results: Early postoperative surgical complications (0.5%)-which were mostly infections (0.4%)-and medical complications (0.3%) were rare. A readmission risk factor was diabetes (risk ratio [RR], 4.238; 95% confidence interval [CI], 1.180-15.218). Non-home discharge risk factors were smoking (RR, 3.006; 95% CI, 1.123-8.044) and ≥60 years of age (RR, 4.150; 95% CI, 1.611-10.686). Maleness was protective for medical complications (RR, 0.024; 95% CI, 0.005-0.126). Surgical complication risk factors were obese class II (RR, 4.120; 95% CI, 1.123-15.120), chronic obstructive pulmonary disease (COPD; RR, 21.981; 95% CI, 3.719-129.924), and inpatient surgery (RR, 8.606; 95% CI, 2.266-32.689). Conclusions: Complication rates after distal biceps repair are low. Various patient demographics, medical comorbidities, and surgical factors were all predictive of short-term complications.

• Korea Journal of Hospital Management
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• v.28 no.1
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• pp.14-23
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• 2023

Purposes: The Specialty hospital designation policy had launched in 2011 and 110 designated specialty hospitals have been operating nationwide in 2022. This study was to estimate the market share of specialty hospitals for the specific diseases compared to other types of hospitals. Methodology: Data were derived from the National Health Insurance Claim data from 2018 to 2019. Subjects were all the inpatients with MDC(Major Disease Category) that specialty hospitals specialized in. A total of 34,231,387 claims were analyzed to estimate the market share. Findings: 90 specialty hospitals were responsible for 2.4 percent of inpatient care with specific diseases for specialty hospitals. There were regional variations in the market share of the specialty hospitals as the number of specialty hospitals in regions. Specialty hospitals' market shares were relatively high in burn(31.3%), ophthalmology(16.4%), obstetrics and gynecology(7.1%), alcohol(6.0%), joint(3.7%), spine(2.7%). After adjusting the number of inpatients per hospital, hospitals specialized in burn, alcohol, ophthalmology, breast, joint, obstetrics and gynecology, and hand replantation had treated more patients than tertiary hospitals. Practical Implications: Although specialty hospitals' market share was small, some types of specialty hospitals had an impact on the regional market as well as the national level market. To improve patients' accessibility to a specialty hospital, it is necessary to government supports non-specialized hospitals to change into specialty hospitals in certain fields and regions where the number of specialty hospitals is insufficient.

• Journal of Korean Living Environment System
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• v.25 no.1
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• pp.90-97
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• 2018

The purpose of this study is to compare and analyze the air infections in middle and small hospitals with the facilities of large national hospitals that have air-borne infection isolation (AII) wards through actual condition investigation and airflow analysis simulation (CFD) and to provide basic data for prevention. The method and scope of the study are as follows. First, through literature review, data related to prevention of infection spread in domestic medical institutions were investigated. Second, we conducted a survey on the status of isolation facilities to prevent the spread of infectious diseases in large hospitals and small and medium - sized clinics in Korea. Third, airflow analysis simulation (CFD) was carried out using the isolation ward of the nationally designated inpatient ward and the data of the plane and facility system of the small clinic. As a result of the study, it is found that regulations applicable to small and medium-sized clinics are insufficient. In addition, the simulation results show that the infectious disease virus is likely to spread to other patients in the hospital.

• Journal of Preventive Medicine and Public Health
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• v.56 no.6
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• pp.542-551
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• 2023

Objectives: Prospective studies on vaccination status and mortality related to coronavirus disease 2019 (COVID-19) in low-resource settings are still limited. We assessed the association between vaccination status (full, partial, or none) and in-hospital mortality among COVID-19 patients at most hospitals in Jakarta, Indonesia during the Delta predomination wave. Methods: We conducted a retrospective cohort study among hospitalized COVID-19 patients who met the study criteria (>18 years old and admitted for inpatient treatment because of laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection). We linked individual-level data in the hospital admission database with vaccination records. Several socio-demographic and clinical characteristics were also analyzed. A Cox proportional hazards regression model was used to explore the association between vaccination status and in-hospital mortality in this patient group. Results: In total, 40 827 patients were included in this study. Of these, 70% were unvaccinated (n=28 543) and 19.3% (n=7882) died during hospitalization. The mean age of the patients was 49 years (range, 35-59), 53.2% were female, 22.0% had hypertension, and 14.2% were treated in the intensive care unit, and the median hospital length of stay across the group was 9 days. Our study showed that the risk of in-hospital mortality among fully and partially vaccinated patients was lower than among unvaccinated adults (adjusted hazard ratio [aHR], 0.43; 95% confidence interval [CI], 0.40 to 0.47 and aHR, 0.70; 95% CI, 0.64 to 0.77, respectively). Conclusions: Vaccinated patients had fewer severe outcomes among hospitalized adults during the Delta wave in Jakarta. These features should be carefully considered by healthcare professionals in treating adults within this patient group.

• Journal of The Korea Institute of Healthcare Architecture
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• v.29 no.4
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• pp.29-35
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• 2023

Purpose: The 2015 Middle East Respiratory Syndrome (MERS) outbreak and the recent COVID-19 pandemic have highlighted the lack of negative pressure isolation rooms and the fragility of the healthcare system. The need for healthcare facility transformation for respiratory infectious diseases has become more prominent due to COVID-19, and the purpose of this study is to provide a foundation for the rapid, economical, and safe construction of negative pressure isolation wards. Methods: This study analyzes the current status of hospitals that have been converted to negative pressure isolation rooms, and provides architectural plans and examples to provide a reference for bedroom change. Research data of this study have been obtained by analyzing the drawings of negative pressure isolation wards of nationally designated inpatient treatment beds and urgent isolation beds. In addition, the relevant literature of urgent isolation beds has been analyzed to derive bedroom change type. Result: In this study, a total of 21 isolation bed conversion methods have been presented. Implications: In order to change efficiently from a general ward to an isolation ward, it is necessary to consider the actual hospital's infectious disease transmission patterns and facility conditions.

• Journal of Hospice and Palliative Care
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• v.21 no.1
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• pp.23-32
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• 2018

Purpose: Little is known regarding the extent to which dying patients with chronic obstructive pulmonary disease (COPD) receive life-sustaining procedures and palliative care in U.S. hospitals. We examine hospital cost trends and the impact of palliative care utilization on the use of life-sustaining procedures in this population. Methods: Retrospective nationwide cohort analysis was performed using National Inpatient Sample (NIS) data from 2005 and 2014. We examined the receipt of both palliative care and intensive medical procedures, defined as systemic procedures, pulmonary procedures, or surgeries using the International Classification of Diseases, 9th revision (ICD-9-CM). Results: We used compound annual growth rates (CAGR) to determine temporal trends and multilevel multivariate regressions to identify factors associated with hospital cost. Among 77,394,755 hospitalizations, 79,314 patients were examined. The CAGR of hospital cost was 5.83% (P<0.001). The CAGRs of systemic procedures and palliative care were 5.98% and 19.89% respectively (each P<0.001). Systemic procedures, pulmonary procedures, and surgeries were associated with increased hospital cost by 59.04%, 72.00%, 55.26%, respectively (each P<0.001). Palliative care was associated with decreased hospital cost by 28.71% (P<0.001). Conclusion: The volume of systemic procedures is the biggest driver of cost increase although there is a cost-saving effect from greater palliative care utilization.

• Health Policy and Management
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• v.34 no.2
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• pp.196-210
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• 2024

Background: In January 2018, revised elderly fixed outpatient copayment for the elderly were implemented. When people ages 65 years and older receive outpatient treatment at clinic-level medical institutions (clinic, dental clinic, Korean medicine clinic), with medical expenses exceeding 15,000 won but not exceeding 25,000 won, their copayment rates have decreased differentially from 30%. This study aimed to examine the changes of health utilization of elderly after revised elderly fixed outpatient copayment. Methods: We used Korea health panel data from 2016 to 2018. The time period is divided into before and after the revised elderly fixed outpatient copayment. We conducted Poisson segmented regression to estimate the changes in outpatient utilization and inpatient utilization and conducted segmented regression to estimate the changes in medical expenses. Results: Immediately after the revised policy, the number of clinic and Korean medicine outpatient visits of medical expenses under 15,000 won decreased. But the number of clinic outpatient visits in the range of 15,000 to 20,000 won and Korean medicine clinic in the range of 20,000 to 25,000 won increased. Copayment in outpatient temporarily decreased. The inpatient admission rates and total medical expenses temporarily decreased but increased again. Conclusion: We confirmed the temporary increase in outpatient utilization in the medical expense segment with reduced copayment rates. And a temporary decrease in medical expenses followed by an increase again. To reduce the burden of medical expense among elderly in the long run, efforts to establish chronic disease management policies aimed at preventing disease occurrence and deterioration in advance need to continue.