• Journal of Preventive Medicine and Public Health
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• 제45권3호
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• pp.127-136
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• 2012

The challenge facing the Korean National Health Insurance includes what to spend money on in order to elevate the 'value for money.' This article reviewed the changing issues associated with quality of care in the Korean health insurance system and envisioned a picture of an effective pay-for-performance (P4P) system in Korea taking into consideration quality of care and P4P systems in other countries. A review was made of existing systematic reviews and a recent Organization for Economic Cooperation and Development survey. An effective P4P in Korea was envisioned as containing three features: measures, basis for reward, and reward. The first priority is to develop proper measures for both efficiency and quality. For further improvement of quality indicators, an electronic system for patient history records should be built in the near future. A change in the level or the relative ranking seems more desirable than using absolute level alone for incentives. To stimulate medium- and small-scale hospitals to join the program in the next phase, it is suggested that the scope of application be expanded and the level of incentives adjusted. High-quality indicators of clinical care quality should be mapped out by combining information from medical claims and information from patient registries.

• Korean Journal of Acupuncture
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• 제21권1호
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• pp.129-147
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• 2004

Objectives and methods : This research aims to study about conversion system of channels. In the present study, we investigated the movement and conversion of channels on the base of three step theory(三才論), Yeak(易), Hado.Laksea(河圖洛書) and five elements motion and six kinds of factors(Six-Qi). Results and Conclusions : The organization of meridian is composed of the following three parts: hand and foot, Yin and Yang, and the viscera and bowals. It is play an important role in energy flow and its conversion. The law governing energy conversion is divided into three groups i.e. taiyin-yangming channel, shaoyin-taiyang channel and jueyin-shaoyang channel group. Those are composed of Deadea(對待) of Six-Qi, making the body homeostasis. Taken together, we suggest that the conversion system of meridian is founded on the unity between the human body and nature which provides the medical workers with a necessary method of thinking in treating diseases.

• 성인간호학회지
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• 제23권3호
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• pp.255-266
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• 2011

Purpose: The purpose of this study was to explore nurses' access and use of information resources and to identify the barriers and competency to evidence based practice (EBP). This study used descriptive method to identify baseline data for the purpose of developing strategies for establishing EBP in clinical nursing practice. Methods: Participants in this study were 278 nurses from five hospitals in Daegu and Kyungsangbukdo. The data were collected by self administered questionnaires and SPSS/WIN 15.0 program was used to analyze the data with descriptive statistics, t-test, Pearson's correlation coefficients, and ANOVA. Results: Nurses reported $^*most$ frequently using paper and human resources. The mean score of barriers was $3.02{\pm}0.41$, and competency was $2.70{\pm}0.50$. The reported competency was correlated with nurse factors (r=-.31, p<.001) organization factors (r=-.20, p<.001) and research factors (r=-.12, p<.040) as the barriers to evidence based practice. Conclusion: To promote competency in EBP and to decrease the barriers, it would be necessary to develop the organizational culture that encourages nurses to be involved in research activities. In addition, the development of systemic methods to introduce and establish an education program for facilitating EBP in the clinical settings is needed.

• Asian Pacific Journal of Cancer Prevention
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• 제16권9호
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• pp.3799-3803
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• 2015

Background: The Functional Assessment of Cancer Therapy - Breast (FACT-B) scale is widely used to measure health-related quality of life in cancer patients. The aim of the present study is to validate the FACT-B in a sample of Iranian women with breast cancer. Materials and Methods: The sample consisted of 300 women selected through non-random convenient sampling procedure from oncology hospitals and clinics in Kermanshah and Shiraz cities. They were asked to fill in the Persian versions of the FACT-B scale, Hospital Anxiety and Depression Scale, the European Organization for Research and Treatment of Cancer quality of life EORTC QLQ30. Confirmatory factorial analysis of the methods, concurrent validity and discriminant, and Cronbach's alpha for internal consistency were applied. Results: Internal consistency using Cronbach's alpha was 0.63 to 0.93 for the subscales and 0.92 for the total scale. Significant correlations between FACT-B and other measures indicate that this scale had concurrent and discriminant validity. The values of fit indices were satisfactory. Conclusions: The Persian version of the FACT-B scale is valid and reliable and, therefore, the scale can be used in research and clinical settings to assess health-related quality of life in Iranian patients with breast cancer.

• 보건행정학회지
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• 제24권4호
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• pp.380-388
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• 2014

Background: The volume of surgery has been examined as a major source of variation in outcome after surgery. This study investigated the direct effect of surgery volume to in hospitals mortality and the moderating effect of structural complexity-the level of diversity and sophistication of technology a hospital applied in patient care-to the volume outcome relationship. Methods: Discharge summary data of 11,827 cancer patients who underwent surgery and were discharged during a month period in 2010 and 2011 were analyzed. The analytic model included the independent variables such as surgery volume of a hospital, structural complexity measured by the number of diagnosis a hospital examined, and their interaction term. This study used a hierarchical logistic regression model to test for an association between hospital complexity and mortality rates and to test for the moderating effect in the volume outcome relationship. Results: As structural complexity increased the probability of in-hospital mortality after cancer surgery reduced. The interaction term between surgery volume and structural complexity was also statistically significant. The interaction effect was the strongest among the patients group who had surgery in low volume hospitals. Conclusion: The structural complexity and volume of surgery should be considered simultaneously in studying volume outcome relationship and in developing policies that aim to reduce mortality after cancer surgery.

• Archives of Plastic Surgery
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• 제45권4호
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• pp.375-378
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• 2018

In this report, we present a case of successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug. A 70-year-old man underwent total gastrectomy and developed anastomotic leakage and dehiscence of the abdominal wound a week later. He was dependent upon extracorporeal membrane oxygenation, continuous hemodiafiltration, and a respirator. Bowel fluids contaminated the open abdomen. Two months after the gastric operation, a plastic surgery team, in consultation with general surgeons, performed perforator flaps on both sides and constructed, as it were, a bridge of skin sealing the orifice of the fistula. The aponeurosis of the external oblique muscle was elevated with the flap to be used as a plug. The perforators of the flaps were identified on preoperative and intraoperative ultrasonography. This modality allowed us to locate the perforators precisely and to evaluate the perforators by assessing their diameters and performing a waveform analysis. The contamination decreased dramatically afterwards. The bare areas were gradually covered by skin grafts. The fistula was closed completely 18 days after the perforator flap. An ultrasound-guided perforator flap with an aponeurosis plug can be an option for patients suffering from an open abdomen with a bowel fistula.

• 가정간호학회지
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• 제14권1호
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• pp.11-17
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• 2007

The purpose of this study was to describe the policy agenda and alternatives for the home health care system in Korea. The home health care system development was not fully integrated while the medical laws were established in 2000, community health law in 1995, and elderly long-term health insurance law in 2007. Because of the increasing population of people over the age of 65 and dramatically decreasing fertility rate, the burden of various health-care expenses has become a great obstacle for the Korean government. Under these circumstances, the home of home health care system in has taken on an important role under the mandate of the national health care system. The types of home health care system in Korean shows a greater contrast from those utilized in other more industrialized countries, such as, U.S. or Japan. In conclusion, the strategy in overcoming the obstacles to enhance home health care system under the national health system would be developing it as a comprehensive and exchangeable consumer-focused organization.

• 한국직업건강간호학회지
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• 제26권1호
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• pp.55-64
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• 2017

Purpose: This study was performed for the effective management of nursing organization as surveyed choice motives and job satisfaction about nurses who changed to public hospitals. Methods: This study is a descriptive study. This study surveyed 214 nurses who changed jobs to public hospital in six Gyeonggi-do hospitals from October 23 to November 20, 2015. The collected data were analyzed for descriptive statistics, t-test, one-way ANOVA, sheffe test, multiple linear regression analysis using the SPSS/WIN 21.0 program. Results: Most of the nurses chose public hospitals due to benefits correspond to public officials. They had worked in general hospitals located on provinces and changed jobs due to a heavy workload and low benefits. Of the participants 84.1% were satisfied with changing jobs to public hospitals and the advantages of public hospitals of their choice were job stability and good employee benefits(guaranteed maternity and paternity leave, etc). On the other hand there were complaints about low salaries compared to the workload after changing jobs to public hospitals. Conclusion: Hospitals need to enhance job stability and provide nurses with good employee benefits to reduce turnover rate.

• 한국간호교육학회지
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• 제23권3호
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• pp.290-299
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• 2017

Purpose: The purpose of this study is to investigate nurses' role conflict and intention to remain and to identify factors that may influence this intention. Methods: Data were collected from 172 nurses in a 600-plus bed hospital on nurses' intention to remain, which included 47 items and nurses' role conflict, which included 82 items from a self-reported questionnaire. Data were analyzed by descriptive statistics and stepwise multiple regression using SPSS 22.0 Results: The mean of the role conflict frequency was 2.71(${\pm}.39$) and the mean severity was 2.86 (${\pm}.47$). The most significant item among the items of intention to remain was "a nurse's job is to help people." The intention to remain employed showed a significant difference in the duration of desired working period and subjective job satisfaction. The subjective job satisfaction of nurses was the most influential variable as a factor affecting the intention to remain, followed by frequency of role conflict in nursing practice. Conclusion: These results suggest that inadequate nursing environments in nursing practice require improvement and support the idea that nurses with positive attitudes of the nursing organization and theirs leaders reduce nurses' related fatigue.

• Asian Pacific Journal of Cancer Prevention
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• 제14권8호
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• pp.4641-4646
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• 2013

Objective: To explore clinical experience and propose new ideas for treating children diagnosed with orbital rhabdomyosarcoma (RMS). Methods: We retrospectively analyzed the clinical data for30 patients (16 males and 14 females, with a median age of 6.2 years) with primary orbital RMS who were enrolled in the Department of Eye Oncology and Pediatrics of our hospital from November 2004 to December 2012. International Rhabdomyosarcoma Organization Staging Standards indicated that among the 30 patients, 4 cases were in phase II, 20 were in phase III, and 6 were in phase IV. All patients underwent a multidisciplinary collaborative model of comprehensive treatment (surgery, chemotherapy, external radiotherapy, $^{125}I$ radioactive particle implantation, and autologous peripheral blood stem-cell transplantation). Results: Follow-up was conducted until March 2013, with a median follow-up time of 47.2 months (5 to 95 months), and 7 deaths occurred. The 2-year estimated survival rate reached 86.1%, the ${\geq}3$-year estimated survival rate was 77%, and the 5-year estimated survival rate was 70.6%. Conclusions: The multidisciplinary collaborative model can be a safe and effective approach to the comprehensive treatment of children with orbital RMS. It has clinical significance in improving the tumor remission rate.