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The Analysis of Risk Factors of Treatment Failure in MDR-TB (다제내성 폐결핵 치료실패의 위험인자 분석)

  • Kim, Hyoung-Soo;Choi, Kwang-Min
    • Tuberculosis and Respiratory Diseases
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    • v.50 no.6
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    • pp.686-692
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    • 2001
  • Background : Outbreaks of multidrug-resistant tuberculosis(MDR-TB) are caused by the low rate of treatment response due to limitation in number of available drugs and high rates of adverse drug side-effects. This study analysed the risk factors for MDR-TB patients, who did not respond to treatment, with an aim to improve the rate of treatment response. Methods : Retrospective study of 111 MDR-TB patients at National Mokpo Tuberculosis Hospital from Jan. 1996 to Dec. 1998 was made. The patients were separated into two groups ; group I comprised of patients who were treated successfully and group II comprised of those were not treated successfully. In order to analyze the risk factors for treatment failure, differences between the two groups were compared and the confidence limit regarding the results were tested using an independent t-test. chi-square test and a Fisher's exact test. Results : The treatment failure rate of MDR-TB patients was 32% (36 patients), and treatment success rate 68%(75 patients). This study found no significant difference between two groups in terms of age, sex, family history, extent of the disease on the chest X-ray, the number of sensitive drugs in the treatment regimen, and the number of sensitive bactericidal drugs in the treatment regimen (p>0.05). However, a past history of pulmonary tuberculosis, cavitary lesions on the chest X-ray, the number of treatments, the number of resistant drugs and the number of drugs used showed a significant difference(p<0.05). Conclusion : The rate of treatment failure in MDR-TB was increased by a past history of pulmonary tuberculosis, cavitary lesions on the chest X-ray, the number of treatments, the number of resistant drugs and the number of drugs used. For improving the treatment response of MDR-TB, every effort should be made to reduce the drug resistance caused by failure of the first treatment.

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An Increase of Patients Diagnosed as Precocious Puberty among Korean Children from 2010 to 2015 (통계자료를 통한 국내 성조숙증 진료현황 분석)

  • Choi, Kyu Hee;Park, Seung Chan
    • The Journal of Pediatrics of Korean Medicine
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    • v.30 no.4
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    • pp.60-65
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    • 2016
  • Objectives The purpose of this study is to emphasize the importance of preventing precocious puberty. This study assessed current number of the patients with early puberty and their medical expenses from 2010 to 2015. Methods Using the data from Korean Statistical Information Service and Heathcare Bigdata Hub, number of patients diagnosed with precocious puberty by gender, age, and year from 2010 to 2015 were reviewed. Also, annual medical insurance expenses and the incidence of leuprorelin use were reviewed. Results Number of the patients with precocious puberty has increased from 29,251 in 2010 to 75,945 in 2015. Total medical insurance expenses have increased from 25,716,431 won in 2010 to 56,367,981 won in 2015. The use of lueprorelin also has increased annually from 11,097,590,000 won in 2010 to 21,617,585,000 won in 2015. Conclusions As a result, the patients diagnosed with precocious puberty are increasing in number, and their medical costs have been rising as well. It may be necessary to control the environmental causes of precocious puberty to reduce not only the physical and psychosocial health problems, but also the social costs.

Early Clinical Result of Coronary Artery Bypass Surgery for Ischemic Heart Diaseas (허혈성심장질환의 치료에서 관상동맥 우회술의 조기성적;53례의 임상적 결과)

  • 최종범
    • Journal of Chest Surgery
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    • v.26 no.4
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    • pp.271-275
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    • 1993
  • In this country, the number of patients with coronary artery disease is progressively increasing with the change of life style and improvement of the diagnostic procedures. In addition, the medically invasive procedure for treating ischemic heart disease was rapidly developed and the surgical patients have more complex and multiple lesions and more surgical risks. Fifty three patients with ischemic heart disease underwent coronary bypass grafting [CABG] for recent 24 months. Twenty patients had three-vessel disease, 17 patients two-vessel disease, and 2 patients single-vessel disease. The average number of distal anastomoses was 3.3 per patient with the range of I to 6 grafts. Forty-one patients [77.4 %] had preoperative left ventricular ejection fraction of 50 % or more and 14 patients[26.4%] had a significant left main coronary lesion. Saphenous vein grafts were employed in 52/53 patients [98.1%] and internal mammary grafts, which were anastomosed to left anterior descending artery, in 38/53 patients[71.7%]. Two patients, whom percutaneous transluminal coronary angioplasty failed for, underwent emergency CABG with only saphenous vein grafts and both patients survived.The hospital mortality was 1.9 % and there was no late death. Perioperative myocardial infarction occurred in 1.9%. All survivors were asymptomatic[in 83% of the patients] and/or improved over their preoperative status. Twenty-nine patients were included in blood conservation group and 21 patients [72.4 %] underwent CABG without any homologous blood transfusion. Our early result of coronary bypass grafting was comparable to that which was reported in other coronary surgery units.

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A Clinical Study of One Hundred Twenty Patients Admitted with Headache (두통을 주소증으로 하여 입원한 환자 120예에 대한 임상적 고찰)

  • Kwon, Kyoung-Man;Kim, Koang-Lok;Shin, Yoon-Ri;Park, Sun-Young;Park, Dong-Il
    • Korean Journal of Acupuncture
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    • v.29 no.4
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    • pp.643-661
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    • 2012
  • Objectives : The Purpose of this study is to investigate clinical characteristics with 120 patients who have sufferred from headache and were treated. Methods : We classified 120 patients into several groups by International Headache Society(IHS) classification and evaluated the effects of oriental medical therapy on headache. Results : 1. According to the statistics, women patients were more than men. And 50s has highest number of headache patients. 2. In classification by IHS, tension type headache were highest. 3. 24.2% of patients had entered Department of Internal Medicine, Colleage of Oriental Medicine Dongeui Univ for treatment within six month of onset. 4. According to the statistics, headache of whole part has highest number of headache patients. 5. The most number of associated symptoms were nausea, vomiting, dyspepsia etc. 6. The most number of headache patient's past history were hypertension. 7. In classification by oriental medical differentiation of symptom and signs, the rate of blood deficiency were highest. 8. 64.2% of patients said they were satisfied with treatment, reporting half the frequency of headache or better from before treatment. Conclusions : In conclusion, the present results suggest that oriental medical therapy has effects on headache.

The Economic Evaluation of Outpatient-chemotherapy administration model (외래 항암 화학요법 주사실 모델의 적정성 분석)

  • Song, Jung Hup
    • Quality Improvement in Health Care
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    • v.11 no.1
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    • pp.16-30
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    • 2004
  • Background: Although the number of cancer patients increase, the resources for cancer management are not increased. If the outpatient chemotherapy administration room is operated, the shift of patients from inpatient 10 outpatient is occurred. So the capacities for chemotherapy increased and the shifted rooms were occupied with new non-chemotherapy patients. The income of the hospital increased. The purpose of this study was to assess usefulness and cost-effectiveness of the outpatient-chemotherapy adminstration model. Method: There are six beds, two chairs and two nurses and one personnel in the outpatient chemotherapy room. The satisfaction study by patients/family and doctors and the cost analysis over 12 months, by comparing costs of chemotherapy administration at outpatient chemotherapy room with inpatient at ward and inpatient-nonchemotherapy at ward were done. Results: The 97.1 percent of patients/family and the 94.4 percent of doctor who involved chemotherapy were satisfied with outpatient chemotherapy administration. The 91.7% of doctors said there were no differences in treatment outcome between outpatient and inpatient chemotherapy administration. The average number of patients in outpatient chemotherapy room increased from 10.7 to 15.4 but in inpatient from 19.4 to 18.3. The average number of inpatient chemotherapy were not changed related to increase of the average number of outpatient chemotherapy. The profit between outpatient chemotherapy and inpatient chemotherapy administration was 45,344,710 won and the profit between outpatient chemotherapy and non chemotherapy treatment was -185,294,614 won. Conclusion: The outpatient chemotherapy administration model is good for patients/family, doctors and hospital partially. But the hypothesis described above was not correct. The process of cancer patients treatment were from diagnosis and treatment to first administration of chemotherapy. So the shift from inpatient to outpatient was not occurred. In economic aspect, the profit between outpatient chemotherapy and non chemotherapy treatment was in the red. As the level of health care fees was so low, the hospitals hesitate operating the room of outpatient chemotherapy. It is necessary to raise the level of health case fees for outpatient chemotherapy administration.

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A study on the characteristics of patients with facial palsy treated with Korean medicine - Based on the Korean National Health Insurance statistical yearbook (한의치료를 받은 안면마비 환자의 진료비 특성 분석 - 건강보험통계연보를 중심으로)

  • Hae-chang Yoon
    • The Journal of Korean Medicine
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    • v.44 no.2
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    • pp.10-19
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    • 2023
  • Objectives: This study aimed to find out the characteristics of patients with facial palsy based on the National Health Insurance(NHI) statistical yearbook and provide the information pertaining to supplement Coverage of NHI. Methods: Based on the data of NHI between 2004 to 2021 for facial palsy(G51) obtained from the Ministry of Health and Welfare, the analyses were carried out according to the distribution of gender and the number of patients, visits, reimbursed days, and medical expenses by using the SAS 9.4. Results: The crude rate of facial palsy was reported as 361.71(2021) comparable with 419.60(2004) and 534.11(2009). The rate of men increased from 293.96(2004) to 302.27(2021) but the rate of women decreased from 450.88(2014) to 420.80(2021). The number of patients maintained around 190,000, however, it declined for patients treated Korean medicine(KM) after 2010. As the medical expenses were elevated, especially Western medicine(WM), that of WM exceeded KM's since 2018. The expenses of women were higher than men's in KM. By contrast, there was no difference with gender in WM. For reimbursed days per visits, it has been increased in WM but there was no difference in KM. Conclusion: Although the rate of patients with facial palsy in KM was high with no difference in the whole number of patients and reimbursed days per visits in KM annually, the number of patients in KM decreased but medical expenses elevated. According to this, it is necessary for reinforcing Coverage of NHI to research other factors related to KM.

The National Status of Tuberculosis Using Nationwide Medical Records Survey of Patients with Tuberculosis in Korea

  • Park, Yoon-Sung;Hong, Sung-Jin;Boo, Yoo-Kyung;Hwang, Eun-Suk;Kim, Hyun Jung;Cho, Seung-Hee;Na, Kyung-In;Cho, En-Hi;Shin, Sang-Sook
    • Tuberculosis and Respiratory Diseases
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    • v.73 no.1
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    • pp.48-55
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    • 2012
  • Background: The epidemiology of tuberculosis (TB) has been assessed based on the data of the analysis of TB patients notified to the surveillance system in Korea. However, the national status of TB is not validated through this surveillance system. The objective is to determine the epidemiology of TB and to understand the accurate status of TB patients treated in private institutions. Methods: Medical records of 53,579 patients who had been diagnosed with TB in 2008 were analyzed. Results: Among 53,579 patients, the number of sputum smear positive cases was 15,639(29.2%) and the number of new cases was 39,191 (73.1%). The drug resistance rate of new cases was 5.3%, while the rate stood at 13.3% for TB patients with treatment history. The number of multi-drug resistant TB (MDR-TB) patients was 2,472 (4.6%), which consists of 2.9% of new cases and 9.3% of TB patients with prior treatment history. The number of extensively drug-resistant TB patients was 749 (1.4%), consisting of 1.1% of new cases and 2.2% of TB patients with prior treatment history. In terms of treatment outcomes, 66.4% of all TB patients, 70.5% of new cases, 64.4% of relapse cases, and 46.8% of MDR-TB cases were cured or completed. It was inferred that in 2008, the total number of TB patients reached 70,767, 145.6 per 100,000 people (95% confidence interval, 145.5~145.7). Conclusion: We conclude that the medical records review of the Health Insurance Review and Assessment Service (HIRA) data can be very effective in promoting the understanding of the current status of TB in private institutions.

Analysis of Long Term Hospitalization in Korean Medical Hospital and Its Affecting Factors - Based on Usage and consumption of Korean medicine Report In 2014 - (전국 한방병원의 장기입원과 이에 영향을 미치는 요인 - 2014년 한방의료이용 및 한약소비실태조사(보건복지부)를 중심으로 -)

  • Lee, Sundong
    • Journal of Society of Preventive Korean Medicine
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    • v.22 no.2
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    • pp.41-53
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    • 2018
  • Objectives : It was to classify and its affecting factors to the patients of Korean medicine hospital with short term and long term hospitalization. Methods : I focused on long-term hospitalized patients. I was conducted on 344 hospitalized patients among the original data of usage and consumption of Korean medical report in 2014. Among those patients, I have classified them into long term inpatients(131 patients) and short term inpatients(213 patients) based on 16 days of hospitalization. Also multiple regression analysis was conducted to investigate the characteristics of the hospitalization, treatment satisfaction and dissatisfaction, the characteristics of long term hospitalization according to the sociodemographic of the subjects, the top 21 diseases and the distribution of human bodies, side effects and kinds of Korean medicine. Results : There was a statistically significant difference between the short term and long term hospitalized patients due to age, occupation, marital status, all 21 diseases and institutional fees, experience of Korean medical treatment due to traffic accidents. There was no significant difference in gender, education level, residence, income level, type of medical insurance, whether private insurance, type of medical treatment for Korean medicine, medical expenses for car accidents, reason for dissatisfaction with treatment. The number of long term patients at Korean medicine hospitals increased by a statistically significant by age in model 1 where confounding factors were differently controlled. In model 2, the number of long term patients at Korean medicine hospitals increased by a statistically significant by age, among those who earned 5,000,000 Korean won or more, and among those with nerve diseases. The number of long term patients at Korean medicine hospitals decreased by a statistically significant amount among the unemployed and others in model 2. In model 3, the number of long term patients at Korean medicine hospitals increased by a statistically significant by age, among those who earned 5,000,000 Korean won or more, and among those with nerve diseases, while the number decreased by a statistically significant amount among the married. Conclusions : These results suggest that the factors affecting the short term and long term hospitalization of patients with Korean medicine hospital are different from each other. Especially it was significant by age, over 5,000,000won Income per month, nerve disease, but decrease significant married.

A Study on Degree of Importance in Nursing Activities for the Quality of Nursing (질적간호 제공을 위한 간호업무 중요도에 관한 조사연구)

  • 홍춘실;김종임
    • Journal of Korean Academy of Nursing
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    • v.14 no.2
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    • pp.19-27
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    • 1984
  • This study was carried out for the purpose of investigating the degree of importance in nursing activities for the quality of nursing, and was conducted with 72 nurses and 69 patients in Chungnam National University Hospital from January to April, 1984. The results are as follows; 1. The mean importants score in physical care activities of the patients (2.58) is higher than that of the nurses (2.48). There is not significant difference for the mean important score in physical care activities between the patients and nurses (t=0.637, df=139, p>0.05). 2. The mean important score in psychological aspects of activities of the patients (2.94) is higher than that of the nurses (2.44). There is a significant difference for the mean important score in psychological aspects of activities between the patients and nurses (t=2.338, df= 139, p<0.05). 3. The mean important score in observation, recording and implementing medical care activities of the nurses (2.98) is higher than that of the patients (2.79) There is not significant difference for the mean important score in observation, recording and Implementing medical care activities between the patients and nurses (t=1.329, df=139, p> 0.05) 4. The mean important score in nursing management activities of the nurses (2.63) is higher than that of the patients (2.57). There is not significant difference for the mean important score in nursing management activities between the patients and nurses (t=1.329, df=139, p>0.05). 5. A number of items in nursing activities considered most important by nurses (Mean important score of 3.0 or above) were 12 items. The most importants item was“shift and exchange of information concerning patient”. 6. A number of items in nursing activities considered most important by patients (mean important score of 3.0 or above) were 14 items. The most important item was“Explain about diagnostic test ahead of time”. 7. A number of items in nursing activities considered least important by nurses and patients(Mean important score less than 1.9) were 5 items and 2 items, respectively. The least important item by nurses was“plan some diversion or recreation for patient”, and the least important item by patients was“Give a bed shampoo”.

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An exploratory study of factors related to long-term hospitalization of inpatients using the quality assessment data for long-term care hospitals (요양병원 입원급여 적정성 평가 결과를 활용한 요양병원 입원환자의 장기입원 관련 요인 탐색 연구)

  • Ji-Yoon Lee;Eun-Woo Nam;Hyoung-Sun Jeong;Min-Hee Heo;Jin-Won Noh
    • Korea Journal of Hospital Management
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    • v.28 no.3
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    • pp.58-67
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    • 2023
  • Purpose: The purpose of this study was to analyze the factors associated with long-term hospitalized patients in long-term care hospitals using the quality assessment data for long-term care hospitals by the Health Insurance Review. Methods: Among 1,376 long-term care hospitals, frequency analysis and descriptive statistics were used to analyze the characteristics of these hospitals. Multiple linear regression was conducted to examine the associations between infrastructure characteristics, medical personnel characteristics, health outcomes and the proportion of long-term hospitalized patients. Results: The research findings indicate that the number of patients per doctor, the number of patients per nurse, and the number of patients per nursing staff were positively associated with the proportion of long-term hospitalized patients. Among health outcomes, a higher proportion of patients with more than a 5% weight loss compared to the previous month and the proportion of patients showing improvement in ADL, were more likely to have a lower proportion of long-term hospitalized patients. However the proportion of diabetic patients with HbA1c test results within the appropriate range was positively associated with the proportion of long-term hospitalized patients. Conclusion: The present study results provide fundamental data for the establishment of policies for long-term care hospitals. Based on this study, it is important to suggest screening methods for unnecessary long-term hospitalizations, such as sufficient medical personnel to improve the quality of care in long-term care hospitals. It is also necessary to clearly separate the roles of medical institutions and long-term care facilities and implement policies to support patients' social reintegration.

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