• Korean Journal of Adult Nursing
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• v.16 no.2
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• pp.222-232
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• 2004

Purpose: The purpose of this study was to identify the change in foot care knowledge, self care behavior, and physiologic indexes after foot reflexomassage education program, and the related factors. Method: Data were collected from 20 patients who were visited out patients clinic. The change and difference were analyzed with non-parametric statistics. Result: There were significant differences in foot care knowledge(P=.001), self care behavior(P=.000), dosalis pedis blood flow volume (P=.011), skin temperature of foot(P=.001), dorsalis pedis pulse(P=.000), capillary filling time of foot (P=.000) between pre and post. The level of changes of foot care knowledge was significant differences according to admission experience (P=.049), and negative related to systolic blood pressure(P=.028). The level of changes of self care behavior was related to age(P=.049), that of dosalis pedis blood flow was significant difference according to smoking(P=.042), that of skin temperatureof foot(P=.002) and dosalis pedis pulse(P=.038) were significant difference according to weight. The level of changes of capillary filling time of foot was related to diagnosis period(P=.014). Conclusion: Foot-Reflexo-Massage education program is an effective nursing intervention to promote foot care in diabetic patients. And the related factors can be recommended for the management of diabetic patients.

• Journal of agricultural medicine and community health
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• v.24 no.2
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• pp.315-329
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• 1999

Recently, dissatisfaction with aspects of health care has been complemented by directly at complaints such as informal, formal and litigation. But some people take action and other not in spite of feeling of dissatisfaction. This study was to investigate an accounts of patient's disagreement with doctor's care from a community sample, and make a distinction between felt disagreement and disagreement actions. This study was done in six hundred forty residents in Sungjoo County of Kyungbuk Province and Nonman city of Chungnam Province. The questionnaires of interview included sociodemographic data, health status data, a nature of patient's disagreement with doctor and actions taken following or during the disagreement episode. Approximately sixteen percent of sample reported a disagreement, and nine percent reported action taken following or during the disagreement episode. Age, educational attainment, income and area were significantly related with experience of disagreement episode in univariate analysis. In people who experienced the disagreement episode, nearly forty-one percent reported on disagreement about the diagnosis related, twenty-eight percent reported doctor-patients relationship related, twenty percent reported treatment related, and eleven percent reported prescription drug related. In people who experienced actions taken following or during the disagreement episode, nearly fifty-four percent acted as 'sought a second opinion or visit other doctor', thirty-six percent acted as 'verbally challenged the doctor', thirty-two percent acted as 'stopped prescribed treatment or medication', twenty-nine percent acted as 'made repeat visits to the same doctor', twenty-five percent acted as 'eventually left and changed doctor'. Results of multivariate analysis, age, marital status, have or haven't chronic disease, and general satisfaction with health service were significantly related with experience of disagreement episode and marital status was significantly related with experience of actions taken following or during the disagreement episode. This study is experimental and exploratory trial about a relationship between patient's disagreement with doctor and actions taken following or during the disagreement episode in some community of Korea. We find that patient's disagreement with doctor and actions taken following or during the disagreement episode is latent in our community. We suggest that the relationship between felt disagreement and disagreement action is more complicated and worthy of further study.

• Journal of Digital Convergence
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• v.17 no.11
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• pp.279-288
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• 2019

The aim of this study was to identify the factors related to the practice of patient safety management (PSM) in nursing college students. The participants comprised 139 students in a nursing college. Data collection was conducted for five days from November 26, 2018 to November 30, 2018. The data were analyzed using descriptive statistics, paired t-test, independent t-tests, one-way analysis of variance (ANOVA), Pearson's correlation coefficient, and a multiple regression analysis. The total score for practice of PSM was $4.25{\pm}0.48$ out of a maximum of 5. Practice of PSM had a statistically significant relationship with attitude (r=.39, p<.001), confidence (r=.43, p<.001), and perception of the importance (r=.54, p<.001). The factors affecting practice of PSM were perception of the importance (${\beta}=.43$, p<.001) and confidence (${\beta}=.26$, p=.001); the explanatory power of the model was 38%. Therefore, it is necessary to include the perception of importance of PSM and confidence in the practice of PSM by nursing college students.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.4
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• pp.207-214
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• 2019

Objectives: Medically compromised patients often fear required dental surgical procedures that can increase the risk of medical emergency when combined with reduced tolerance for stress. A stress reduction protocol (SRP) helps doctors minimize treatment-related stress and improves patient management with minimum complications. Diabetes and co-morbid hypertension carry 4-fold risk of aggravation of cardiovascular emergencies and 7.2-fold risk of mortality. Diabetic neuropathy can result in difficult diagnosis of myocardial infarction and reduces chances of surviving a myocardial infarction compared with a non-diabetic person. The aim of the study was to assess the feasibility of a protocol for management of patients having both diabetes and hypertension who required minor oral surgery to minimize the rate of cardiovascular emergencies. Materials and Methods: A prospective study was conducted in 140 patients having both diabetes and hypertension who required minor oral surgical procedures. A systematic approachable protocol was designed for management of such patients. Results: Among 140 patients, 6 patients (4.3%) had cardiovascular complications, while 3 patients (1 with syncope and 2 with hypertension) did not require any intervention other than observation. Two patients were managed with aspirin and nitroglycerin, and 1 patient had possible myocardial infarction (overall incidence 0.7%) with chest pain, S-T segment elevation on electrocardiogram, and troponin level of 0.60 ng/mL. Conclusion: The proposed protocol helps to improve management of patients having both diabetes and hypertension. We recommend that patients with uncontrolled diabetes and uncontrolled hypertension and/or patients having history of cardiovascular complication should be treated in a medical facility with a readily available cardiology unit. This facilitates prompt response to emergency and instant implementation of treatment, helping to reduce morbidity and mortality.

• Korea Journal of Hospital Management
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• v.6 no.2
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• pp.173-201
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• 2001

This study purports to examine the current management and information technology related strategy of Korean hospitals and suggest the effective management strategy in the 21st century when is digital era. Specifically the study tries to analyze the changing trends of strategic orientation and investigate the general management and information technology strategy of Korean hospitals. Self-administered Questionnaires were distributed to 721 hospitals nationwide and finally 98 Questionnaires were analyzed for the study. The results of the study are as follows : 1) Half of the respondent hospitals reported that they have an analyzer orientation in 2000, whereas 19.4% were prospectors, reactors 16.4%, and defenders 14.3%. However, the respondent hospitals intended to have a prospector orientation in the future (2002), while 29.6% planned on being analyzers, 17.3% reactors, and 3.1% defenders. 2) Hospital services for improving patient satisfaction were the most common. strategy for the respondent hospitals, followed by cost containment, organizational restructuring, employee education, purchasing system change, specialization of clinical services, quality improvement of medical care, strengthening the networking with the stakeholders, public relations and marketing strategy, diversification, and installing the information system. However, the strategies of annual salary system, retrenchment of unprofitable services, merit payment based on performance were still not popular for the respondent hospitals. 3) As for the strategies related with information technology, most hospitals have not implemented actively, except for the establishment of home-pages, order communication systems, and insurance claims through electronic data interchange system. 4) There were significant differences in the level of strategy implementation in terms of the ownership, bed size, financial performance, and the top managers I knowledge of information technology. The larger bed size, the higher financial performance, the better knowledge of information technology the top managers have, the more strategies the respondent hospitals implemented. The managerial and political implications for Korean hospitals in digital era were also discussed.

• Korea Journal of Hospital Management
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• v.23 no.4
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• pp.1-14
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• 2018

Purpose : Customers with loyalty are very important to hospitals for sustainable growth in their medical market. Individuals with loyalty are likely to visit same hospital repeatedly when they need medical services. This study was to identify factors associated with selection of specialty hospitals among customers with loyalty. Methods : The subjects of this study were 735 inpatients in 22 specialty hospitals in 6 designated fields(joints, spine, colorectal-anal, obstetrics and gynecology, ophthalmology, otolaryngology). Customer types classified as customers with high loyalty, neutral customers, and customers with low loyalty according to net promoter score(NPS). Factor analysis was conducted to classify 22 hospital selection factors into some similar properties. Logistic regression analysis was conducted to confirm the selection factors related to loyal customers. Findings : Most of specialty hospitals received high NPS of 8 points or higher in all the designated fields. Five factors associated with selection of specialty hospital are (1) hospital facilities and convenience, (2) trust in doctor and hospital, (3) rapidness of treatment, (4) hospital awareness, and (5) accessibility. As a result of logistic regression analysis, selection factors related to loyal customers were 'hospital facilities and convenience', 'trust in doctor and hospital' and 'rapidness of treatment'. Differences in the degree of importance of three selection factors by customer types appeared for each designated field. Practical Implications : This study confirms the high level of patient experience among inpatients of specialty hospitals. Factors associated with selection of hospital among inpatients with loyalty are 'facilities and convenience of hospitals', 'trust of doctor and hospital' and 'rapidness of treatment'. This study will be meaningful as basic data to systematically enhance the roles and functions of the health care system and to provide securing competitiveness according to designated fields in the management aspect of specialty hospitals.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.48-54
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• 1987

This report provides follow-up data on 557 patients [73 aortic, 357 mitral, and 127 multiple valve replacements] undergone lonescu-Shiley pericardial Xenograft valve replacement at Seoul National University Hospital between January, 1979 and December, 1985. There were 35 early death [6.3%] and 522 operative survivors were observed, and the cumulative follow-up is 1,140 patient-years [mean: 2.18 years per patient] The thromboembolic complications occurred in 34 cases [3.0% per patient-year] and the rate was 2.1% per patient-year for mitral and 0.3% per patient-year for aortic valve replacement in the presence of anticoagulation therapy. Among the 34 embolic episodes, 9 patients were dead [0.8% per patient-year] and the cause of death were 5 cerebral thromboembolism, 2 pulmonary embolism, and 2 intracerebral hemorrhage due to inappropriate anticoagulation after thromboembolic episode. Actuarial probability [+ SEM] of remaining free of thromboembolism for AVR is 88.1 x 11.1% at 5 years, for MVR 79.1 a 13.4% at 7 years and for multiple valve replacement 77.2 e 5.21% at 7 years. The incidence rate of thromboembolic complications after AVR is not less than that of MVR [0.3 Among the potential thromboembolic risk factors, atrial fibrillation is possible risk factor to increase the thromboembolic complication [0.05 < P < 0.1], but the importance of other factors, such as atrial clot, large left atrial size, mitral position, NYHA functional class, and age is less definite. A careful follow-up and the proper control of anticoagulation without omission, poor control, and arbitrary withdrawal is important for the successful management of the thromboembolic complications and the anticoagulation-related morbidity and mortality.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.309-314
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• 2011

Purpose: Necrotizing fasciitis is a life-threatening, destructive soft tissue infection with a very high rate of mortality that needs early diagnosis and aggressive treatment. Systemic Lupus Erythematosus (SLE) is a systemic, autoimmune disease and it's major cause of mortality is an infection. But necrotizing fasciitis in SLE is very rare and there have been only 22 cases reported in the literatures. We reported a patient of necrotizing fasciitis with SLE and reviewed 22 others from literature research. Methods: A 40-year-old female patient with a history of SLE for 6 years came to the emergency room. The patient complained of severe pain and swelling on her right leg. She was diagnosed as necrotizing fasciitis and underwent emergency fasciotomy. As wound cultures showed variable organisms, she was treated with broad-spectrum antibiotics and underwent several surgical debridements. Then, the wound was treated with the V.A.C (Vacuum Assisted Closure) device and split thickness skin grafting was performed two times. Results: Skin graft was well taken within 2 weeks after operations and the patient was discharged to outpatient follow up. There was no complication related with surgery and she could walk without cane after 3 months. Conclusion: We treated a necrotizing fasciitis in a patient with SLE and reviewed 22 others from literature research. The case presented here suggests that necrotizing fasciitis is a rare disease in SLE patients, but should be considered in the differential diagnosis of soft tissue infection in SLE patients. A high index of suspicion is needed for early diagnosis and proper management in these patients.

• Health Policy and Management
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• v.30 no.3
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• pp.418-429
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• 2020

Background: This study aims to analyze the cost and the length of stay (LOS) of acute myocardial infarction (AMI) patients with coronary artery stenting according to the characteristics of individuals and institutions. Methods: The data was collected from Korean National Health Insurance Service's customized database in 2010 and 2015. Chi-square test, t-test, analysis of variance, and multilevel analysis were performed. Results: The intraclass correlation coefficients for cost were 7.02% in 2010, 5.61% in 2015 and for LOS were 3.17%, 1.40%, respectively. The average costs were 9,067,000 won in 2010 and 9,889,000 won in 2015 (p<0.0001). However, the cost in 2015 was lower than the cost applying increased fee. The costs increased in aged 50-59 years, 60-69 years, and aged ≥70 years versus in aged under 49 years. The cost was higher in Charlson comorbidity index (CCI) 3 to 4 and ≥5 than in CCI 0. The costs were lower in male, medical aid recipients, metropolises, and local hospitals in other regions in 2010. LOS decreased from 8.1 days in 2010 to 7.4 days in 2015. It decreased in male, high income group, and the group of admission via emergency room. However, it increased in higher ages and medical aid recipients, and it also increased when CCI rose. The Internal Herfindahl Index was related to LOS in 2010. Conclusion: The variation of hospital level was small compared to the patient level. Therefore, it is important to implement applicable policies at the patient level in order to reduce cost and LOS of AMI patients.

• Health Policy and Management
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• v.26 no.1
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• pp.51-62
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• 2016

Background: The publicness concept in healthcare has been built to its social consensus relying on historical context, with the result that the meaning of publicness has a great diversity and heterogeneous nature in Korea. Thus it needs to be addressed to clarify the meaning and boundary of the publicness concept in healthcare, so as to discuss its social implication. Methods: In order to investigate whether or how the publicness concept is used in healthcare, we conducted a text network analysis in 779 news articles from 8 Korean daily newspapers over a recent 5-year period. Results: The publicness concept was closely related to medicine and medical institution, and formed a conceptual network with public health, medicine, welfare, patient, government, Jin-ju city, and health. Keywords relating publicness tended to be similar between four major newspapers; however, the association with Jin-ju city, government, and society was noticeable in Kyunghyang Shinmun and Hankyoreh, and so was patient and service in Dong-A Ilbo. Conclusion: Publicness and medicine was closely associated, and government seemed to remain as a main actor for public interest. Publicness was related with a variety of actors and values, with its expanded boundary. The different contexts of publicness by newspapers might reflect each ideological inclination. The textual importance of publicness was relatively low in part, which suggests that publicness was used in a loose sense or as a routine.