• Clinical Pain
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• 제20권2호
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• pp.145-149
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• 2021

Ankylosing spondylitis (AS) is a chronic inflammatory disease presenting progressive spinal stiffness and sacroiliitis. Cervical spine fracture combined with AS should be treated with operation, but it is closely related with increased rates of surgical site infection, which are associated with an elevated erythrocyte sedimentation rate and elevated C-reactive protein. We report a case of delayed postoperative infection appeared in cervical paravertebral space, which was masked by laboratory findings and clinical characteristics represented in this rheumatic disease. A 53-year-old man who had medical history of AS got operation after cervical spine fracture. During hospitalization, he experienced aching pain originating from left posterior neck to shoulder, which was revealed out to be delayed postoperative infection, diagnostically obscured by elevated values of inflammatory markers. This case emphasizes detailed evaluation considering symptoms and comorbidity of the patient should be performed to apply proper management.

• Journal of Korean Neurosurgical Society
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• 제54권3호
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• pp.225-231
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• 2013

Objective : Spinal dysraphism defects span wide spectrum. Wound dehiscence is a common postoperative complication, and is a challenge in the current management of cerebrospinal fluid (CSF) leaks and wound healing. The purpose of this study is to evaluate the risks of CSF-related morbidity in the surgical treatment of spinal dysraphism. Methods : Ten patients with spinal dysraphism were included in this retrospective study. The median age of the cohort was 4.8 months. To assess the risk of CSF morbidity, we measured the skin lesion area and the percentage of the skin lesion area relative to the back surface for each patient. We then analyzed the relationship between morbidity and the measured skin lesion area or related factors. Results : The overall median skin lesion area was 36.2 $cm^2$ (n=10). The percentage of the skin lesion area relative to the back surface ranged from 0.6% to 18.1%. During surgical reconstruction, 4 patients required subsequent operations to repair CSF morbidity. The comparison of the mean area of skin lesions between the CSF morbidity group and the non-CSF morbidity group was statistically significant (average volume skin lesion of $64.4{\pm}32.5cm^2$ versus $27.7{\pm}27.8cm^2$, p<0.05). CSF morbidity tended to occur either when the skin lesion area was up to 44.2 $cm^2$ or there was preexisting fibrosis before revision with an accompanying broad-based dural defect. Conclusion : Measuring the lesion area, including the skin, dura, and related surgical parameters, offers useful information for predicting wound challenges and selecting appropriate reconstructive surgery methods.

• 보건행정학회지
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• 제23권1호
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• pp.44-51
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• 2013

Background: This study designed to evaluate the homogeneity of Korean diagnosis related group (KDRG) version 3.4 classification system. Methods: The total 5,921,873 claims data submitted to the Health Insurance Review and Assessment Service during 2010 were used. Both coefficient of variation (CV) and reduction in variance of cost were measured for evaluation. This analysis was divided into before and after trimming outliers at the level of adjacent DRG (ADRG), aged ADRG (AADRG) split by age, and DRG split by complication and comorbidity. Results: At the each three level of ADRG, AADRG, and DRG, there were 38.9%, 38.7%, and 30.0% of which had a CV > 100% in the untrimmed data and there were 1.4%, 1.4%, and 1.9% in the trimmed one. Before trimming outliers, ADRGs explained 52.5% of the variability in resource use, AADRGs did 53.1% and DRGs did 57.1%. The additional explanatory power by age and comorbidity and complication (CC) split were 0.6%p and 4.6%p for each, which were statistically significant. After trimming outliers, ADRGs explained 75.2% of the variability in resource use, AADRGs did 75.6%, and DRGs did 77.1%. The additional explanatory power were 0.4%p and 2.0%p for each, which were statistically significant too. Conclusion: The results demonstrated that KDRG showed high homogeneity within groups and performance after trimming outliers. But there were DRGs CV > 100% after age or CC split and the most contributing factor to high performance of KDRG was the ADRG rather than age or CC split. Therefore, it is recommended that the efforts for improving clinical homogeneity of KDRG such as review of the hierarchical structure of classification systems and classification variables.

• 보건행정학회지
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• 제28권2호
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• pp.178-185
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• 2018

Background: We investigated association between introduction of the diagnosis-related groups (DRG) system for anal operation and length of stay. Also, we investigated how it is different among hospitals with longer length of stay and among hospitals with shorter length of stay before introduction of the DRG system. Methods: We used data from Health Insurance Review and Assessment which were national health insurance claim data. Total 13,111 cases of anal surgery cases were included which were claimed by hospitals since July 2012 to June 2014. Two-level multivariable regression was conducted to analysis the association between length of stay and characteristics of hospital and patient. Results: Before introducing DRGs, the average length of stay was 5.41 days. After introducing DRGs, average length of stay was decreased to 3.92 days. After introducing DRGs, length of stay has decreased (${\beta}=-1.0450$, p<0.0001) and it was statistically significant. Among hospitals which had short length of stay (shorter than mean of length of stay) before introducing DRGs, effect of introducing DRGs was smaller (${\beta}=-0.4282$, p<0.0001). On contrary, among hospitals which had long length of stay (longer than mean of length of stay) before introducing DRGs, effect of introducing DRGs was bigger (${\beta}=-1.8280$, p<0.0001). Conclusion: Introducing DRGs was more effective to hospitals which had long length of stay before introducing DRGs.

• 한국인터넷방송통신학회논문지
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• 제9권6호
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• pp.201-210
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• 2009

유비쿼터스 환경이라는 새로운 개념의 네트워크 환경이 등장하면서 인간을 중심으로 한 서비스에 대한 연구는 최고점을 향하고 있다. 이러한 유비쿼터스 서비스 기술 중 헬스케어와 관련된 서비스는 현재의 사회적 환경과 매우 밀접한 관계가 있다. 본 논문에서는 사회적 고령화와 유비쿼터스 기반의 IT 환경의 변화에 따라 필수적인 응용 서비스 중 헬스케어에 대한 연구를 핵심응용 기술로 규정하고 이와 관련된 연구를 수행하였다. 또한 기존의 헬스케어를 위한 연구를 분석하고 요구사항을 도출함으로서 유비쿼터스에 핵심적으로 적용 될 수 있는 헬스케어 서비스를 제안하였다. 특히, 기존의 헬스케어 서비스에서 고려되지 않았던 특수한 중환자들만을 위한 관리 프로토콜을 제안하고자 한다. 제안된 방식은 RFID 태그 기반으로 병원 시스템의 전체적인 데이터베이스 정보를 구성하고 환자의 상태를 지속적으로 모니터링하며, 실시간으로 처리하는 시스템으로 구성된다.

• Advances in pediatric surgery
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• 제20권1호
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• pp.17-22
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• 2014

The aim of this study was to identify the risk factor related to the need for operative treatment and avoid unnecessary non-operative management for intussusception in children. We retrospectively reviewed medical records of patient treated for intussusception at our institution between January 2006 and January 2013. Clinical features such as gender, age, seasonal variation, symptoms and signs, treatment results were analyzed. Univariate and multivariate analyses including a chi-square test for categorical variables and logistic regression analysis were performed. During the study period, 356 patients were treated for intussusception. 328 (92.1%) was treated successfully by the non-operative pneumoreduction, and 28 (7.9%) required operative management. On univariate analysis, risk factors which were related to the need for operative treatment were age, vomiting, bloody stool, lethargy, and symptoms duration. A logistic regression analysis in order to assess for independent predictors of operative treatment was performed. Age (<6 vs ${\geq}12$ months) (OR 4.713, 95% CI 1.198~18.539, p=0.027) and symptoms duration longer than 48 hours (OR 4.534, 95% CI 1.846~11.137, p=0.001) were significantly associated with a requirement for operative treatment. We conclude that younger age and a longer duration of symptoms (${\geq}48$ hours) are the independent risk factor related to the need for operative treatment for intussusception. Early surgical intervention or transfer to a hospital with pediatric surgical capabilities should be considered for patients with these findings.

• 한국융합학회논문지
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• 제12권2호
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• pp.129-134
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• 2021

본 연구는 치과교정치료 환자의 구강건강관련 삶의 질과 구강보건행동 변화를 알아보기 위해 교정치료를 완료한 성인 300명을 대상으로 설문조사를 시행하였다. 수집된 자료의 분석은 spss22.0프로그램을 이용하여 분석 하였다. 교정치료전은 사회적인 요인이(4.68) 관련 삶의 질 점수가 가장 낮게 나타났고, 교정치료 후에는 사회적 요인 관련 삶의 질이 3.72점 높아져 가장 높은 증가를 나타냈다. 구강보건행동변화는 정기적인 스켈링이 교정 전에 비해 교정 후가 1.28점 더 증가하였다. 교정치료를 통해 구강건강 삶의 질과 구강보건행동이 변화 된 바 치과의 전문인력은 환자 개개인별 맞춤형 구강보건교육을 통해 적절한 관리를 기울일 필요가 있으며 교정치료 환자의 삶의 질을 향상시키기 위해 적절한 접근법 개발이 필요하다.

• 품질경영학회지
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• 제37권4호
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• pp.87-99
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• 2009

Medical tourism is a contemporary phenomenon which has its root in both tourism and health service. Especially, Korea's medical tourism market has grown dramatically after activation of foreign patient attraction law. The purpose of this study is to find out which is the most influential factors among political, economic, relative and national image in case of Japanese tourists when they purchase Korean medical tourism. This study estimates the Japanese tourists' Trust in the Korean health service quality and tourism service quality. It means perception of medical tourism. The results are as follows; The political, relative and economic image not have any significant influences on tourism service and trust in health service quality. And just the national image has a positive influence on tourism service and trust in health service quality. Tourism service quality is related with trust in the health service quality. Trust in health service quality is only related with purchase intention of medical tourism. The implications of this study are: First, the national image factors such as thoughtfulness, high education and polite attitude should be utilized as a Korea medical tourism marketing strategy to differentiate itself from the other foreign country in Japan. Next, the differentiated national image in Japan will be the most important factors for Korean hospital and tourism companies to attract medical tourists.

• 보건의료산업학회지
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• 제12권2호
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• pp.125-134
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• 2018

Objectives : The purpose of this study was to analyze factors related to the functional state of stroke patients after discharge from hospital. Methods : The data was provided from a hospital in Wonju, Gangwon-do. The subjects of the analysis were those who were admitted to the emergency room due to stroke from July to December 2016. The dependent variable was the patient's functional status as measured by the modified Rankin Scale(mRS). Independent variables were demographic factors (age, sex, and marriage status), transportation and distance factors (transportation, travel distance), inpatient factors (lengths of stay, Charlson Comorbidity Index (CCI), Tissue plasminogen activator, National Institute of Health Stroke Scale (NIHSS). Hierarchial regression analysis was applied for the analysis. Results : In the hierarchical regression analysis, Model 3, including socio-demographic factors, transportation, distance factors, and inpatient factors, was the best fitted model. It showed that functional status of stroke patients was positively associated with age, length of stay, CCI, NIHSS, and negatively associated with unmarried status. Conclusions : Results indicated that management of stroke requires care from the pre-disease stage, and a customized education program policy is needed for high-risk stroke patients who are older and have comorbid illness.

• Clinical Endoscopy
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• 제56권3호
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• pp.340-352
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• 2023

Background/Aims: Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. Methods: We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. Results: From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p<0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. Conclusions: Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.