• 병원약사회지
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• 제35권4호
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• pp.409-417
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• 2018

Background : Febrile neutropenia (FN) is one of the side effects in the patients treated with chemotherapy, and the patients who have FN generally need immediate treatment with extended-spectrum antibiotics and hospitalization. Pegfilgrastim and pegteograstim, which are used for the prevention of FN as a granulocyte-colony stimulating factor (G-CSF), have been granted insurance coverage in the Republic of Korea for certain breast cancer patients using doxorubicin and cyclophosphamide (AC) from September 2016. Methods : The data of the patients with breast cancer using AC regimen and G-CSF were collected retrospectively. This study involves cost-utility analysis of pegfilgrastim and pegteograstim. In this study, we constructed a simple decision tree model for short-term observation and calculated quality-adjusted life year (QALY) and the direct medical costs from the medical provider's perspective. Results : From September 2016 to May 2017, 15 patients were treated with pegfilgrastim and 15 patients were treated with pegteograstim. As a result of dividing the average cost by QALY for each treatment group, it was observed that pegfilgrastim and pegteograstim were consumed 24,923,384 won and 22,808,336 won per 1QALY, respectively. Consequently, incremental cost effectiveness ratio (ICER) showed 2,115,048 won more per pegfilgrastim than pegteograstim per 1QALY, and the cost per 1QALY of both the drugs was lower than 30,500,000 won; the Koreans were willing to pay this amount. Conclusions : This study suggests that pegfilgrastim and pegteograstim can be used to improve the quality of life of breast cancer patients undergoing AC therapy. Among the two drugs, pegteograstim seems to be more cost-effective. However, since this study was conducted as a retrospective observation method on a small scale, it is associated with many limitations. Therefore, a long-term prospective cohort study is needed to supplement the present findings.

• 보건행정학회지
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• 제7권1호
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• pp.100-124
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• 1997

In order to suggest the strategies for participation in the PPS(Prospective Payment System), analyses were performed based on variations in utilization pattern and changes in revenues of hospitals in 10 selected KDRGs. The data was collected from the claims data of a tertiary hospital in Kyunggido from September 1, 1995 to August 31, 1996. The studies consisted of 1, 718 inpatients diagnosed for lens procedures, tonsilectomy &/or adenoidectomy, appendectomy with complicated principal diagnosis, Cesarean section, or vaginal delivery without any complications. The resources used in each KDRG were measured including average length of stay, total charges, number of orders, intensity of medical services, frequencies of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders. Then, the changes in hopital revenues due to the composition of medical fee schedules under the PPS were estimated as follows: 1) The variations in average lenght of stay, total charges, number of orders, the intensity of medical services, the frequency of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders among the 10 KDRGs were comparatively small. 2) The average lenght of stay was the longest(6.0 days) for appendectomy with complicated principal diagnosis, while it was the shortest(2.1 days) for two vaginal deliveries. Statistically differences existed in the average length of stay among physicians and among the dates of admission in several KDRGs. 3) The total charges were the highest for lens procedures(1, 716, 000 won), while the lowest charges were for two vaginal deliveries(558, 000 won). Statistically differences in the total charges were found among physicians in several KDRGs: however, there were no differences with the dates of admission. 4) The number of orders was the greatest(155) for appendectomy with complicated principal diagnosis, while it was the smallest(75) for the two vaginal deliveries. Statistical differences in the number of orders did not exist among physicians in the KDRGs. 5) Significant differences were found in the intensity of medical services, and in the frequency of medical services among physicians in the KDRGs. 6) The rate of non-reimbursable charges for each KDRG was not related to the rate of non-reimbursable orders. The rate of non-reimbursable orders was the highest(36.0%) for lens procedures, while the lowest rate(11.6%) was for appendectomy with complicated principal diagnosis. The rate of non-reimbursable charges was the highest(39.4-39.7%) for vaginal deliveries, while the lowest rate(13.1%) was for tonsillectomy &/or adenoidectomy(<17 ages). 7) If the physician's practicing style were not change under the PPS, the hospital revenuses could be increased by 10%, and the portion of patient payment could be decreased by 1.4-22.4%. However, the non-reimbursable charges for showed little change between two reimbursement systems. Based upon the above findings, this hospital could be eligible for participation in the PPS(Prospective Payment Systm). However, the process of diagnosis and treatment should be standardized, inentifying methods to reduce cost and to assure quality of medical care. Furthermore, consideration should be given to finding ways to increase patient volume.

• 벤처창업연구
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• 제12권5호
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• pp.177-189
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• 2017

본 연구는 주된 일자리에서 은퇴했거나 은퇴를 앞둔 베이비붐 세대 직장인들을 대상으로 은퇴 이후 창 재취업의도에 영향을 미치는 요인과 사회적자본의 매개효과를 규명하고자 한다. 2010년 이후 베이비붐 세대의 대규모 퇴직이 시작되고 있으나 경제적 노후준비를 충분히 확보하지 못한 상태에서의 대규모 은퇴는 노동시장의 불안정과 사회복지비용 지출증가 등 사회 경제적으로 커다란 이슈가 되고 있다. 퇴직 후 30년 이상의 새로운 커리어를 시도할 수 있는 준비를 하도록 개인의 인식변화와 제도적인 지원이 구체화 되어야 한다. 연구결과, 경력지향성과 사회적자본간의 영향관계에서 관리지향성은 사회적자본에 정(+)의 영향을 미치고 자율지향성은 영향을 미치지 않는 것으로 나타났다. 경력지향성과 창 재취업의도간의 영향관계에서 관리지향성은 창업의도에 영향을 미치지 않으나 재취업의도에 정(+)의 영향을 미치고, 자율지향성은 창업의도와 재취업의도 둘 다 정(+)의 영향을 미치는 것으로 나타났다. 사회적자본은 창 재취업의도에 정(+)의 영향을 미치며, 경력지향성과 창 재취업의도간의 영향관계에서 사회적자본의 매개효과가 확인되었다. 따라서 잠재적 은퇴자인 베이비부머 직장인들이 재직하는 기간 동안에 개인의 경력지향에 맞는 교육, 훈련, 재취업 프로그램을 체계적으로 지원받고, 네트워크나 신뢰 등 사회적자본을 강화하여, 은퇴 후 상대적으로 폭넓은 창 재취업의 기회를 얻고, 퇴직 후에도 노동시장에 오랜 기간 머물도록 함으로써 경제적 안정과 공적연금 등 사회적 비용증가에 대한 해결책이 될 시사점을 얻을 수 있었다.

• Tuberculosis and Respiratory Diseases
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• 제87권4호
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• pp.465-472
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• 2024

Background: Patients with chronic obstructive pulmonary disease (COPD) expressing eosinophilia experience slightly fewer episodes of community-acquired pneumonia (CAP), than those without eosinophilia. However, the severity and burden of hospitalized pneumonia patients with COPD involving eosinophilia have not been assessed. Methods: We evaluated the differences in clinical characteristics between patients with CAP and COPD with or without eosinophilia by a post hoc analysis of a prospective, multi-center, cohort study data. Results: Of 349 CAP patients with COPD, 45 (12.9%) had eosinophilia (blood eosinophil ≥300 cells/µL). Patients with eosinophilia had a lower sputum culture percentile (8.1% vs. 23.4%, p<0.05), a lower percentile of neutrophils (70.3% vs. 80.2%, p<0.05), reduced C-reactive protein levels (30.6 mg/L vs. 86.6 mg/L, p<0.05), and a lower pneumonia severity index score (82.5 vs. 90.0, p<0.05), than those without eosinophilia. The duration of antibiotic treatment (8.0 days vs. 10.0 days, p<0.05) and hospitalization (7.0 days vs. 9.0 days, p<0.05) were shorter in eosinophilic patients. The cost of medical care per day (256.4 US$ vs. 291.0 US$, p<0.05), cost for the medication (276.4 US$ vs. 349.9 US$, p<0.05), and cost for examination (685.5 US$ vs. 958.1 US$, p<0.05) were lower in patients with eosinophilia than those without eosinophilia. Conclusion: Eosinophilia serves as a favorable marker for the severity of pneumonia, health-care consumption, and cost of medical care in patients with CAP and COPD.

• The Korean Journal of Pain
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• 제30권4호
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• pp.265-271
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• 2017

Background: Health care services effort to provide alternative cardiac rehabilitation (CR) models to serve patients according to their preferences and needs. So, the present study aimed to assess and compare the effects of hospital-based and hybrid CR programs on chest pain intensity and discomfort in cardiac surgery patients. Methods: In this prospective study, 110 cardiac surgery patients were invited to the CR department of a hospital in the western part of Iran between March and July 2016. Patients were divided into two groups: hospital-based and hybrid CR. The hospital-based program included 26 sessions, and the hybrid program included 10 training sessions and exercise. The Brief Pain Inventory and Pain Discomfort Scale were used as research instrument, and data were analyzed using the paired t-test and ANCOVA. Results: The results indicated that both hospital-based and hybrid CR are effective in reducing the chest pain intensity and discomfort of cardiac surgery patients (P < 0.05). In addition, the comparison of scores before and after treatment using ANCOVA shows that no significant differences were observed between the two programs (P > 0.05). Conclusions: Traditional hospital-based CR delivery is still the first choice for treatment in developing countries. However, hybrid CR is as effective as a hospital-based program in reducing pain components and it includes only 38% of the total cost in comparison to hospital-based delivery. So, we recommend using hybrid CR according with the recommendations of American Heart Association about using CR for the management of angina symptoms.

• 비파괴검사학회지
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• 제28권2호
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• pp.157-163
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• 2008

본 논문에서는 대형 구조물의 감시를 위한 새로운 광섬유 경사계를 제시한다. 이 경사계 시스템은 센서 헤드, 광 조절부 그리고 신호처리부로 이루어진다. 또한 본 시스템은 무아레 프린지 현상의 원리를 이용하며 광섬유라는 새로운 광측정 장치를 적용하였다. 이를 통해, 센서 시스템은 가격이 저렴하고 전자기학 잡음에 강하며 설치가 용이해 졌다. 실제로 본 논문에서는 저비용의 광전자 구동 시스템을 포함한 실제 시제품을 성공적으로 개발하였다. 그리고 실제 실험을 통해 센서의 선형성을 포함한 성능을 검증하였고 이를 통해 실제 토목구조물의 처짐각을 측정할 수 있는 광섬유 경사계 시스템으로서의 가능성과 성능을 입증하였다.

• Journal of Information Technology Applications and Management
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• 제14권4호
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• pp.159-174
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• 2007

The purpose of this research is to investigate the relationships among the perceived satisfaction, the perceived the trust, the commitment, the key features for mobile phone, the brand image, the switching cost and the repurchasing intention. We also examine the differences between Korean and Indonesian markets concerning the relationships of these key successfactors. The structural model is tested with the data form each of the sub-samples (i. e. Korean and Indonesian users taken separately). Properties of the casual paths, including standardized path coefficients, the significance of difference, and variance explained for trust, satisfaction, commitment and repurchasing in the hypothesized model, are presented. This study indicated that hardware (sound quality, LCD display, design) user interface (GUI, Menu, Key pad) and extra functions (camera phone, wireless internet, MP3 player) are the three important factors effecting the trust and the satisfaction. The proposed model has been newly tested from the technological prospective in order to get the more practical result. Following the model test, we conduct a test of the differences in path coefficients between Korean and Indonesian users. MSEM show that, compared to Korean market, Indonesian had more emphasized on extra-function for the mobile phone as well as giving more influence to the satisfaction from the brand image. It means Korean market consider the extra-function as basic or no-premium points. And the satisfaction has been effected by switching-cost in Korea but the trust in Indonesia. Other interesting result from the structural weight invariance indicate that, compared to Korean market, the brand-image has effected the satisfaction in addition to placing more the trust on determining the commitment in Indonesia.

• 한국의료질향상학회지
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• 제5권1호
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• pp.152-165
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• 1998

Background : In this paper patient outcomes research is going to be reviewed and described, to be compared with relevant studies, and to consider the application in Korea. Methods : We compiled and reviewed the articles and materials related to patient outcomes research especially by PORT(Patient Outcomes Research Team) and rearranged them for seeking the main point and comparing with relevant studies. Results : Patient outcomes research emphasizes patient outcomes as well as conventional clinical outcomes. It is prospective study observing effectiveness in real situation instead of efficacy in ideal condition. Patient outcomes research comprises of 6 fields ; literature review and meta-analysis, use of claims data, decision modeling, outcomes assessment, cost of care, dissemination of research findings. SAA(small-area variations analysis), appropriateness study and clinical practice guideline are connected with patient outcomes research. Conclusion : In view of the fact that current medical policy in Korea is shifting its focus from accessibility to the improvement in quality and cost containment, and is stressing patient-based research, patient outcomes research is one direction for which the medicine is accountable and assessable. Considering that the number of patient receiving medical treatment in Korea is higher than the West, patient outcomes research has competitive power as against the West.

• Clinical and Experimental Pediatrics
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• 제65권3호
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• pp.136-141
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• 2022

Background: High-flow nasal cannula (HFNC) is a noninvasive respiratory support that provides the optimum flow of an air-oxygen mixture. Several studies demonstrated its usefulness and good safety profile for treating pediatric respiratory distress patients. However, the cost of the commercial HFNC is high; therefore, the modified high-flow nasal cannula was developed. Purpose: This study aimed to compare the effectiveness, safety, and nurses' satisfaction of the modified system versus the standard commercial HFNC. Methods: This prospective comparative study was performed in a tertiary care hospital. We recruited children aged 1 month to 5 years who developed acute respiratory distress and were admitted to the pediatric intensive care unit. Patients were assigned to 2 groups (modified vs. commercial). The effectiveness and safety assessments included vital signs, respiratory scores, intubation rate, adverse events, and nurses' satisfaction. Results: A total of 74 patients were treated with HFNC. Thirtynine patients were assigned to the modified group, while the remaining 35 patients were in the commercial group. Intubation rate and adverse events did not differ significantly between the 2 groups. However, the commercial group had higher nurses' satisfaction scores than the modified group. Conclusion: Our findings suggest that our low-cost modified HFNC could be a useful respiratory support option for younger children with acute respiratory distress, especially in hospital settings with financial constraints.

• 한국시스템다이내믹스연구
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• 제8권2호
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• pp.141-173
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• 2007

In Korean context, the innovative cities imply new towns or urban clusters in the Non Capital Regions, all of which would accommodate the relocated Capital based public organizations. The central government-initiated innovative cities have provoked pros and cons towards their effectiveness and efficacy for the balanced territorial development. From a broader prospective, this paper firstly examines the current status quo of the innovative cities. Based on their master plans, it analyzes physical and non physical factors which would exert significant impact on the innovative cities. Secondly, it pays attention to how key factors strengthen or weaken their behavioral patterns in terms of dynamic location and implementation policies of the innovative cities. Using System dynamics approaches, it sets up couples of scenarios, categorizing between supporting and opposing arguments towards the innovative cities. Lastly, after divulging systematic structure of the innovative cities, it proposes a series of practical alternatives which would contribute to minimizing unexpected side effects or unwanted social cost in the long run. In order to guarantee reinforcing structure of the innovative cities, the paper suggests that QOL (quality of life) variables, which would require continuous investment in the social infrastructure, are pivotal in achieving original goals of the innovative cities. Otherwise, the innovative cities would not be innovative per se. In the worst case, they might be degraded into the unpopular ghost towns.