• 한국산학기술학회논문지
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• 제20권4호
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• pp.435-447
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• 2019

불필요한 재입원을 예방하기 위해서는 재입원 확률이 높은 집단을 집중적으로 관리할 필요가 있다. 이를 위해서는 재입원 예측모형의 개발이 필요하다. 재원예측 모형을 개발하기 위해 1개 대학병원의 2016년에서 2017년의 2년간의 퇴원요약환자 데이터를 수집하였다. 이때 재입원 환자는 연구 기간 내에 2번 이상 퇴원한 환자라 정의 하였다. 재입원환자의 특성을 파악하기 위해 기술통계와 교착분석을 실시하였다. 재입원 예측 모형개발은 데이터마이닝 기법인 로지스틱회귀모형, 신경망, 의사결정모형을 이용하였다. 모형평가는 AUC(Area Under Curve)를 이용하였다. 로지스틱회귀모형이 AUC가 0.81로 가장 우수하게 나옴에 따라 본 연구에서는 로지스틱 회귀모형을 최종 재입원 예측 모형으로 선정을 하였다. 로지스틱회귀모형에서 선정된 재입원에 영향을 끼치는 주요한 변수는 성별, 연령, 지역, 주진단군, Charlson 동반질환지수, 퇴원과, 응급실 경유 여부, 수술여부, 재원일수, 총비용, 보험종류 등이었다. 본 연구에서 개발한 모형은 1개병원의 2년치 자료이므로 일반화하기에는 제한점이 있다. 추후에 여러 병원 장기간의 데이터를 수집하여 일반화 할 수 있는 모형을 개발하는 것이 필요하다. 더 나아가 계획에 없던 재입원 까지 예측을 할 수 있는 모형을 개발하는 것이 필요하다.

• Journal of Communications and Networks
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• 제7권4호
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• pp.509-524
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• 2005

Due to the strict requirements of emerging applications, per-flow admission control is gaining increasing importance. One way to implement per-flow admission control is using an on­path resource reservation protocol, where the admission decision is made hop-by-hop after a new flow request arrives at the network boundary. The next-steps in signaling (NSIS) working group of the Internet engineering task force (IETF) is standardising such an on-path signaling protocol. One of the reservation methods considered by NSIS is reduced-state mode, which, suiting the differentiated service (DiffServ) concept, only allows per-class states in interior nodes of a domain. Although there are clear benefits of not dealing with per-flow states in interior nodes-like scalability and low complexity-, without per-flow states the handling of re-routed flows, e.g., after a failure, is a demanding and highly non-trivial task. To be applied in carrier-grade networks, the protocol needs to be resilient in this situation. In this article, we will explain the consequences of a route failover to resource reservation protocols: Severe congestion and incorrect admission decisions due to outdated reservation states. We will set requirements that handling solutions need to fulfill, and we propose extensions to reduced-state protocols accordingly. We show with a set of simulated scenarios that with the given solutions reduced-state protocols can handle re-routed flows practically as fast and robust as stateful protocols.

• 대한한방내과학회지
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• 제38권2호
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• pp.118-124
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• 2017

Objective: This study describes the case of a patient with a left basal ganglia (BG) infarct who had made almost a complete recovery upon discharge from the hospital in 2014 but who was re-admitted after 31 months with a worsened hemiplegic gait. Methods: The patient had undergone no rehabilitation treatment in the 31 months since his discharge. When the patient was re-admitted to our hospital in 2017, stance and gait data were collected on the patient using a treadmill gait analysis system. In addition, the patient underwent a manual muscle test (MMT) evaluation, and his Motricity index (MI) and modified Barthel index (MBI) scores were recorded. After rehabilitation for one month, the patient was reassessed, and the results were compared to those on the day of re-admission and those recorded in 2014. Results: Compared to the 2014 evaluation results, the patient's stance parameters and gait parameters had worsened at re-admission. However, there was no significant change in the patient's MMT grade or MI and MBI scores in comparison to the results of the 2014 evaluation. After one month of rehabilitation, the patient was re-evaluated again, but there was no significant change in comparison to the evaluation results at re-admission. Conclusion: Some of the stroke patients who have passed six months since the onset of their stroke may require ongoing rehabilitation although the functions of them is almost recovered. Because there is a possibility that recovered functions get worse again without any rehabilitation for a long time. And once the recovered functions get worse, re-recovery of them is not easy.

• Neonatal Medicine
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• 제25권3호
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• pp.96-101
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• 2018

Purpose: We aimed to evaluate the respiratory illness-related hospital visits (out-patient clinics, emergency room, and re-admission) of preterm infants, and compare them according to corrected age and prematurity. Methods: We reviewed the medical records of preterm infants born at <37 weeks of gestation admitted to the neonatal intensive care unit (NICU) at Inha University Hospital between January 2012 and June 2015. Infant follow-up appointments in both neonatology and pulmonology out-patient clinics occurred for at least 2 years after NICU discharge. Results: The proportion of infants who visited the hospital due to any respiratory illness was as high as 50% until 12 months of corrected age, and subsequently decreased over time. Hospital admission was significantly higher in early preterm infants (<34 weeks of gestation) compared to late preterm infants (${\geq}34$ and <37 weeks of gestation). The proportion of infants who were re-admitted due to lower respiratory tract illness was significantly higher until 6 months of corrected age compared to the later, and did not differ between early and late preterm infants. Conclusion: The proportion of hospital visits of preterm infants due to respiratory disease was high until 12 months of corrected age. Most notably, the re-admission proportion from lower respiratory tract illness was high under 6 months in both early and late preterm infants. Preterm infants within this age that are visiting the hospital with respiratory symptoms should be carefully observed and followed up.

• 한국병원경영학회지
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• 제14권4호
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• pp.149-162
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• 2009

The purpose of this study is to design strategic hospital service based on each hospital's features. For this study, an assessment was conducted by 398 in-patents of one university hospital located in Seoul. The self-questionnaires, which were investigated from Oct. 15th to 29th in 2008, compared central reception desk with ward reception desk in satisfaction and re-use rate of patients. The major results of this study are as follow. First, according to each reception desk user, they have different satisfaction of it. As for the staff kindness, admission procedure, discharge procedure and manner of staff, those made patients be gratified as well. Second, when it comes to the intention of re-use, there were no significant features between them. Only convenience in admission and discharge procedure, however, was an attractive factor for the recommendation. Third, this study found out the reasons for higher re-use rate of central reception desk users. Regarding service, they were contented with the time for test and treatment. As for the hospital service, they would like to re-use this hospital because of convenient steps of paying interim fee and getting certificates. Forth, this study found out the reasons for higher re-use rate of ward reception desk users. As a point of hospital service view, they responded that respected privacy, hospital facility and general service were good for staying. As for the manner of staff, they mentioned nurses and staff in charge and whole staff members were kind. When it comes to the procedures of patient management, steps of discharge and paying interim fee were convenience. In conclusion, the results of this study suggest that providing a ward reception desk service can boost the satisfaction and re-use rate of in-patients. Furthermore, this strategic management method would be good for not only cutting the moving line but also efficient in-patient care system. These results can be used for the strategic hospital marketing field, as well. Even though this study has a limitation of the targeted populations which were only in a ward reception desk running hospital, it can say that having competitiveness in satisfaction of hospital service is good for promoting and differencing each hospital. Consequently, whole general management system would be adjusted first for differencing each hospital; however, this sort of additional factor should be concerned as well. I expect that this study would give meaningful data for designing strategic and differencing marketing method to lots of hospitals.

• Korean Journal of Radiology
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• 제23권8호
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• pp.828-834
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• 2022

Objective: This study aimed to assess the outcomes of outpatient day-care management of unruptured intracranial aneurysm (UIA), and to present the risks associated with different management strategies by comparing the outcomes and adverse events between outpatient day-care management and management with longer admission periods. Materials and Methods: This retrospective cohort study used prospectively registered data and was approved by a local institutional review board. We enrolled 956 UIAs from 811 consecutive patients (mean age ± standard deviation, 57 ± 10.7 years; male:female = 247:564) from 2017 to 2020. We compared the outcomes after embolization among the different admission-length groups (1, 2, and ≥ 3 days). The outcomes included pre- and post-modified Rankin Scale (mRS) scores and rates of adverse events, cure, recurrence, and reprocedure. Events were defined as any cerebrovascular problems, including minor and major stroke, death, or hemorrhage. Results: The mean admission period was 2 days, and 175 patients (191 aneurysms), 551 patients (664 aneurysms), and 85 patients (101 aneurysms) were discharged on the day of the procedure, day 2, and day 3 or later, respectively. During the mean 17-month follow-up period (range 6-53 months; 2757 patient years), no change in post-mRS was observed compared to pre-mRS in 99.6% of patients. Cure was achieved in 95.6% patients; minimal recurrence that did not require re-procedure occurred in 3.5% patients, and re-procedure was required in 2.3% (22 of 956) patients due to progressive enlargement of the recurrent sac during follow up (mean 17 months, range, 6-53 months). There were eight adverse events (0.8%), including five cerebrovascular (two major stroke, two minor strokes and one transient ischemic stroke), and three non-cerebrovascular events. Statistical comparison between groups with different admission lengths (1, 2, and ≥ 3 days) revealed no difference in the outcomes. Conclusion: This study revealed no difference in outcomes and adverse events according to the admission period, and suggested that UIA could be managed by outpatient day-care embolization.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.254-260
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• 2012

Purpose: Ongoing treatment and care, as well as initial stabilization, are required for trauma patients. With increasing number of sickest trauma patients and shortage of surgeons, the need for advanced practice nurse to provide and coordinate trauma care has been greater. The purpose of this study is to analyze the effect of hiring a trauma clinical nurse specialist and its influence on the treatment of trauma patients. Methods: Based on the employment of the clinical nurse specialist in December 2010, the patients were divided into two groups: patients admitted from January 1, 2010 to November 30, 2010 and patients admitted from December 1, 2010 to December 31, 2011. Retrospectively, data were collected using electronic medical records. The general characteristics, clinical courses, and ICU re-admission rates, collaboration (transfers to other departments and collaborative surgery) were compared. Results: To have a clinical nurse specialist on the trauma team resulted in a statistically significant reductions in the length of general ward hospital stay (p<0.05), the ICU re-admission rate, (p<0.03), the lead-time before transfer to other departments (p<0.05). Conclusion: The clinical nurse specialist, as a professional practitioner, improved the quality of treatment through early detection and management of problems. In addition, as a coordinator, the clinical nurse specialist maintained a cooperative relationship with multi-disciplinary medical personnel. The trauma clinical nurse specialist contributed to the treatment of trauma patients positively through a decrease in ICU re-admission rate and length of hospital stay.

• 한방안이비인후피부과학회지
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• 제24권3호
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• pp.37-54
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• 2011

Background and Objective : Recently it is true that increasing interest in Oriental medicine and usage of herbal medicine. On the other hand, there are many concerns about the stability of herbal medicine. So, this study is carried out to see whether or not the treatment with Sanghan-Bang(傷寒方) is effective on the liver function besides its effectiveness in treating facial palsy. Methods : We examined serum TP, Albumin, TB, AST, ALT, ALP, LDH, ${\gamma}$-GGT levels, and facial palsy states in 37 patients with facial palsy who had admission treatment in an oriental medical hospital. Results and Conclusion : 1. We found the levels of TP, albumin, TB, and ${\gamma}$-GGT had decreased statistically significant. Also, AST, ALT, LDH and ALP levels had decreased however it was not statistically significant. 2. We analyzed the herbal group that may be efficient to the liver function; Daehwang-Jae(16 case), Injin-Jae(12 case), and Chija-Jae(6 case) in this order. 3. From the eight cases using oriental medicinal concoctions using one of Daehwang, Injin-Jae or Chija as their main component, the liver function test results displayed decreasing values, re-entering into normal LFT ranges. 4. As we compared the admission House-Brackmann Scale with discharge, the treatment was efficient and statistically significant.

• 기본간호학회지
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• 제13권2호
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• pp.200-207
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• 2006

Purpose: This study was done to identify factors influencing falls in inpatients. A comprehensive analysis of individual, disease, and environment related factors and an assessment of being in a risk factor group were included in the data. Method: The medical records of 325 inpatients were reviewed. Data were collected from January to July 2003. Frequencies, 1-test and $X^2-test$ were used to analyze the data and the SPSS program was used. Results: Individual-related factors for inpatients falls were age, drinking and weakness. Disease-related factors for inpatients falls were diagnostic department, admission from ER or OPD, admission by wheelchair or orther method and activity status. Environment-related factors for inpatient falls were re-education and side-rails. Assessment of the risk factor group related factors were age, history of falls, body balance, depression, communication, medication, chronic disease, urinary condition and total score for risk factors. Conclusion: Experienceing a fall among Korean inpatients was associated not only with individual factors, but also with disease and environmental factors. The findings of this study suggest that broad intervention programs should be provided to prevent inpatient falls.

• 성인간호학회지
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• 제14권2호
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• pp.205-212
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• 2002

Purpose: The purpose of this study was to investigate the level of nausea, vomiting, anorexia, fatigue and quality of life as well as to determine the relationship between those variables and identify the influencing factors on fatigue and quality of life in stomach cancer patients receiving adjuvant chemotherapy. Method: Subjects were 94 stomach cancer patients undergoing postoperational chemotherapy in a general hospital in Seoul. Nausea and vomiting were measured with Rhodes et al(1984) and anorexia with one 5-point item. Fatigue was measured using Lee's tool(1999) except open questions. The tool for quality of life was modified based on the Quality of Life Index by Padilla et al(1983). Result: Subjects reported low level of fatigue(mean=3.86, range=0-10) compared with the results of previous researches and moderate quality of life(mean=2.64, range=1-4). Fatigue was positively correlated with nausea, vomiting and anorexia(r=.21 ~ .55, p<.05). Quality of life was negatively correlated with nausea, vomiting, anorexia(r= -.24 ~ -.45, p<.05) and fatigue (r=-.61, p<.01). Multiple regression analysis revealed that activity level, vomiting before admission, anorexia during chemotherapy and age explained 52.8% of the variance in fatigue. Fatigue, anorexia before admission, age and sex explained 50.5% of the variance in quality of life. Fatigue and quality of life were not influenced by the stage of disease, nor weight change. Conclusion: These results may contribute to a better understanding of how much the side effects of anticancer drugs can affect fatigue and quality of life in cancer patients undergoing chemotherapy. Also it is the remarkable fact that symptoms remaining after discharge such as vomiting or anorexia continued until re-admission, contributing to patients fatigue and lowered their quality of life.