• Quality Improvement in Health Care
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• v.28 no.2
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• pp.14-29
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• 2022

Purpose:In order to improve the quality of cardiac rehabilitation, it is important to examine the experiences of the patients and how they feel about each part of the process. We used a qualitative research methodology to conduct an in-depth review of the experiences of patients who participated in cardiac rehabilitation. Methods: According to semi-structured guidelines, in-depth interviews were conducted with a total of five patients undergoing cardiac rehabilitation. Results: A total of 232 codes was derived; these codes were split into 4 categories and 10 subcategories. Although the patients were apprehensive about the diagnosis of heart disease, it also gave them a chance to reflect on their health behaviors of the past. In addition, they began to appreciate their families and support networks more as the disease progressed. The participants did not know about cardiac rehabilitation until the medical staff recommended it, but they participated in the program with the expectation that they could become healthier. The participants felt that they became more physically and mentally healthy while undergoing cardiac rehabilitation. Rehabilitation served as an opportunity to improve other health behaviors as well. However, they emphasized that it is necessary to continuously maintain improved health behavior, find an exercise method that is suitable for one's physical ability and not monotonous, and prepare a plan to reduce the time and economic burden of cardiac rehabilitation. Conclusion: The participants' positive experiences confirmed in this study will be used as evidence for the expansion of cardiac rehabilitation programs.

• Journal of Preventive Medicine and Public Health
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• v.52 no.1
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• pp.21-29
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• 2019

Objectives: The Regional Cardiocerebrovascular Center (RCCVC) Project designated local teaching hospitals as RCCVCs, in order to improve patient outcomes of acute cardiocerebrovascular emergencies by founding a regional system that can adequately transfer and manage patients within 3 hours. We investigated the effects of RCCVC establishment on treatment volume and 30-day mortality. Methods: We constructed a panel dataset by extracting all acute myocardial infarction cases that occurred from 2007 to 2016 from the Health Insurance Review and Assessment Service claims data, a national and representative source. We then used a panel fixed-effect model to estimate the impacts of RCCVC establishment on patient outcomes. Results: We found that the number of cases of acute myocardial infarction that were treated increased chronologically, but when the time effect and other related covariates were controlled for, RCCVCs only significantly increased the number of treatment cases of female in large catchment areas. There was no statistically significant impact on 30-day mortality. Conclusions: The establishment of RCCVCs increased the number of treatment cases of female, without increasing the mortality rate. Therefore, the RCCVCs might have prevented potential untreated deaths by increasing the preparedness and capacity of hospitals to treat acute myocardial infarction patients.

• Journal of Physiology & Pathology in Korean Medicine
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• v.26 no.4
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• pp.539-545
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• 2012

To evaluate of the ultrasonographic changes in hemiplegic and unaffected knee joints of hemiplegic ambulators with recent onset stroke. Twenty patients (40 knees) with prevalence duration of 14-39 weeks (mean 24.70 weeks) after a stroke insult were included. All participants were walking independently without leg dragging, had no previous knee injury. There were significant differences in intercondylar cartilage thickness and pes anserinous tendinopathy (PAT) between hemiplegic and unaffected knees (p<0.05). There were no differences in cartilage thickness of medial condyle and lateral condyle, patellar tendinitis/bursitis, suprapatellar effusion, synovitis, joint space narrowing, and Baker's cyst of ultrasonographic findings and x-ray findings in hemiplegic knee compared to the control except PAT (p<0.05). In hemiplegic knee, medial or lateral condylar cartilage thickness was significantly correlated with body weight, intercondylar cartilage thickness, and PAT (p<0.05). PAT was significantly correlated with Brunnnstrom stage and condylar cartilage thickness (p<0.05). Knee pain was significantly correlated with lateral condylar cartilage thickness (p<0.1). The hemiplegic knee had more ultrasonographic abnormalities including PAT and more cartilage thickness preservation in patient with recent onset stroke. Intraarticular sonographic findings including cartilage thickness was significantly correlated with extraarticular findings including PAT and a symptom of knee pain.

• Journal of muscle and joint health
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• v.21 no.2
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• pp.153-163
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• 2014

Purpose: This study was to analyze the job of coordinators working in the regional cardiocerebrovascular center. Methods: Using Developing a Curriculum (DACUM) method, the role of coordinators was defined and their duties and tasks were identified. The developed duties and tasks were classified and validated according to importance, difficulty, and frequency of the job. Results: A coordinator is defined as a clinical nurse specialist affiliated in a cardiocerebrovascular center. The coordinator is responsible for managing the major critical pathway to provide adequate medical service and providing education to the patient with myocardial infarction and cerebrovascular attack admitted via emergency room for prevention and management of disease. Ten duties and sixty-nine tasks were identified on the DACUM chart which represented the importance, difficulty, and frequency of tasks showed as A, B, C respectively. Based on determinant coefficient of the task, the highest ranked task was 'analysis for variation of CP' and the lowest was'investing the articles in stock'. Conclusion: The results of study showed that coordinators were doing various duties and tasks and they felt burden from their work and were in confusion. The results of this study can be used to develop training programs for coordinators and evaluation-scale of the coordinators' job performance as the basic data.

• Quality Improvement in Health Care
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• v.27 no.2
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• pp.2-17
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• 2021

Purpose: The purpose of this study is to seek in-depth perspectives of stakeholders on the necessity and specific criteria for designating a specialized hospital for urologic diseases. Methods: Eight participants experts in urology medicine and specialized hospital system were divided into four groups. Following the semi-structured guidelines, an in-depth interview was conducted twice and a focus group discussion was conducted three times. All the interviews were transcribed verbatim and analyzed. Results: The majority of participants predicted that there would be demand for specialized hospitals for urologic diseases. The criteria of designating a specialized hospital, such as the number of hospital beds and quality of health care, have to be modified in consideration of the specificity of urology. The introduction of a specialized hospital would improve the healthcare delivery system, positively affecting hospitals and patients. Furthermore, government support is essential for the maintenance of specialized hospital systems as urology hospitals experience difficulties in generating profits. Conclusion: This study is expected to be used as base data for introducing and operating a specialized hospital for urologic diseases. In addition, it is expected that the methodology and results of this study would encourage follow-up studies on specialized hospitals and provide guidelines to evaluate the effectiveness of such hospitals in other medical fields.

• Korean Journal of Health Education and Promotion
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• v.32 no.1
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• pp.1-10
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• 2015

Objectives: This study evaluated the effects and relevant factors of community-based education and advocacy intervention on stroke awareness among the general population. Methods: The study enrolled 505 community-dwelling adults aged 19 years or older who completed a survey before and after a community-based intervention held between May 2014 and December 2014. Trained staff collected data about knowledge of five stroke warning signs, emergency response, golden window of time (${\leq}3h$), and demographics. Results: After the intervention, public awareness of all five stroke warning signs increased significantly from 26.5% to 33.9% (p=0.011). Public awareness of the golden window of time also increased significantly from 70.1% in April 2014 to 75.8% in December 2014 (p=0.040). In a multivariate logistic regression analysis, older age, higher education level, and exposure to stroke-related public service announcements or educational materials were significant predictors of knowledge of all five warning signs for stroke. Conclusions: Comprehensive community-based intervention is effective for improving public awareness of the warning signs of stroke and the golden window of time.

• Journal of Korean Neurosurgical Society
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• v.50 no.2
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• pp.75-80
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• 2011

Objective : Leukoaraiosis (LA) has been suggested to be related to the poor outcome or the occurrence of symptomatic intracerebral hemorrhage (sICH) after acute ischemic stroke. We retrospectively investigated the influences of LA on long-term outcome and the occurrence of sICH after thrombolysis in acute ischemic stroke (AIS). Methods : In this study, we recruited 164 patients with AIS and magnetic resonance image (MRI)-detected thrombolysis. The presence and extent of LA were assessed using the Fazekas grading system. The National Institutes of Health Stroke Scale score was used to assess the baseline measure of neurologic severity, and the modified Rankin Scale score assessment was used up to 1 year after thrombolysis. Results : Of 164 subjects, 56 (34.2%) showed LA on MRI. Compared to the 108 patients without LA, the patients with LA were of much older age (p<0.01), had a higher prevalence of hypertension (p<0.01), and had a much poorer outcome at 90 days (p=0.05) and 1 yr (p=0.01) after thrombolysis. There were no significant differences in sICH between patients with and without LA on MRI. In univariate analysis for the occurrence of poor outcome at 90 days after thrombolysis, the size of ischemic lesion on diffusion weighted images (DWI), [odds ratio (OR), 1.03; 95% confidence interval (95% CI), 1.01-1.04; p<0.01], recanalization (OR, 0.03; 95% CI, 0.01-0.10; p<0.01), sICH (OR, 12.2; 95% CI, 1.54-95.8), neurologic severity (OR, 1.17; 95% CI, 1.09-1.25; p<0.01), blood glucose level (OR, 1.01; 95% CI, 1.00-1.02; p=0.03), and the presence of LA on MRI (OR, 2.01; 95% CI, 1.04-3.01; p=0.04) were statistically significant. In multivariate analysis, neurologic severity (OR, 1.14; 95% CI, 1.04-1.24; p<0.01), recanalization (OR, 0.03; 95% CI, 0.01-0.11; p<0.01), lesion size on DWI (OR, 1.02; 95% CI, 1.01-1.03; p=0.02), serum glucose level (OR, 1.01; 95% CI; 1.01-1.02; p=0.03), and the presence of LA on MRI (OR, 3.2; 95% CI, 1.22-8.48; p<0.01) showed statistically significant differences. These trends persisted up to 1 yr after thrombolysis. Conclusion : In this study, we demonstrated that the presence of LA on MRI might be related to poor outcome after use of intravenous tissue plasminogen activator in AIS.

• Health Policy and Management
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• v.23 no.2
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• pp.176-187
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• 2013

Background: In 2006 Emergency Medical Services Index (EMSI), which summarizes the performance of regional emergency medical services system, was developed. This study assesses the performance of the EMSI to help determine whether EMSI can be used as evaluation tool. Methods: To build a composite score of the EMSI from predefined 24 indicators, 3 normalized values were calculated for each indicator, the normalized values of each indicator were weighted using 4 weighting methods, and the weighted values were aggregated into the final composite score using 2 aggregation schemes. The performance of EMSI was evaluated using 3 criteria: discrimination, construct validity, and sensitivity. Discrimination was the proportion of regions that did not include the overall median rank in the 5th to 95th percentiles rank interval, which was calculated from Monte Carlo simulation. Construct validity was a correlation among the alternative EMSIs. Sensitivity of EMSIs was evaluated by total shift of quartile membership and changes of 5th to 95th percentile intervals. Results: The total discrimination performance of the EMSI was 50.0%. Correlation coefficients between EMSIs using standardized values and those using rescaled values ranged from 0.621 to 0.997. Variation of the quartile membership of regions ranged from 0.0% to 75.0%. The total change in the 5th to 95th percentile intervals ranged from -19 to +17 places. Conclusion: The results suggested that the EMSI could be used as a tool for evaluating quality of regional EMS system and for identifying the areas for quality improvement.

• Biomedical Science Letters
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• v.17 no.3
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• pp.197-202
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• 2011

Mitosis count is one of the most helpful morphologic features for distinguishing pulmonary typical carcinoid (TC) from atypical carcinoid (AC). However, identifying areas of highest mitotic activity is tedious and time-consuming, and mitosis count may vary substantially among pathologists. Anti-phosphohistone H3 (PHH3) is an antibody that specifically detects histone H3 only when phosphorylated at serine 10 or serine 28, an event that is concurrent with mitotic chromatin condensation and not observed during apoptosis. In this study, immunohistochemical staining for PHH3 was performed to determine whether PHH3 was a reliable and objective mitosis-specific marker for pulmonary carcinoid tumors. Seventeen cases of surgically resected pulmonary carcinoid tumors (12 TCs and 5 ACs) were obtained and classified according to the 2004 World Health Organization classification. Mitotic counts determined by PHH3 correlated to ones determined by hematoxylin and eosin (H&E) staining; however, PHH3 mitotic counts (mean mitotic counts: 1 in TCs and 3.2 in ACs) were slightly higher than H&E mitotic counts (mean mitotic counts: 0.25 in TCs and 1.8 in ACs). The mitotic counts determined by experienced observer were more correlated to those determined by inexperienced observer with the PHH3-based method (R=0.968, P<0.001) rather than H&E staining (R=0.658, P<0.001). These results suggest that the PHH3 mitotic counting method was more sensitive and simple for detecting mitoses compared to traditional H&E staining. Therefore, PHH3 immunohistochemistry may contribute to more accurate and reproducible diagnosis of pulmonary carcinoid tumors and may be a valuable aid for administrating appropriate clinical treatment.

• Journal of Preventive Medicine and Public Health
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• v.46 no.5
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• pp.282-290
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• 2013

Objectives: This study aimed to develop a health needs assessment (HNA) tool for persons with brain disorders and to assess the unmet needs of persons with brain disorders using the developed tool. Methods: The authors used consensus methods to develop a HNA tool. Using a randomized stratified systematic sampling method adjusted for sex, age, and districts, 57 registered persons (27 severe and 30 mild cases) with brain disorders dwelling in Seoul, South Korea were chosen and medical specialists investigated all of the subjects with the developed tools. Results: The HNA tool for brain disorders we developed included four categories: 1) medical interventions and operations, 2) assistive devices, 3) rehabilitation therapy, and 4) regular follow-up. This study also found that 71.9% of the subjects did not receive appropriate medical care, which implies that the severity of their disability is likely to be exacerbated and permanent, and the loss irrecoverable. Conclusions: Our results showed that the HNA tool for persons with brain disorders based on unmet needs defined by physicians can be a useful method for evaluating the appropriateness and necessity of medical services offered to the disabled, and it can serve as the norm for providing health care services for disabled persons. Further studies should be undertaken to increase validity and reliability of the tool. Fundamental research investigating the factors generating or affecting the unmet needs is necessary; its results could serve as basis for developing policies to eliminate or alleviate these factors.