Objective : Health insurers and policy makers are increasingly examining the hospital mortality rate as an indicator of hospital quality and performance. To be meaningful, a risk-adjustment of the death rates must be implemented. This study reviewed 5 severity measurement methods and applied them to the same data set to determine whether judgments regarding the severity-adjusted hospital mortality rates were sensitive to the specific severity measure. Methods : The medical records of 584 patients who underwent coronary artery bypass graft surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups, Disease Staging, Computerized Severity Index, APACHE III and KDRG were used to quantify severity of the patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex to evaluate the hospitals' performance, the ratio of the observed number of deaths to the expected number for each hospital was calculated. Results : The overall in-hospital mortality rate was 7.0%, ranging from 2.7% to 15.7% depending on the particular hospital. After the severity adjustment, the mortality rates for each hospital showed little difference according to the severity measure. The 5 severity measurement methods varied in their statistical performance. All had a higher c statistic and $R^2$ than the model containing only age and sex. There was a little difference in the relative hospital performance evaluation by the severity measure. Conclusion : These results suggest that judgments regarding a hospital's performance based on severity adjusted mortality can be sensitive to the severity measurement method. Although the 5 severity measures regarding hospital performance concurred, more often than would be expected by chance, the assessment of an individual hospital mortality rates varied by the different severity measurement method used.
"본 논문은 대한외과학회지 2006년 제70권제1호에 실렸던 논문으로 대한외과학회 편집위원회 승인을 득하고 본 협회지에 게재함.
Purpose: Malnutrition has been frequently reported for patients on their admission to the hospital and it has been associated with an increase in morbidity, mortality and the length of the hospital stay. Although a number of screening tools have been developed to identify those patients at risk for malnutrition, there is no' gold standard' for defining malnutrition and the malnourished patients remain largely unrecognized. The aim of this study is to evaluate the efficacy of a nutritional screening tool for use in Dankook University Hospital. Methods Nutritional evaluation was performed for 53 patients who were admitted to the department of surgery and internal medicine between October and December 2004. The screening tool was completed by the ward nurse and the nutritional support team nurse on the same patients within24 hours of admission. The nutritional support team nurse performed the full assessment. The screening sheet included 4 questions regarding body mass index, recent unintentional weight loss, food intake and disease severity. Each answer was scored and a total of 5 was tested as the criterion fey malnutrition. The full assessment included current body weight, recent weight loss, triceps skinfold thickness, mid-arm muscle circumference, serum albumin)in and total lymphocyte count. Malnutrition was defined by 3 or more values below the reference values. The reliability of the screening tool was assessed using kappa statistic. Sensitivity, specificity and accuracy were calculated to evaluate the validity of the screening tool. The receiver operating characteristic(ROC) curve was drawn to choose a cutoff valve that maximizes sensitivity and specificity. Results' The level of agreement between the ward nurse and the NST nurse was good for BMI and food intake and moderate for weight loss and disease severity. The full assessment identified7 patients(13.2%) as malnourished. The screening sheet had a sensitivity of 86% and a specificity of 80%. According to the ROC curve, a score of 5 points provided the best validity. Conclusion The nutritional screening tool is reliable when completed by different observers and it is valid for nutritional assessment.
Most conventional instruments measuring disability rely on total score by simply adding individual item responses, which is dependent on the items chosen to represent the underlying construct (test-dependent) and a test statistic, such as coefficient alpha for the estimate of reliability, varying from sample to sample (sample-dependent). By contrast, item response theory (IRT) method focuses on the psychometric properties of the test items instead of the instrument as a whole. By estimating probability that a respondent will select a particular rating for an item, item difficulty and person ability (or disability) can be placed on same linear continuum. These estimates are invariant regardless of the item used (test-free measurement) and the ability of sample applied (sample-free measurement). These advantages of IRT allow the creation of invariantly calibrated large item banks that precisely discriminate the disability levels of individuals. Computer adaptive testing (CAT) method often requiring a testing algorithm promise a means for administering items in a way that is both efficient and precise. This method permits selectively administering items that are closely matched to the ability level of individuals (measurement precision) and measuring the ability without the loss of precision provided by the full item bank (measurement efficiency). These measurement properties can reasonably be achieved using IRT and CAT method. This article aims to investigate comprehensive overview of the existing disability instrument for back pain and to inform physical therapists of an alternative innovative way overcoming the shortcomings of conventional disability instruments. An understanding of IRT and CAT method will equip physical therapist with skills in interpreting the measurement properties of disability instruments developed using the methods.
The Agricultural Land Remodeling Project was launched for agricultural fields with potential risk of flooding which were placed in low-lying area as a part of agricultural sectors of the National 4 River Project. It induced of the reclaimed agricultural fields on a national scale. The arable lands reestablished by reclamation have caused several big problems such as destruction of soil physicochemical properties, and thus the techniques to solve disadvantages were urgently required. In this study, we collected experimental samples from top soils in three agricultural areas, one from conventional agricultural fields (Hwasun, Jeollanam-do) and the others from reclaimed (remodelled) agricultural fields (Naju, Jeollanam-do and Gumi, Gyeongsangbuk-do), The soil chemistry data were analyzed using statistic tools such as semi-variance and kriging, and differences between natural and reconstructed soils were examined. The score, R (Ao) which indicates a dependence distance between each chemical element, was as follows; 21.8~43.5 (Conventional, Hwasoon), 4.4~70.6 (Remodelled, Naju) and 5.3~43.6 (Remodelled, Gumi). These results suggested that chemical properties of the reclaimed agricultural fields had a huge variation. Moreover, the result of kiriging maps also represented a ununiform pattern in the reclaimed lands. As a result of this study, it is strongly required to build up the soil type-specific management techniques for the reclaimed agricultural lands.
Kim, Kyung-Ja;Lee, Yoon-Young;Hyun, Dong-Su;Park, Kwang-Ok
Journal of Korean Biological Nursing Science
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v.6
no.1
/
pp.43-52
/
2004
Purpose : The purpose of this study was to find effects of early oral water intake on thirsty feeling, nausea, and vomiting after ambulatory surgery. Method : Sixty patients who received PET(Pressure Equalizing Tube) insertion surgery under general anesthesia were conveniently sampled and divided into two groups. Experimental group was instructed to drink water after two hours and control group was directed to intake water after three hours postoperatively. Data were collected from May 1, 2002 to August 31, 2002 at ambulatory surgery center of Asan Medical Center. The thirsty feeling, nausea and vomiting score between experimental and control group were compared at the time of recovery, recovering consciousness, 2hr, 3hr, right before discharge and/or 24hr(telephone interview) postoperatively. The collected data were analyzed by SPSS 8.0 statistic program. Result : Result of this study are as follows. 1) There was a statistically significant difference(t=-10.31, p=0.00) in the occurrence of thirsty feeling at the 3hr postoperatively between experimental and control groups. 2) There was a statistically significant difference($x^2=6.66$, p=0.02) in the incidence of nausea during the 2hr postoperatively between experimental and control groups. 3) There was no difference($x^2=0.35$, p=0.55) between groups in vomiting scores. Conclusion : It was generally known that the delay of oral water intake decreases post operative complications. But, this study shows that early oral water intake decreases discomfort of thirsty and there was no adverse effects on the occurrence of postoperative nausea and vomiting.
The purpose of this study is to design men's clothing pattern that supplemented the problems of body shapes, by grasping the physical characteristics of middle-aged men and classifying their body shapes through comparing measurements after carrying out the human-body measurement targeting 120 middle-aged men at the age of 35-49 in full. As to the technical-statistic analysis of the measurement items, it could be seen that the middle-aged people who are the research target, have the obese body shapes. As a result of carrying out the factor analysis by the measurement analysis, it was derived the totally five factors such as thickness and width, stature and height, weight and girth, the bust length, and the shoulder shape. The total communality is 78.47%, and as a result of the cluster analysis by the factor score, it was classified into three clusters. Type 1 is the body shape with the great stature, the waist region a little obese, and the biggest thickness, width and girth. It is a flat body shape with the narrow shoulder and the smallest difference between the breast width and the waist width. As type 2 is the body shape that is small stature and is relatively not fat, it is the shape with the biggest difference between the breast width and the waist width and with the wide shoulder. Type 3 is the body shape that belongs to the middle of type 1 and type 2, has the upper-part body longer than other body shapes, and has the developed breast region with the biggest bosom width and bosom thickness.
The objectives of the present study is to examine the validity of Charlson Comorbidity Index(CCI) based on medical record data; to utilize the index to determine outcome indexes such as mortality, length of stay and cost for the domestic patients whose have received total hip arthroplasty. Based on medical record date, 1-year Mortality was analyzed to be 0.664 of C statistic. The $R^2$ for the predictability for length of stay and the cost was about 0.0181, 0.1842. Fee of national health insurance and total cost including the cost not covered by insurance, also had statistically significance above 3 points of Charlson point score(p=0.0290, 0.0472; $p.{\le}0.05$). The 1-year mortality index, length of stay and cost of the total hip arthroplasty patients which was obtained utilizing CCI have a limitative prediction power and therefore should be carefully analyzed for use.
The aim of this study was to analyze relations of stress, job satisfaction, organizational commitment and turnover intention in medical technicians. The subjects were 468 medical technicians in 10 general hospitals. Data were collected using a structured questionnaire from July 1, 2015 to August 30, 2015 and analyzed with descriptive statistics, ANOVA, t-test, Pearson's correlation, Hierarchical multiple regression analysis. The mean score of stress level was $2.62{\pm}0.69$, satisfaction level $2.92{\pm}0.62$, organizational commitment $3.37{\pm}0.63$, and turnover intention $2.97{\pm}0.68$. We found the positive correlations of turnover intention with stress. There were negative correlations among job satisfaction, organizational commitment and turnover intention. These results showed that medical technicians were needed to minimize stress in order to maintain job satisfaction, organizational commitment and decrease turnover intention.
Kim, Nam-Kwen;Lee, Dong-Hyo;Jo, Ga-Won;Seo, Eun-Sung
Journal of Society of Preventive Korean Medicine
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v.16
no.3
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pp.15-26
/
2012
Objective : Only a few studies have investigated the life expectance and health related quality of life (HRQOL) about stroke patients. The purpose of this study is to analyze the life expectancy, preference based quality of life(QOL) and quality adjusted life years(QALYs) of stroke patients. Methods : We used data of 10,533 adults from 4th Korean national health and nutritional examination survey 2009 for evaluating HRQOL of stroke patients. We also analyzed the life expectancy for stroke patients using life table from national public health data. Finally we calculated the QALYs with and without stroke conditions and assumed the difference of QALYs. Results : The mean age of stroke patients was assumed to be 65. Lower income and less educated groups were prone to be exposed to the stroke conditions. Common comorbidities of stroke patients were ischemic heart attack, hypertension, diabetes and hyperlipidemia. The proportions of participants who reported problems in each of the five EQ-5D dimensions increased significantly at chronic stroke group. Participants with chronic stroke conditions had an almost 6-fold higher risk of impaired health utility(the lowest quartile of EQ-5D utility score) compared with non stroke participants, after adjustment of age, gender, income, education, comorbidity variables. The differences of life expectancy and QALYs between non-stroke and stroke group from the age of 65 till death were assumed to be 0.767 year and 3.103 QALYs. Conclusions : Although the authors analyzed the affecting factors of QOL and assumed the differences of life expectance and QALYs about stroke patients using domestic national data and statistic references, well designed cohort studies should be needed to prove the causal effects of affecting factors and to assume more correct QALY differences.
Proceedings of the Korean Institute of Information and Commucation Sciences Conference
/
2019.05a
/
pp.163-164
/
2019
In this study, we compared the differences between groups in a model that investigates the effect of smartphone users on the intent to use continuously. There are various methodologies for group difference analysis, but in this study, we try to verify the size comparison of regression analysis $R^2$. In order to analyze the difference between groups, we try to prove through hypothesis test whether there is a meaningful difference in the intention of continuous use of Korean and Chinese smartphone users collected through previous research. The results of the analysis are useful as a method to determine whether smartphone users in China and Korea are aware of differences or not. According to this procedure, first, the formula for calculating Z-transformation of Fisher and Z-score test statistic calculation formula were used. However, this methodology is also used in the verification of control effect using correlation coefficient. Also, the theoretical implications are presented based on the analysis results.
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