• Health Policy and Management
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• v.4 no.1
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• pp.49-76
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• 1994

Small area variations in health care utilization have long been studied as an important issue related to boto cost containment and quality assurance. This study was conducted to investigate if variations in hospital services across small geographic areas in Korea existed. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows : 1. Extremal Quotients(EQ) of hospital expenditure per capita and hospital days per capita varied among diagnosis types. The EQ ranged from 2.05(cataract) to 41.67(pneumonia) in hospital expenditure per capita and from 1.86(cataract) to 45.89(pneumonia) in hospital days per capita. The diagnosis groups which showed high variation were pneumonia, cephalo-pelvic disproportion, gastritis and duodenitis, fracture of rib, and acute bronchitis. Those which showed low variation were acute appendicitis and cataract. 2. The EQ level of admission rate was different in terms of diagnosis types, ranging from 2.57(catarct) to 44.45(pneumonia). The variations were high in medical disorders such as pneumonia, oephalo-pelvic disproportion, gastritis and duodenitis and acute bronchitis, while relatively low in surgical conditions such as acute appendicitis and cataract. 3. As an indicator of service intensity, the EQ of expenditure per admission ranged from 1.67(acute appendicitis) to 31.27(essential hypertension). The diagnoses which had high variation were essential hypertension, gastric ulcer, whereas those which had low variation were cephalopelvic disproportion and acute appendicitis. With regard to hospital days per admission, the EQ ranged from 1.55(acute appendicitis) to 28.13(gastric ulcer) by diagnosis types. The diagnosis groups with showed high variation were gastric ulcer, essential hypertension, and acute bronchitis, whereas those with low variation were cephalo-pelvic disproportion, intervertebral disc disorders, and acute appendicitis. Both the expenditure and hospital days per admission showed lewwer variations than the expenditure per capita, hospital days per capita and admission rate. 4. Comparing patterns of variation in utilization indices, diagnoses such as essential hypertension, gastric ulcer, fracture of rib showed higher variations in expenditure per admission than in admission rates, whereas diagnoses such as pneumonia, cephalo-pelvic disproportion and gastric ulcer showed higher variations in admission rate than expenditure per admission. These findings suggest that wide variations existed in several diagnoses groups across small areas in Korea. Further research should be performed to investigate factors related to small area variations including provider behavior.

• The Korean Journal of Health Service Management
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• v.10 no.1
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• pp.13-26
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• 2016

Objectives : The aim of this study was to investigate whether there is a difference in the factors affecting the financial performance and profitability before and after the specialty hospital designation and thereby identifying the differentiated significance of the financial performance of specialty hospitals. Methods : Based on the year 2011, the analysis period was divided into the pre-specialty hospital designation (2007-2010) and post-specialty hospital designation (2011-2014), and the data were pooled according to the respective analysis period and analyzed by descriptive statistics and regression analysis. Results : The difference in the financial factors that affected the financial performance and profitability before and after the specialty hospital designation was discovered, and a financial performance factor different from prior studies was found. Conclusions : This study identified improved outcomes in financial performance due to the specialty hospital designation and the factors that affect profitability in terms of the finance of specialty hospitals.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.16 no.3
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• pp.190-194
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• 2013

Internal hernia (IH) is a rare cause of small bowel obstruction occurs when there is protrusion of an internal organ into a retroperitoneal fossa or a foramen in the abdominal cavity. IH can be presented with acute or chronic abdominal symptom and discovered by accident in operation field. However, various kinds of imaging modalities often do not provide the assistance to diagnose IH preoperatively, but computed tomography (CT) scan has a high diagnostic accuracy. We report a case of congenital IH in a 6-year-old boy who experienced life threatening shock. CT scan showed large amount of ascites, bowel wall thickening with poor or absent enhancement of the strangulated bowel segment. Surgical exploration was performed immediately and had to undergo over two meters excision of strangulated small bowel. To prevent the delay in the diagnosis of IH, we should early use of the CT scan and take urgent operation.

• The Korean Journal of Cytopathology
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• v.12 no.2
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• pp.121-125
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• 2001

Primary small cell carcinoma of the urinary bladder is a rare malignant tumor. A more rapidly fatal course may be seen in advanced stages of small cell carcinoma as compared to similar stages of urothelial carcinoma. It is very important to recognize this distinct form of bladder cancer by urinary cytology The differential diagnosis of small cell carcinoma of the urinary bladder includes metastatic small cell carcinoma, urothelial carcinoma, and primary or secondary malignant lymphoma. This article highlights the urinary cytologic diagnosis of a case of primary small cell carcinoma. A 59-year-old male presented with gross hematuria for five months. Urinary cytology showed high cellularity consisting of tiny monotonous tumor cells in the necrotic background. The tumor cells occurred predominantly singly, but a few in clusters. The cytoplasm was so scanty that only a very narrow rim of it was seen. The nuclei were oval or round and had finely stippled chromatin. Rarely, the nuclei contain visible nucleoli. Frequently cell molding was noted in clusters. Many single cells demonstrated nuclear pyknosis or karyorrhexis. The histologic findings of transurethral resection and partial cystectomy specimen were those of small cell carcinoma. Cytologic distinction may be very difficult but careful attention to clinical features and cellualr details can classify these neoplasms correctly.

• Clinics in Shoulder and Elbow
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• v.4 no.2
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• pp.186-190
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• 2001

Purpose: The aim of this study was to investigate the diagnostic accuracy of Neer, Hawkins provocative tests and supraspinatus manual muscle test for the assessment of impingement syndrome, partial tear and small complete tear of De rotator cuff. Materials and Methods: Seventy-one female and 115 male patients were included in the study. Patients were divided into four groups of no impingement, impingement without tear, partial tear and small complete tear of the rotator cuff, which were confirmed by sonogram, magnetic resonance imaging and surgery. Neer and Hawkins provocative tests and supraspinatus manual muscle test were performed respectively. SAS 6.12 version was used in statistical analysis. Results: We found that Neer test had 94% sensitivity, 54% specificity for impingement without tear and 89% sensitivity, 78% specificity for partial tear and 96% sensitivity, 23% specificity for small tear. Hawkins test revealed 95% sensitivity, 54% specificity for impingement without tear and 93% sensitivity, 78% specificity for partial tear and 100% sensitivity, 23% specificity for small tear. Supraspinatus manual muscle test revealed 27% sensitivity, 94% specificity for impingement without tear and 29% sensitivity, 82% specificity for partial tear and 48% sensitivity, 82% specificity for small tear. Conclusion: Neer and Hawkins tests have high sensitivity, low specificity for impingement syndrome, partial and small tear. Supraspinatus manual muscle test had low sensitivity and high specificity. However this test was not effective to differentiate the partial and small rotator cuff tear. We thought that more effective provocative test should be designed to detect the partial and small rotator cuff tear.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.7
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• pp.4325-4328
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• 2013

Introduction: The influence of season at diagnosis on cancer survival has been an intriguing issue for many years. Most studies have shown a possible correlation in between the seasonality and some cancer type survival. With short expected survival, lung cancer is an arena that still is in need of new prognostic factors and models. We aimed to investigate the effect of season of diagnosis on 3 months, 1 and 2 years survival rates and overall survival of non small cell lung cancer patients. Materials and Methods: The files of non small cell lung cancer patients that were stages IIIB and IV at diagnosis were reviewed retrospectively. According to diagnosis date, the patients were grouped into 4 season groups, autumn, winter, spring and summer. Results: A total of 279 advanced non small cell lung cancer patients' files were reviewed. Median overall survival was 15 months in the entire population. Overall 3 months, 1 and 2 years survival rates were 91.0%, 58.2% and 31.2% respectively. The season of diagnosis was significantly correlated with 3 months survival rates, being diagnosed in spring being associated with better survival. Also the season was significantly correlated with T stage of the disease. For 1 and 2 years survival rates and overall survival, the season of diagnosis was not significantly correlated. There was no correlation detected between season and overall survivals according to histological subtypes of non small cell lung cancer. Conclusion: As a new finding in advanced non small cell lung cancer patients, it can be concluded that being diagnosed in spring can be a favorable prognostic factor for short term survival.

• Journal of Chest Surgery
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• v.45 no.1
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• pp.35-39
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• 2012

Background: The aims of the study were to determine the accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting pulmonary metastasis through video-assisted thoracoscopic surgery (VATS), a technique that allows the excisional biopsy of small pulmonary nodules in patients with known malignancies. Materials and Methods: Between October 2007 and April 2010, 28 patients with known malignancies and small pulmonary nodules underwent VATS excisional biopsies. All patients were in follow-up for a previously treated malignancy. The malignancies included the following: colorectum (9), breast (6), head and neck (5), stomach (3), lymph (1), ovary (1), uterus (1), bladder (1), and liver (1). Results: There were 16 men and 12 women whose mean age was 56.7 years old (range, 38 to 77 years). The sizes of the mean nodules removed were 11.3 mm (range, 7 to 21 mm). Diagnoses included metastatic (11), bronchioloalveolar carcinoma (1), primary adenocarcinoma (1), pulmonary tuberculosis (6), fibrosis (5), organizing pneumonia (3), lymphoid hyperplasia (1). Among these lesions, 46.4% were malignant. Conclusion: True positive FDG-PET was 39.2%. FDG-PET is not a sensitive test in the evaluation of patients with a history of an extrathoracic malignancy and newly diagnosed small pulmonary nodules. VATS excision allows the early diagnosis of small pulmonary nodules, with low morbidity, in patients with known malignancies.

• Journal of Korean Traditional Oncology
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• v.19 no.1
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• pp.61-68
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• 2014

Objectives : To study the effect of SB injection on tumor size in an advanced non-small cell lung cancer patient. Methods : A patient was clinically diagnosed as advanced non-small cell lung cancer (Stage IIIa). Four cycles of intravenous SB injection were conducted. Each cycle lasted 4 days. The content of 7vials SB was injected every day. To compare the tumor size before treatment and after four cycles of SB injection, chest computed tomography (CT) was performed. Results : Follow-up CT images showed that the tumor size was reduced. In admission, size of the tumor $6.7{\times}8.5{\times}9.5cm$ on the left lower lobe of lung. After SB injection, size of the tumor $5.6{\times}6.8{\times}8.4cm$ by Chest CT. The patient's symptoms such as cough, sputum were improving until four cycles of SB injection. Numerical rating scale (NRS) showed improvement of Chest pain from point 3 to point 0. Conclusions : This case study suggests that intravenous SB injection may have significant effects of anti-tumor for non-small cell lung cancer.

• Journal of Digital Convergence
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• v.18 no.2
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• pp.313-321
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• 2020

This study was conducted to provide basic data for the development of a nursing manpower maintenance and management program by assessing the relationship among the calling, resilience, leader-member exchange, and nursing work environments of small and medium-sized hospital nurses. Data was collected through a structuralized questionnaire survey conducted on small and medium-sized hospital nurses. The results of this study indicated calling had positive correlation with resilience, leader-member exchange, and nursing work environments, while resilience had positive correlation with leader-member exchange and nursing work environments. There also was positive correlation between leader-member exchange and nursing work environments. Accordingly, there is a need to develop a program to offer motivation to increase calling and resilience from the personal perspective of the small and medium-sized hospital nurses. In addition, a program is necessary to strengthen continuous leadership of the hospital administrator to improve the leader-member exchange and nursing work environment from organizational perspective.

• The Journal of Internal Korean Medicine
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• v.44 no.3
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• pp.594-601
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• 2023

Objective: To demonstrate an improvement in metastatic cancer pain and a decrease in tumor size in a patient with non-small cell lung cancer. Method: A 53-year-old female patient diagnosed with metastatic non-small cell lung cancer in August 2022 underwent integrative cancer treatment (ICT) for two months to decrease the tumor size and improve back pain from bone metastasis. The patient underwent chemotherapy with ICT. Radiologic outcomes were assessed by chest, abdomen, and pelvis computed tomography based on the Response Evaluation Criteria in Solid Tumors (RECIST) protocol. Clinical outcomes were assessed using National Cancer Institute Common Terminology Criteria for Adverse Event (NCI-CTCAE), Eastern Cooperative Oncology Group (ECOG), and a numeric rating scale (NRS). Result: During the two months of treatment, the NRS scores for back pain were improved, and the ECOG score improved from grade 2 to 1. The size and metabolic activity of the primary lung tumor decreased and underwent partial remission based on RECIST. No serious side effects of grade 3 or higher were noted on the NCI-CTCAE test. Conclusion: This case suggests that ICT may have a therapeutic effect for cancer pain and a synergetic effect with chemotherapy for metastatic non-small cell lung cancer.