• Korea Journal of Hospital Management
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• v.9 no.3
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• pp.128-142
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• 2004

To evaluate the effects of critical pathway on the length of hospital stay, the cost and quality of care provided to gastrectomy patients in a tertiary care academic medical center. The basic research design is a retrospective case-control comparative study. 470 patients of gastrectomy were included in the study; 180 before pathway development (control), 163 right after pathway implementation (path group I) and 127 one year after pathway implementation (path groupII). 476 patients of modified radical mastectomy were also analyzed to examine whether the reduction of the length of hospital stay is from the hospital-wide trend or due to the critical pathway. Death after operation, ICU stay, unplanned re-operation, readmission after discharge, the length of hospital stay and cost were analyzed. 2-test, one-way ANOVA, Bonferroni and Turkey's test were used for statistical analysis. (1) There were no significant differences in patient clinical conditions and no sign of deterioration of quality from critical pathway. (2) The length of hospital stay was 13.0 days in control group, 12.2 days in path group I and 10.0 days (p<0.01) in path groupII. (3) The total costs during the hospital stay were reduced. However the cost per day was significantly increased from reduction of hospital stay (358,488won in control, 366,017won in path group I and 413,220won (p<0.01) in path groupII). Critical pathway reduced the length of hospital stay, total hospital costs and resource utilization without harming quality of patient care.

• The Journal of the Korea Contents Association
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• v.12 no.12
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• pp.269-281
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• 2012

The purpose of this study is to analyze effects of medical service quality on the customer satisfaction and intention of revisit in cancer patients. To achieve purpose of the research, the data was collected from 420 patients in university hospitals using a standardized questionnaires. Using the structural equation modeling(SEM), this study examines the relationship among medical service quality, customer satisfaction and intention of revisit. The results show that the medical service quality factors such as medical expertise, administrative service have positive effects on the customer satisfaction which positively relates to intention of revisit. Medical expertise, convenience, administrative service of the medical service quality factors have positive influence upon intention of revisit. Therefore, the results of this study show that the medical service quality factors which are medical expertise, administrative service leading to customer satisfaction are important factors to revisit hospitals.

• Asian Oncology Nursing
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• v.12 no.3
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• pp.204-212
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• 2012

Purpose: To investigate the effectiveness and variance of a critical pathway (CP) for laparoscopic colon resection in colon cancer patients, and nurses'satisfaction with the CP. Methods: A CP for laparoscopic colon resection was applied to the CP-group that included 50 patients, who underwent elective colon resection between March and May, 2011. The non-CP group included 51 patients who had the same operation without the CP applied from March to May, 2010. Results: The means of length of hospital stay were 11.7 and 7.3 days (p<.001) and the lengths of postoperative hospital stay were 8.6 and 5.1 days (p<.001) in the non-CP group and CP group, respectively. There was no significant difference between two groups for total healthcare costs, pain score, complications, or emergency room visits within 30 days after discharge. By examining variances of the CP, there were 162 variances and the most frequent cause was patient's condition. Nurses'satisfaction with the use of CP was favorable and the mean score of satisfaction was 3.76 on the 5 point Likert scale. Conclusion: There are clear benefits to use of CP, resulting in standardized and effective patient care. In conclusion, analysis of variance data can assist in evaluating and revising CP for optimal care and reducing variances.

• Archives of Plastic Surgery
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• v.44 no.4
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• pp.324-331
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• 2017

Background Lipedema is a condition consisting of painful bilateral increases in subcutaneous fat and interstitial fluid in the limbs with secondary lymphedema and fibrosis during later stages. Combined decongestive therapy (CDT) is the standard of care in most countries. Since the introduction of tumescent technique, liposuction has been used as a surgical treatment option. The aim of this study was to determine the outcome of liposuction used as treatment for lipedema. Methods Twenty-five patients who received 72 liposuction procedures for the treatment of lipedema completed a standardized questionnaire. Lipedema-associated complaints and the need for CDT were assessed for the preoperative period and during 2 separate postoperative follow-ups using a visual analog scale and a composite CDT score. The mean follow-up times for the first postoperative follow-up and the second postoperative follow-up were 16 months and 37 months, respectively. Results Patients showed significant reductions in spontaneous pain, sensitivity to pressure, feeling of tension, bruising, cosmetic impairment, and general impairment to quality of life from the preoperative period to the first postoperative follow-up, and these results remained consistent until the second postoperative follow-up. A comparison of the preoperative period to the last postoperative follow-up, after 4 patients without full preoperative CDT were excluded from the analysis, indicated that the need for CDT was reduced significantly. An analysis of the different stages of the disease also indicated that better and more sustainable results could be achieved if patients were treated in earlier stages. Conclusions Liposuction is effective in the treatment of lipedema and leads to an improvement in quality of life and a decrease in the need for conservative therapy.

• Journal of Chest Surgery
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• v.45 no.2
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• pp.95-100
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• 2012

Background: The purpose of this report is to describe the perioperative outcomes of standard carotid endarterectomy (CEA) with general anesthesia, routine shunting, and tissue patching in symptomatic carotid stenoses. Materials and Methods: Between October 2007 and July 2011, 22 patients with symptomatic carotid stenosis (male/female, 19/3; mean age, $67.2{\pm}9.4$ years) underwent a combined total of 23 CEAs using a standardized technique. The strict surgical protocol included general anesthesia and standard carotid bifurcation endarterectomy with routine shunting. The 8-French Pruitt-Inahara shunt was used in all the patients. Results: During the ischemic time, the shunts were inserted within 2.5 minutes, and 5 patients (22.7%) revealed ischemic cerebral signals (flat wave) in electroencephalographic monitoring but recovered soon after insertion of the shunt. The mean shunting time for CEA was $59.1{\pm}10.3$ minutes. There was no perioperative mortality or even minor stroke. All patients woke up in the operating room or the operative care room before being moved to the ward. One patient had difficulty swallowing due to hypoglossal nerve palsy, but had completely recovered by 1 month postsurgery. Conclusion: Routine shunting is suggested to be a safe and reliable method of brain perfusion and protection during CEA in symptomatic carotid stenoses.

• Journal of Korean Clinical Nursing Research
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• v.19 no.2
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• pp.245-254
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• 2013

Purpose: This study was done to examine predictive validity of Critical Care Non-verbal Pain Scale (CNPS) and develop criteria for pain assessment using CNPS with critically ill patients who have communication problems. Methods: Data were collected from intensive care units at three major general hospitals in Seoul and Kyunggi province. During each observation, a nurse assessed pain severity using CNPS ratings (range 0-9) at four treatment stages: at rest, during central catheter dressing change (nonpainful procedure), position change and suctioning (routine painful procedures). Patients also assessed their pain using a self-report 4-point VRS-4. Results: There were significant differences between the four treatment stages except between "at rest" and "nonpainful procedure". Strong correlations were found between CNPS and VRS-4 for "at rest" (r=.552, p<.001), central catheter dressing change (r=.505, p<.001), position change (r=.709, p<.001), and suctioning (r=.662, p<.001). ROC curve analysis of CNPS based on 3 point on VRS-4 showed the cutoff point was 3 for CNPS, the starting point for pain management with 73% sensitivity, 92.2% specificity, 73% positive predictive value, and 92.8% negative predictive value. Conclusion: Results indicate that CNPS is a valid tool for measuring pain in critically ill patients with communication problems and 3 point should be the standardized pain treatment point.

• Journal of Korean Clinical Nursing Research
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• v.23 no.2
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• pp.258-266
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• 2017

Purpose: The study aimed to examine quality of sleep in hemodialysis patients and explore physical, physiological, and psychological factors determining sleep quality. Methods: The survey was conducted among 165 patients on maintenance hemodialysis at a university hospital. Data were collected from July to October in 2015. The sleep quality and its related factors were assessed by standardized questionnaires, anthropometric measures, and lab tests after obtaining a written consent from the participant. Results: The mean age of the participants was 62.58 years old, and 67.9% of the participants experienced sleep disorders such as 'not falling asleep within 30 minutes' or 'frequently waking up at night'. Pain (t=-3.29, p=.007) and depression (t=-6.028, p<.001) were significantly different between the group with sleep disorder and the other without. The demographic factors (age, shared room, sleep during the day), physical factors (pain and symptom), and psychological factors (depression and trait and status anxiety) together explained 20.0% of variance in sleep quality. Conclusion: Sleep disorder was frequently experienced among the patients on maintenance hemodialysis. The effective nursing strategies should focus on sleep environment, pain and depression management. Further study is warranted to explore the effect of physiological factors related to the disease on sleep disorder in this population.

• Tuberculosis and Respiratory Diseases
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• v.78 no.2
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• pp.78-84
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• 2015

Background: Reports of therapeutic drug monitoring (TDM) for second-line medications to treat multidrug-resistant tuberculosis (MDR-TB) remain limited. Methods: A retrospective cohort from the Virginia state tuberculosis (TB) registry, 2009-2014, was analyzed for TDM usage in MDR-TB. Drug concentrations, measured at time of estimated peak ($C_{max}$), were compared to expected ranges. Results: Of 10 patients with MDR-TB, 8 (80%) had TDM for at least one drug (maximum 6 drugs). Second-line drugs tested were cycloserine in seven patients (mean $C_{2hr}$, $16.6{\pm}10.2{\mu}g/mL$; 4 [57%] below expected range); moxifloxacin in five (mean $C_{2hr}$, $3.2{\pm}1.5{\mu}g/mL$; 1 [20%] below); capreomycin in five (mean $C_{2hr}$, $21.5{\pm}14.0{\mu}g/mL$; 3 [60%] below); para-aminosalicylic acid in five (mean $C_{6hr}$, $65.0{\pm}29.1{\mu}g/mL$; all within or above); linezolid in three (mean $C_{2hr}$, $11.4{\pm}4.1{\mu}g/mL$, 1 [33%] below); amikacin in two (mean $C_{2hr}$, $35.3{\pm}3.7{\mu}g/mL$; 1 [50%] below); ethionamide in one ($C_{2hr}$, $1.49{\mu}g/mL$, within expected). Two patients died: a 38-year-old woman with human immunodeficiency virus/acquired immune deficiency syndrome and TB meningitis without TDM, and a 76-year-old man with fluoroquinolone-resistant (pre-extensively drug-resistant) pulmonary TB and low linezolid and capreomycin concentrations. Conclusion: Individual pharmacokinetic variability was common. A more standardized approach to TDM for MDR-TB may limit over-testing and maximize therapeutic gain.

• Korean Journal of Community Nutrition
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• v.9 no.2
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• pp.225-232
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• 2004

The objective of this study is to investigate how patients satisfaction are affected by satisfaction with the patient menu and differentiated service resulting from QI activities and to evaluate the efficiency of QI activities. In order to improve satisfaction with menus through QI activities, this study strengthened meal round, examined the quantity of food waste produced by patients, diversified one-dish menus and used seasonal food as much as possible to reflect patients ′tastes to the maximum. With regard to cooking, additionally, it strengthened sampling and standardized recipes to maintain the constancy of taste and cooking/seasoning. From July 2003, dining time was changed from 08 : 00 to 07 : 30 for breakfast and from 17 : 30 to 18 : 00 for dinner. Statistical data analyses were completed using the SPSS 11.0 program. The results can be summarized as follows: The goal of QI was to improve food service by raising the score of "Satisfaction with Offered Menus" from 3.49 before QI to 3.55 after QI and differentiating nutrition service at the VIP ward. The score of "Satisfaction with offered menus" after QI was 3.56, and services related to the VIP ward were 7 dishes per meal, meal round once per day and the use of a napkin for a spoon in setting the table. In addition a variety of dishes were used in order to heighten the visual effect. Among the 10 items included on the patient satisfaction questionnaire, 8 items showed higher scores before QI. "Taste of meals" (p ＜ 0.05), "Satisfaction with offered menus" (p ＜ 0.05), "Kindness of meal serving assistants" (p ＜ 0.05) and "Cleanliness of clothes ＆ features" (p ＜0.05) of VIP ward were significantly higher than those of a general ward.

• Quality Improvement in Health Care
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• v.25 no.2
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• pp.2-15
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• 2019

Purpose: The purpose of this study is to provide basic data for the development of the most appropriate and effective educational materials for patients and their caregivers through the educational experiences of patient safety officer. Methods: This study is a qualitative analysis that involves using the focus group interview to understand the patient safety education experience of the patient safety officer. Results: The patient safety education experience of the patient safety officer is divided into four topics: (1) patient safety education content (2) patient safety education method (3) patient safety education status (4) activation and improvement of patient safety education. Additionally, the study incorporated twelve subtopics: (a) falls (b) speak up (c) patient safety campaign (d) patient safety rounding and a one on one training (e) education through medical staff (f) education using broadcast, video, post, among others (g) a lot of education in patient (h) patients not interested in patient safety education (i) patient safety education is less effective (j) human and medical expenses support (k) provision of standardized educational materials (l) patient safety culture for patient participation. Conclusions: This study indicate that education for patients and the caregivers should be inclusive and protective of stakeholders from the risks involved in patient safety events. The experience of patient safety officer is necessary for patient safety education for both patients and the caregivers since it is the source of basic data for the future development of patient safety education.