• Archives of Plastic Surgery
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• 제47권5호
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• pp.473-477
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• 2020

Superficial inferior epigastric artery (SIEA) flaps represent a useful option in autologous breast reconstruction. However, the short-fixed pedicle can limit flap inset options. We present a challenging flap inset successfully addressed by de-epithelialization, turnover, and counterintuitive rotation. A 47-year-old woman underwent left tertiary breast reconstruction with stacked free flaps using right deep inferior epigastric perforator and left SIEA vessels. Antegrade and retrograde anastomoses to the internal mammary (IM) vessels were preferred; additionally, the thoracodorsal vessels were unavailable due to previous latissimus dorsi breast reconstruction. Optimal shaping required repositioning of the lateral ends of the flaps superiorly, which would position the ipsilateral SIEA hemi-flap pedicle lateral to and out of reach of the IM vessels. This problem was overcome by turning the SIEA flap on its long axis, allowing the pedicle to sit medially with the lateral end of the flap positioned superiorly. The de-epithelialized SIEA flap dermis was in direct contact with the chest wall, enabling its fixation. This method of flap inset provides a valuable solution for medializing the SIEA pedicle while maintaining an aesthetically satisfactory orientation. This technique could be used in ipsilateral SIEA flap breast reconstructions that do not require a skin paddle, as with stacked flaps or following nipple-sparing mastectomy.

• 임상간호연구
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• 제27권2호
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• pp.149-164
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• 2021

Purpose: The purpose of this study was to develop a Korean Nurse Residency Program (KNRP) in order to facilitate new nurses' transition to clinical practice working at tertiary hospitals in Korea. Methods: The KNRP was developed through a literature review, investigation of NRP cases in United States, two rounds of expert consultation, and appropriateness survey. For appropriateness survey of the program, a questionnaire with 118 items and 14 subcategories including overview and operation of KNRP, education programs, staffing criteria for new nurses' education, preceptor supporting strategies, evaluation standards for new nurse's education, infrastructure, and KNRP benefits was used. Data were collected from 369 nurses including nurse educators, nurse managers, preceptors, and new nurses working at 43 tertiary hospitals in Korea from February 16, 2021 to March 22, 2021. Data were analyzed with descriptive statistics. Results: Appropriateness score of KNRP was 3.42±0.31 (out of 4) and those of 14 subcategories ranged from 3.18±0.47 to 3.58±0.46. The final version of the KNRP postulated is a one-year program, which is composed of off-job training and on-site training including preceptorship over 3 months, and competency reinforcement and adaptation supporting programs. Conclusion: The application of the one-year KNRP will facilitate new graduate nurses' transition to clinical practice. In order for effective application of the KNRP, cooperative efforts of the government, professional associations, and hospitals are needed.

• 보건행정학회지
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• 제12권2호
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• pp.43-75
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• 2002

This study focuses on the factors that make the financial structure of hospitals in Korea different, and on recommended courses of action that could be very helpful to hospitals in maintaining a sound financial structure. Data used in this study were collected from 132 hospitals with complete general data of present conditions as well as financial statements. They were chosen from the 174 hospitals that passed the standardization audit undertaken by the Korean Hospital Association from 1996 to 2000 for the purpose of accrediting training hospitals. The dependent variable in this study is financial structure. It consists of liabilities as against total assets (total liabilities to total assets, short-term liabilities to total assets, long-term liabilities to total assets, short-term borrowings to total assets, long-term borrowings to total assets). The independent variables are ownership type, hospital type, location, whether or not a representative is a director of the hospital, the possibility of changing a hospital director, bed size, period of establishment, asset structure, profitability, growth, tax shields, business risk, competition. The factors that appear to have the strongest impact on the liabilities to total assets of all the hospitals sampled are ownership type, hospital type, profitability, tax shields, and business risk. It was found that not-for-profit private hospitals and for-profit private hospitals have more liabilities than public hospitals, and tertiary medical institutions have less liabilities than the secondary general hospitals. Moreover, hospitals earning more at the expense of high business risk have a distinct tendency to lower liabilities. Concerning the current ratio, it was found that factors such as ownership type, hospital type, period of establishment, asset structure, and business risk are the more significant variables. The current ratio of public hospitals is higher than that of both not-for-profit private hospitals and for-profit private hospitals, and the current ratio of tertiary medical institutions is higher than that of general hospitals. As business risk is higher in hospitals compared to other businesses, the current ratio becomes higher; this is because it is assumed that for fear of bankruptcy, hospitals lessen liabilities to total assets. On the other hand, as hospitals become older, the fixed assets to total assets become lower. It is remarkable that in hospitals, the factors affecting liabilities to total assets have an opposite regression coefficient sign against factors affecting current ratio. It brings out the same results borne out by the old financial theories and researches, in which a lot of the liabilities of hospitals are considered as the cause of worsening liquidity. Therefore, it is very important for hospitals to maintain a sound financial structure in order to survive using the rational acquisition and maintenance of capital.

• 한국산학기술학회논문지
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• 제21권5호
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• pp.274-280
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• 2020

이 연구의 목적은 건강보험심사평가원에서 공개한 2015년 4월부터 2018년 4월까지 상급종합병원의 비급여 진료비 자료를 사용하여 비급여 진료비 항목별로 현황 및 평균 비용과 변이가 있는지 파악하는 것이다. 조사대상은 2015년, 2016년, 2017년, 2018년 4월 기준 상급종합병원 44개 기관 중 취소되거나 신규로 지정된 기관은 제외하고 최종 41개 상급종합병원의 비급여 진료비 현황이다. 연구방법은 건강보험심사평가원 정보공개창구에서 공개 자료를 요청한 후 승인을 받아 진행하였다. 분석방법은 일반적 특성과 연도별 비급여 항목 현황은 빈도분석, 연도별 변이 파악은 변동계수(C.V.)를 선정하여 분석하였다. 연구 결과, 비급여 진료비 세부항목의 현황을 비교 분석한 결과 비급여 항목의 개수가 2015년에는 총 51개였지만, 2016년 53개, 2017년, 98개로 점점 증가 추세를 보였으며 2018년에는 총 193개 항목으로 급격히 증가하였다. 상급종합병원 비급여 진료비 변이에 따른 항목 표준화를 위해서 정부는 비급여 진료비 표준화를 확대하고 의료기관은 표준화된 비급여 진료비 항목이나 명칭 등을 사용하도록 의무화하여야 한다.

• 대한영양사협회학술지
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• 제21권2호
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• pp.123-139
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• 2015

The objective of this study was to document how clinical dietitians working at tertiary hospitals spend their time based on several categories of activities using a time measurement study. The questionnaires were distributed to 14 tertiary hospitals, and dietitians answered by classifying their work activities into several categories such as general care, indirect care, direct care, outpatient care, and food service management. A total of 129 clinical dietitians replied and their answers were analyzed according to the categories of activities. The times spent on the categories are as follows: general care (76.7 mins/day, 14%), indirect care (228.4 mins/day, 35%), direct care (120.1 mins/day, 22%), outpatient care (61.5 mins/day, 11%), and food service management (99.0 mins/day, 18%). The total working hours for dietitians was 590.0 mins, which exceeds the standard working hours of 540.0 mins (9 hrs) a day. From this study, we found that clinical dietitians spent very limited time on direct care. Times spent on activities were different according to type of employment and food service. Internship dietitians spent their more time on general care (P<0.001) while irregular dietitians spent more time on outpatient care (P<0.05). In contracted managed food service hospitals, clinical dietitians spent significantly less time on food service management (P<0.001). Regardless of doctors' order and consultation fees, clinical dietitians performed more than 95 percent of free consultation to patients. Entry-level knowledge and skills of dietitians working at hospitals are very important for quality service, but it is equally important to create an administrative and social environment that encourages clinical dietitian to spend more time on direct patient care.

• 한국임상약학회지
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• 제26권2호
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• pp.121-127
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• 2016

Objective: Until now, there is minimal number of research for overall domestic status of orphan drug use in Korea. The purpose of this study is to identify the list of orphan drugs available in Korea and to understand the status of orphan drug usage in tertiary Hospitals and rare incurable disease Hospital. Methods: We made domestic orphan drug lists based on available orphan drugs in Korea. Based on this lists, we conducted e-mail survey from August, 2014 to September, 2014 to identify domestic status of orphan drug usage including the availability and management of orphan drugs. Results: There are three hundred and eighteen orphan drugs (184 ingredients) registered in Ministry of Food and Drug Safety. Among the three hundred and eighteen orphan drugs, Two hundred and twenty-eight drugs (102 ingredients) were selected. Information on each item was collected and documented with generic and brand names, manufacturers, wholesalers, indications, FDA approval status and insurance coverage. Forty-three tertiary hospitals and thirty-two rare incurable hospitals responded to the survey questionnaire (57.3%). According to the survey result, the antineoplastics and immunomodulating agents group has the highest percentage (40%) usage in the hospital. Of fortythree tertiary hospitals, thirteen hospitals manage orphan drugs separately (30.2%). Based on the reply, most of the healthcare professionals commented the drug information related to efficacy and safety including medication counseling of orphan drugs is insufficient. Conclusion: Through this study we anticipate providing an understanding of orphan drug usage status in Korea. We found the limited resources to the information on orphan drugs and this information requires updating on a regular basis. This can be the basis for further studies about preparing drug information, educational resources for rare disease patients.

• 한국임상보건과학회지
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• 제3권1호
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• pp.276-289
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• 2015

Purpose. To efficiently manage hospitals, this study aims to analyze the general characteristics, common-type balance sheet, common-type profit and loss statement and financial ratio of a tertiary general hospital and use the results as basic data for future hospital development by comprehending causes for problems and analyzing hospital management. Methods. By using information about a tertiary general hospital, located in A Metropolitan City, provided through Alio (www.alio.go.kr), a public organization information provider, Health Insurance Review & Assessment Service, and Ministry of Health and Welfare, this study used data during 3 years(2011 to 2013) by analyzing the general characteristics, common-type balance sheet, common-type profit and loss statement, industrial mean ratio and financial ratio of hospitals. Results. This study came to the following conclusions through the general characteristics, common-type balance sheet, common-type profit and loss statement, industrial mean ratio, financial ratio, circular chart and ROI by analyzing the data from 2011 to 2013. Conclusions. Overall, A Tertiary General Hospital showed an increase in fixed cost due to the construction of J Hospital and even in the size of capital and assets. It also showed an increase in medical profit, but the increase of its medical cost was higher, resulting in a financial loss. Especially, this hospital showed a slight decrease in net profit, featuring a reduction in inventory turnover. When the management of A Tertiary General Hospital was predicted based on such features, this hospital is expected to improve its profit structure through the opening of J Hospital, and it is necessary for this hospital to increase and sustain the turnover rate of inventories accumulated by managing them better.

• 보건교육건강증진학회지
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• 제7권1호
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• pp.27-32
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• 1990

Since the medical insurance covered the total population in Korea in July, 1989, the number of patient's visitation to the tertiary care hospital had changed because of referral regulation. In the referred patients through the secondary care hospitals such as out-patients of departments of internal medicine, general surgery, obstetrics and gynecology, pediatrics had decreased as well in-patients in these departments. However, departments of urology, dermatology, dentistry, ophthalmology and ear-nose-throat had more or less similar number of patients after medical insurance implemented for the total population. Contrarily, the number of patients visited emergency clinics and department of family medicine had increased very many. Thus, expansion of emergency clinic department, new special clinic set-ups, establishment of family medicine department in each hospital etc are strongly recommend.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제19권4호
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• pp.63-72
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• 2013

• 임상간호연구
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• 제21권3호
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• pp.277-292
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• 2015

Purpose: The purpose of this study was to develop a Clinical Ladder System (CLS) model for staff nurses working in inpatient units of tertiary care hospitals in Korea. Methods: The study was carried out in 2 steps. First, a nursing competence evaluation scale was developed. Second, evaluation of the nursing competences, qualifications, and professional activities of 230 nurses from five tertiary care hospitals was done by 49 head nurses between Feb. and Dec., 2014. Nurses were selected by head nurses according to their clinical experience and expected behavioral characteristics at each level of the ladder. Results: A nursing competence scale was developed consisting of 5 subcategories (clinical practice, ethical practice, education, leadership, and professional development) and 11 elements, and 5 levels of behavioral indicators for each element. Cronbach's alphas for the entire tool and subcategories were over .853 and stability of the scale was confirmed. There were significant differences in nursing competence according to the 5 levels of the ladder. Conclusion: The findings indicate that the proposed CLS model with a standard score for nursing competence, recommended or obligatory criteria for qualifications and professional activities provides a good tool for developing nurses' competences and retaining excellent nurses in clinical practice.