• Journal of Oriental Neuropsychiatry
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• v.26 no.3
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• pp.225-234
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• 2015

Objectives: We aimed to evaluate the use of Korean medicine in patients with dizziness or vertigo, since such study has not been performed previously. Methods: In the current study, we included 3 diagnoses i.e., Disorders of vestibular function (H81), Vertiginous syndromes in diseases classified elsewhere (H82), and Dizziness and giddiness (R42) from the Health Insurance Review and Assessment Service (HIRAS) database for 4 years. We analyzed the database and compared treatment with Korean vs. Western medicine. Results: 1. Korean medical visits and cost have been increasing for 4 years, except 2011. Western medical visits are 11.9 times higher than Korean medical visits. 2. The number of women who received Korean medicine was 2.6 times higher than that of men. 3. Among all ages, the 70~79 years group were the most frequent users of Korean medicine. The older age was correlated with more patients' visits. 4. The comparative number of visits by patient care type for 4 years indicated that outpatients had more visits than hospitalization. Furthermore, outpatient visits have been increasing for 4 years. 5. The comparative number of visits by hospital type for 4 years indicated that visits to the Korean medical clinic were the highest. In primary care, patients used more Korean medicine than Western medicine. In tertiary care, patients used more Western medicine than Korean medicine. 6. Korean medical cost per patient by patient care type for 4 years was a total 89,000 won, hospitalization 449,000 won and outpatient 83,000 won. Costs of all patient care types have been increasing. 7. Korean medical cost per patient by hospital type for 4 years was 156,000 won for Korean medical hospital, 83,000 won for local clinic and 127,000 won for miscellaneous facilities. Costs of all types have been increasing. Conclusions: This study provided objective information about epidemiologic characteristics of Korean medicine in patients with dizziness or vertigo. Furthermore, it provides an understanding of the recent status and forms the basis for further expansion of demand for Korean medicine among patients with dizziness or vertigo.

• Journal of Hospice and Palliative Care
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• v.20 no.2
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• pp.93-99
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• 2017

Purpose: This study investigated changes in life-sustaining treatments in terminally ill cancer patients after consenting to a do-not-resuscitate (DNR) order. Methods: Electronic medical records were reviewed to select terminally ill cancer patients who were treated at the oncology unit of the Asan Medical Center, a tertiary hospital in South Korea and died between January 1, 2013 and December 31, 2013. Results: The median (range) age of the 200 patients was 59 (22~89) years, and 62% (124 persons) were male. Among all patients, 83.5% were aware of their medical condition, and 47.0% of the patients had their DNR order signed by their spouses. The median of the patients' hospital stay was 15 days, and time from admission to DNR decision was 10 days. After signing a DNR order, 35.7~100% of the life-sustaining treatments that had been provided at the time of the DNR decision making were administered. The most commonly discontinued interventions were transfusion (13.5%), blood test (11.5%) and parenteral nutrition (8.5%). Conclusion: It is necessary to define the scope of life-sustaining treatments for DNR patients. Treatment guidelines should be established as well to secure terminal patients' death with dignity after their consent to a DNR order, thereby avoiding meaningless life-sustaining treatments and allowing administration of active terminal care interventions.

• Journal of Korean Society of Environmental Engineers
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• v.33 no.2
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• pp.120-131
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• 2011

A pilot-scale experiment of floodplain filtration with a filtration depth of 3.6m was performed employing flood/rest type raw-water supply system in an effort to find ways to improve river water quality by additional treatments of discharged effluent from sewage treatment plant. Soil samples were taken from 3 sites including Gumi, Daegu and Gimhae along the Nakdong river. Reductions of infiltration rates following increases in operating time was investigated in each soil sample, along with the analysis of removal efficiencies of various pollutants according to different depths and infiltration rates. The results show incremental development of clogging on the soil surface with increases in operation time, and illustrate exponential decrease in the infiltration rate. The time required for the removal of the clog from the soil surface was longer than 2 weeks for all soil samples analyzed. The stable infiltration rates for soils were 5 m/day for Gumi and for Daegu and Gimhae was 1 m/day. In unsaturated soils dissolved oxygen levels increased following the increase of filtration depth, suggesting that alternating application of flood and rest for raw-water supply effectively keeps the soil environment aerobic. For all soils, the nature of pollutant removal depending on the depth of filtration remained the same regardless of the infiltration rate. Most of the BOD and turbidity were removed within 1.2 m, about 30% of COD was removed within 3.6m and was expected to be removed further with increases in filtration depth. Nitrification occurred near the surface of all soils; however there was no significant removal of nitrogen in the filtration depths tested in this study. Although removal rate of phosphorus was low for Gumi's soil, it was high enough for other soils, suggesting that the method developed in this study could significantly improve river water quality.

• Journal of Preventive Medicine and Public Health
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• v.26 no.3 s.43
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• pp.400-411
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• 1993

The aim of this study is to analyze the variations among hospitals and hospital groups in resource use and procedures of diagnostic and therapeutic process, such as laboratory tests, radiologic examinations, tissue diagnosis, timing of surgery after admission, the time required for operation. The study was performed for five procedures including cesarean section (C/S), appendectomy, cholecystectomy, cataract extraction, and pediatric pneumonia. The 2,316 subjects were selected from medical insurance claims list, and from this list 413 cases were sampled for medical record review. The patterns of resource utilization and process of treatment were described according to hospitals and characteristics of hospital groups. The major results were as follows : 1. The numbers of laboratory and radiologic tests showed significant difference among hospitals and hospital groups. In case of hospital groups, we could find tendencies of more tests with increasing hospital bed size. 2. In general, the proportion of operative cases evaluated by tissue diagnosis postoperatively among all operations ranged from 28.3% to 100%. The proportion varied among hospital groups, of which general hospital A group(more than 15 specialty) showed the highest proportion. 3. Post-admission delay until operation and the time required for operative procedure were not invariable among hospitals and hospital groups. The duration of operation in tertiary hospitals was slightly shorter than general hospitals, with varying statistical significance. We could find that probably there were differences of quality among hospitals in some components of procedures, which suggested that the implementation of quality assurance activities would be mandatory. In this study, we simply described the patterns of resource utilization and some features of clinical process, with institution of the need for advanced studies with in-depth analyses for each component of diagnosis and treatment procedures.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.113-118
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• 2010

Purpose: Prolonged stay in the emergency department (ED), which is closely related with the time interval from the ED visit to a decision to admit, might be associated with poor outcomes for trauma patients and with overcrowding of the ED. Therefore, we examined the factors affecting the delay in the decision to admit severe trauma patients. Also, a multidisciplinary department system was preliminarily evaluated to see if it could reduce the time from triage to the admission decision. Methods: A retrospective observational study was conducted at a tertiary care university hospital without a specialized trauma team or specialized trauma surgeons from January 2009 to March 2010. Severe trauma patients with an International Classification of Disease Based Injury Severity Score (ICISS) below 0.9 were included. A multivariable logistic regression analysis was used to find independent variables associated with a delay in the decision for admission which was defined as the time interval between ED arrival and admission decision exceeded 4 hours. We also simulated the time from triage to the decision for admission by a multidisciplinary department system. Results: A total of 89 patients were enrolled. The average time from triage to the admission decision was $5.2{\pm}7.1$ hours and the average length of the ED stay was $9.0{\pm}11.5$ hours. The rate of decision delay for admission was 31.5%. A multivariable regression analysis revealed that multiple trauma (odds ratio [OR]: 30.6, 95%; confidence interval [CI]: 3.18-294.71), emergency operation (OR: 0.55, 95%; CI: 0.01-0.96), and treatment in the Department of Neurosurgery (OR: 0.07, 95%; CI: 0.01-0.78) were significantly associated with the decision delay. In a simulation based on a multidisciplinary department system, the virtual time from triage to admission decision was $2.1{\pm}1.5$ hours. Conclusion: In the ED, patients with severe trauma, multiple trauma was a significant factor causing a delay in the admission decision. On the other hand, emergency operation and treatment in Department of Neurosurgery were negatively associated with the delay. The simulated time from triage to the decision for admission by a multidisciplinary department system was 3 hours shorter than the real one.

• Journal of Korean Society on Water Environment
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• v.28 no.5
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• pp.729-742
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• 2012

Recently, to using chemical coagulation process for T-P removal in STP effluent as tertiary treatment process is generalized in the country. The importance of analysis technique to save the treatment & maintenance cost during coagulation process is becoming more increased each day. Thus, it is necessary for the analysis technique during coagulation process to be presented well the characteristic of coagulation in field apply. There are a few analysis techniques such as Jar Test, zeta potential analysis and streaming current detecting techniques. But there are difficult to apply in field immediately due to long test time and difficult analysis techniques. And using PDA technique, it is reviewed applicability of the techniques as field index on pilot plant of P-CAP system The P-CAP system is composed of an in-line static mixer, a Flocculation Tank and the CAP reactor with 2 stage weir for effluent. Pre-test is performed to fix the mixing velocity in the Flocculation Tank using the PDA equipment and it fixed with 30RPM. Also, Jar Test is performed to select optimum dose of each coagulant for each T-P concentration level of influent. Result of continuous test on pilot plant of P-CAP system, the FSI in the Flocculation Tank is increased consistently by increasing each dosing concentration of coagulant such as LAS and PAC in the low level influent T-P concentration comparatively. It is considered that formed Al-hydroxide complexes for dosed coagulant are caused FSI variation. Furthermore, it seems that FSI value in the high level influent T-P concentration appeared lower than the opposite influent condition relatively because it is formed simultaneously Al-hydroxide complexes as solid type and Al-phosphorus complexes as soluble type. Thus, relation of FSI by PDA technique and T-P removal of final effluent on pilot plant of P-CAP system are very limited for the kind of coagulant and the characteristics of influent. And it though that FSI value by PDA technique with analyzing of turbidity in Flocculation Tank will be used restrictedly on field as the relative field-index.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.31 no.1
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• pp.19-26
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• 2020

Background and Objective Endoscopic airway dilation is the primary treatment for pediatric subglottic stenosis (SGS) due to its feasibility and non-invasiveness. The aim of this study is to evaluate the risk factors for the failure of endoscopic airway dilation in pediatric patients with SGS. Materials and Methods This study reviewed medical records of 38 pediatric patients had endoscopic dilation from a single and tertiary referral center, retrospectively. The success of the endoscopic dilation procedure was defined as no dyspneic symptom without tracheostomy or laryngotracheal reconstruction. Demographic profiles, underlying disease, and Myer-Cotton SGS severity grade were recorded. Success rates and risk factors for the failure of treatment were analyzed. Results The SGS patients with severity grade I was most common. After mean 1.8 numbers of procedures, there were 23 patients (60.5%) in the success group and 15 patients (39.5%) in the failure group. Age, sex, underlying diseases, and SGS severity grade were not significantly different between two groups. In patients who had multiple endoscopic procedures, the failure group showed SGS deteriorated after procedures in 66.7%, compared to 11.1% of the success group. In multivariable analysis, a long-term intubation (≥1 month) was identified as an independent risk factor for failure of endoscopic dilation procedure. Conclusion Although endoscopic dilation procedure is safe and effective for the management, repetitive endoscopic dilation may not give clinical benefit in patient with long-term intubation. Other airway procedures must be considered in those group of patients.

• Journal of the Korean Society of Radiology
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• v.12 no.7
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• pp.869-877
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• 2018

This study analyzed the current status of MRI (frequency, amount of treatment) based on the history of application of the MRI health insurance benefit standard and health insurance claim data. MRI examinations began as a health insurance benefit in 2005. In 2005, the indications were restricted for some diseases, but coverage for benefits in 2010, 2013, 2016, and 2018 was expanded. In 2021, the Ministry of Health and Welfare decided to apply health insurance for all MRI examinations. From 2010 to 2017, the number of MRI examinations increased by 86.7% in 2017 compared to 2010, and the amount of treatment increased by 53.5%. According to general characteristics, the number of MRI examinations was higher in women than in men. By age, the number of examinations was the highest among ages 70-79. Outpatient examinations were more frequent than inpatient examinations, and the number of examinations in the tertiary hospitals was the highest among the types of hospitals. The number of brain MRI examinations was the highest in each exam site. In December 2013, the standard of MRI was expanded for heart disease and Crohn's disease, the number of cardiac MRI and abdominal MRI examinations increased in 2014 compared to 2013. However, the number of examinations is small and not associate with the disease, it would be difficult to say that it affected the increase in the total number of MRI examinations. To assess health insurance sustainability and policy effectiveness, monitoring will be necessary.

• Clinical and Experimental Otorhinolaryngology
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• v.11 no.4
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• pp.293-300
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• 2018

Objectives. The current study aims to determine the correlation between nutritional status upon presentation and disease severity, as well as treatment and survival outcomes. Methods. Patients who were diagnosed with deep neck infection, underwent at least one surgical drainage/debridement, and had more than 1 week of hospitalization at a tertiary medical center from 2007 to 2015 were retrospectively included. Thereafter, initial serum albumin, C-reactive protein (CRP), and body mass index (BMI) were reviewed. Results. A total of 135 patients were included in the final analysis. Accordingly, the proportion of patients with simultaneous mediastinitis (21.0%), necrotizing fasciitis (12.9%), disease extent >1 cervical level (72.6%), mean CRP (22.4 mg/dL), mean length of hospitalization (25.0 days), and mean 1-week follow-up CRP (7.2 mg/dL) was significantly higher in the hypoalbuminemia group (initial serum albumin <3.0 g/dL) than in the normoalbuminemia group (all P<0.05). No significant correlations had been observed according to BMI status. After adjusting for age and Charlson comorbidity index, odds ratios for the following outcomes were calculated in patients initially presenting with hypoalbuminemia: simultaneous mediastinitis (3.07), necrotizing fasciitis (7.89), disease extent >1 cervical level (2.12), initial serum CRP over 20 mg/dL (3.79), hospitalization of more than 14 days (4.10), 1-week follow-up CRP over 5 mg/dL (3.78), and increased duration for an over 50% decrease in initial CRP (2.70) (all P<0.05). Although intravascular albumin replenishment decreased the proportion of patients with hypoalbuminemia after 2 weeks (P<0.05), it did not significantly predict better treatment outcomes. Conclusion. Among the markers reflecting an individual's nutritional state, an initial serum albumin of less than 3.0 g/dL was an independent serologic marker predicting increased disease severity and complications in patients with deep neck infection.

• KSCE Journal of Civil and Environmental Engineering Research
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• v.42 no.4
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• pp.481-491
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• 2022

This study investigates the characteristics of the GAC adsorption behavior during the operation of a multi-stage cross-flow filtration and GAC adsorption process for the purpose of devising an advanced treatment of combined sewer overflows (CSOs) and evaluates the regeneration efficiency of spent GAC that has reached the design breakpoint. During the filtration process, suspended substances are easily removed, but dissolved organic substances are not removed, necessitating a process capable of removing dissolved organic substances for the advanced treatment of CSOs. In general, GAC adsorption has been applied under low-concentration organic conditions, such as for water purification and tertiary treatments of sewage, and has rarely been applied under conditions with high organic concentrations, such as with sewage or CSOs. Accordingly, this study will provide a new and interesting experience. Also in this study, the continuous operation and breakthrough characteristics of GAC according to the strength of the inflow organic matter were investigated, electrochemical regeneration was applied to the used GAC, and the regeneration efficiency was evaluated through desorption and re-adsorption tests. The results showed that the breakthrough period was 21 days under high concentration conditions, 28 days at medium concentrations, and 32 days under low concentration conditions. The desorption of adsorbed organic matter through electrolysis occurred in the range of 188 to 609 mgCOD/L depending on the electrolysis conditions, and the effect of the electrolyte type led to the finding that NaOH was slightly higher than H₂O₂.