• Journal of Preventive Medicine and Public Health
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• 제24권4호
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• pp.485-495
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• 1991

This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.

• The Korean Journal of Pain
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• 제35권3호
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• pp.303-310
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• 2022

Background: Open gastrectomy causes severe postoperative pain. Therefore, we investigated the opioid-sparing effect of the ultrasound-guided bilateral erector spinae plane block (ESPB) after open gastrectomy. Methods: Adult patients undergoing open gastrectomy were randomly assigned to either the ESPB group (ESPB + fentanyl based intravenous patient-controlled analgesia [IV-PCA]) or a control group (fentanyl based IV-PCA only). The primary outcome was total fentanyl equivalent consumption during the first 24 hour postoperatively. Secondary outcomes were pain intensities using a numeric rating scale at the post-anesthesia care unit (PACU) and at 3, 6, 12, and 24 hour postoperatively, and the amount of fentanyl equivalent consumption during the PACU stay and at 3, 6, and 12 hour postoperatively, and the time to the first request for rescue analgesia. Results: Fifty-eight patients were included in the analysis. There was no significant difference in total fentanyl equivalent consumption during the first 24 hour postoperatively between the two groups (P = 0.471). Pain intensities were not significantly different between the groups except during the PACU stay and 3 hour postoperatively (P < 0.001, for both). Time to the first rescue analgesia in the ward was longer in the ESPB group than the control group (P = 0.045). Conclusions: Ultrasound-guided ESPB did not decrease total fentanyl equivalent consumption during the first 24 hour after open gastrectomy. It only reduced postoperative pain intensity until 3 hour postoperatively compared with the control group. Ultrasound-guided single-shot ESPB cannot provide an efficient opioid-sparing effect after open gastrectomy.

• 한국콘텐츠학회논문지
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• 제17권2호
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• pp.637-645
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• 2017

본 연구는 매점이용과 구강건강과의 관련성을 규명하기 위해 대구, 경북 28개의 고등학생들 280명의 매점이용에 따른 칫솔질 행태와 구강건강상태인식을 조사하여 다음과 같은 통계적 유의성이 있는 결과를 얻었다. 식사 및 간식 후 칫솔질은 여학생, 3학년에서 높았다. 칫솔질 후 10번 이상 입헹굼은 여학생, 자가용, 구강보조용품을 사용하는 경우는 여학생, 3학년, 자가용에서 높게 평가되었다. 매점이용 빈도 전체 평균은 2.26이며 구강건강상태인식은 3.44이다. 매점이용 빈도는 2학년, 등교시간 오전 8시 이전, 용돈은 많을수록 높았다. 구강건강상태인식은 남학생, 통학버스, 용돈은 많을수록 높았다. 칫솔질행태에 따른 매점이용 빈도는 3분 이상 칫솔질 시간에서 2.45로 높았고, 구강건강상태인식은 구강보조용품을 사용할 경우 3.32로 높았다. 구강건강상태인식, 일반적인 특징, 칫솔질행태가 매점이용 빈도에 미치는 영향을 알아보기 위한 다중회귀분석 결과 Y(매점이용 빈도)= -952 + .393(구강건강상태인식) - 1.721(등교시간) + .991(용돈) + 1.124(칫솔질 시간)으로 분석되었다. 이상의 결과를 바탕으로 학교 내 올바른 구강보건관리 교육이 지속적으로 이루어져 이를 꾸준히 실천할 수 있는 교육적인 시스템이 구축되어야 할 것이다.

• Journal of Hospice and Palliative Care
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• 제23권1호
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• pp.5-10
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• 2020

Purpose: The aim of this study was to investigate celiac plexus neurolysis (CPN) for the treatment of cancerous upper abdominal pain in a tertiary university hospital in Korea. Methods: At the tertiary university hospital in Korea, electronic medical records of cancer patients who underwent CPN and died in the hospital from November 2009 to June 2018 were retrospectively analyzed. Results: The total number of subjects was 51. The 17 patients were from the Department of Gastroenterology (33.0%), followed by 11 patients from the Department of Hemato-oncology (21.6%), 11 patients from the Department of Anesthesia and Pain Medicine (21.6%), 9 patients from the Department of General Surgery (17.6%). The diagnosis was pancreatic cancer in 15 patients (29.4%), stomach cancer in 8 patients (15.7%), hepatobiliary cancer in 20 patients (39.2%), colon cancer in 1 patient (2.0%), esophageal cancer in 2 patient (3.9%) and intra-abdominal metastasis in 5 patients (9.8%). The mean survival time after the surgery was 66.4±55.0 days. The pain intensity before and 1 week after the procedure significantly decreased, but the amounts of opioids consumed before and 1 week after the procedure were not statistically significant. Side effects occurred after the procedure including temporary localized pain in 24 patients (47.0%), hypotension in 12 (23.5%), and diarrhea in 6 (11.8%). Conclusion: CPN is an effective and safe procedure for reducing upper abdominal pain caused by cancer, and it is necessary to perform CPN within the appropriate time by establishing a system of interdepartmental cooperation.

• 한국치위생학회지
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• 제8권1호
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• pp.107-118
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• 2008

The purpose of this study was to transfer the knowledge of oral health care and to improve the oral health after the effective education of oral health behavior. The survey is conducted for 484 middle and high school students in Busan and Gyeongnam province about the oral health behavior, the cause and the preventive of oral diseases and oral health education experience by the self-answering method. The date was analysed using the SPSS 13.0 program. The obtained result were as follows. 1. 38.8% students in middle school have been to the dentist within one year and the reason is the dental care that is to 61.7% in the case of the high school students. 2. For the daily toothbrushing frequency. above 3 times is highest to 57.9% in middle school students and 2 times 59.9% in high school students. 3. 45.9% and 45.0% students in middle and high school have the regular dental check-ups to prevent the dental caries and periodontal disease with greatest portion. 4. 35.7% respondents had experienced oral health education. 48% of them got the education from the dental clinics. 82.2% of the education method is a theory and the contents is toothbrushing method with 58.7% portion. 5. 86% respondents of middle school students answered that regular oral health education is necessary and 78.1% students are willing to participate in the oral health education. The results of this study propose that the regular dental check-ups for middle and high school students enable them have early medical treatment and protection against oral disease. Also for the effective oral health education, those program and various media should be developed systematically to enhance the students' motive for oral health.

• 대한신경집중치료학회지
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• 제11권2호
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• pp.102-109
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• 2018

Background: A sians were known to have a relatively lower incidence of venous thromboembolism (VTE), and there is insufficient evidence to suggest a specific D-dimer threshold level for screening VTE in patients with acute stroke. Methods: We prospectively enrolled patients with acute ischemic stroke admitted to Jeju National University Hospital. The inclusion criteria were: 1) aged ${\geq}18$ years, 2) admission within seven days of symptom onset, and 3) an initial National Institute of Health Stroke Scale (NIHSS) score >1 for the affected lower limb. Ultrasound scans of the lower limbs and plasma D-dimer assays were performed on days 7-14 and 15-28 after stroke onset. Results: Of 285 patients admitted during the study period, 52 patients met inclusion criteria (mean age 74.5, male 40.4%, median initial NIHSS score 12, and unable to walk unassisted at discharge 76.9%). During 7-14 days, 23 of 52 patients (44.2%) had a D-dimer level above 1.57 mg/L, and 9.6% had a level above 5.50 mg/L. Proximal deep vein thrombosis (DVT) was detected in 3 patients (5.8%, 95% confidence Interval 1.2-16.0%) on ultrasound examination. All DVTs were found in elderly female patients with severe leg weakness. No patient was diagnosed with pulmonary embolism during the study period. Conclusion: The incidence of VTE seems to be very low among Korean patients with acute ischemic stroke. Advanced age, female sex, and severe leg weakness were important risk factors for developing DVT in this study.

• Journal of Trauma and Injury
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• 제18권2호
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• pp.161-171
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• 2005

Background: The management of hepatic injuries has changed dramatically during the past two decade after the technologic breakthroughs in radiologic imaging techniques. Recently, the non-operative management of blunt hepatic trauma has become the standard of care in hemodynamically stable patients. We reviewed our experience of the non-operative management of blunt hepatic trauma. And the purpose of this study was to examine the prognostic factors and indicators affecting the decision for treatment modality of emergent hepatic trauma. Methods: The medical records of 84 patients who were treated for blunt hepatic injury at Masan Samsung Hospital from January 2002 to December 2003. The patients were divided two groups, non-operative(Non-OP) and operative(OP), according to the treatment modality. The two groups were compares for age, sex, mechanism of injury, grade of liver injury scale, combined injury, systolic blood pressure, pulse rate, hemoglobin, hematocrit, WBC count, S-GOT, S-GPT, ALP, transfusion amount during initial 24 hours, amount of infused crystalloid fluid, length of ICU stay, length of ward care, morbidity and mortality. The grade of the liver injury were determined by using the organ injury scale(OSI). Results: Among the 84 patients, 46 cases(54.8%) were managed non-surgically, and 3 cases of Non-OP group were treated by transarterial embolization. Between the two groups, there were significant difference in age, injury grade, combined injury, hemoglobin, hematocrit, initial systolic blood pressure, amount of infused crystalloid fluid, amount of transfusion during the first 24 hours, and length of ICU care, morbidity and mortality.(p<0.05) The overall mortality rate was 8.3%, but 2.2% mortality in the non-operative group. Conclusion: Non-operative management may be considered as a first choice in hemodynamic stable patients with blunt liver trauma. The reliable indicators affecting the treatment modality of blunt hepatic trauma were systolic BP, Hb, Hct, amount of infused crystalloid fluid, amount of transfusion during the first 24 hours, liver injury grade and combined injury. Strict selection of treatment madality and aggresive monitoring with intensive care unit were more important.

• 한국치위생학회지
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• 제15권4호
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• pp.705-711
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• 2015

Objectives: The purpose of the study is to evaluate the effect of continuing dental care program by elementary school dental clinic in Gimcheon from 2008 to 2013. Methods: The subjects were experimental group of 152 students from three elementary schools having dental clinics and control group of 136 students from three elementary schools of no dental clinics. The six dentists in Gimcheon community health center carried out the regular dental checkups in the elementary schools and four dental hygienists recorded the dental examination results. After receiving WHO dental survey guideline education, the examiners used dental mirror and dental probe under the natural light. The contents of the survey included dental caries in the deciduous and permanent teeth, malocclusion, remaining ratio of sealant, treatment, and follow up. Results: DFT index by grade showed that 3.71 in experimental group and 4.56 in control group and it was remarkable in the 3rd grade. Thus. DFT index in the experimental group was lower than that of control group (p<0.05). DT index by grade was 0.63 in experimental group and 1.28 in control group marked in the 6th grade. DT index in the control group was higher than that of the experimental group (p<0,001). DFT index and DMFT Index by grade showed no significant difference between the control group and the experimental group. DFT and DMFT Index of the control group in the 3rd and 6th grade were lower score than those of experimental group. DFT and DMFT index in the third and 6th grade showed no significant difference between the control group and the experimental group. The remaining ratio of the sealant was 4.89 experimental group in the 6th grade. The remaining ratio of the sealant in the experimental group was higher than that in the control group. Conclusions: The continuing dental care program in the elementary school is very effective method in the treatment of oral disease in the elementary school children. The oral health care and prevention for the elementary school children should be implemented and carried out continuously.

• Journal of Hospice and Palliative Care
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• 제19권3호
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• pp.222-232
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• 2016

목적: 본 연구는 고등학생을 대상으로 영적안녕, 죽음에 대한 태도, 호스피스 인식 간의 상관관계를 파악하고, 호스피스 인식에 영향을 미치는 요인을 규명하고자 한다. 방법: 대상자는 B 광역시에 소재한 고등학교인 실업계(남자, 여자) 2곳, 인문계(남자, 여자) 2곳에 재학 중인 1, 2학년 학생 229명이었고, 자료수집 기간은 2015년 5월 1일부터 동년 5월 31일까지였다. 자료는 SPSS Win 18.0 program을 이용하여 기술통계, t-test, ANOVA, Pearsion correlation coefficients, Stepwise multiple regression으로 데이터를 분석하였다. 결과: 고등학생의 호스피스 인식은 성별(t=-3.377, P=0.001), 주관적 건강상태(t=3.334, P=0.001), 주관적 학교생활만족도(t=3.233, P=0.001), 부직업(t=2.393, P=0.018), 호스피스 사전인지경험(t=-7.181, P<0.001), 호스피스, 죽음 관련 교육경험(t=-2.120, P=0.035)에 따라 유의한 차이가 있었다. 사후 내 몸에 대한 태도와 죽음준비에 대한 태도가 긍정적일수록 호스피스 인식에 대한 태도가 긍정적이었다. 호스피스 인식에 영향을 미치는 주요 요인은 호스피스 사전 인지 경험, 죽음준비에 대한 태도, 주관적 학교생활 만족도, 성별로 총 설명력은 34.5%였다. 결론: 고등학생의 호스피스 인식을 증진하기 위해서는 죽음준비에 대한 태도와 호스피스에 대한 인지를 높여줄 수 있는 좋은 죽음 및 호스피스 교육프로그램 개발과 시행이 필요하다고 본다.

• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.799-807
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• 2021

Objective : Cerebrospinal fluid leakage related complications (CLC) occasionally occur after intradural spinal surgery. We sought to investigate the effectiveness of early ambulation after intradural spinal surgery and analyze the risk factors for CLC. Methods : For this retrospective cohort study, we enrolled 314 patients who underwent intradural spinal surgery at a single institution. The early group contained 79 patients who started ambulation after 1 day of bedrest without position restrictions, while the late group consisted of 235 patients who started ambulation after at least 3 days of bed rest and were limited to the prone position after surgery. In the early group, Prolene 6-0 was used as the dura suture material, while black silk 5-0 was used as the dura suture material in the late group. Results : The overall incidence rate of CLC was 10.8%. Significant differences between the early and late groups were identified in the rate of CLC (2.5% vs. 13.6%), surgical repair required (1.3% vs. 7.7%), and length of hospital stay (2.99 vs. 9.29 days) (p<0.05). Logistic regression analysis revealed that CLC was associated with practices specific to the late group (p=0.011) and the revision surgery (p=0.022). Conclusion : Using Prolene 6-0 as a dura suture material for intradural spinal surgery resulted in lower CLC rates compared to black silk 5-0 sutures despite a shorter bed rest period. Our findings revealed that suture - needle ratio related to dura defect was the most critical factor for CLC. One-day ambulation after primary dura closure using Prolene 6-0 sutures appears to be a costeffective and safe strategy for intradural spinal surgery.