• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.4
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• pp.408-417
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• 2017

This study was conducted to examine the influence of the nurse staffing level on the level of in-hospital death and infection in cancer patients who received surgery. Secondary data were used and the subjects of this study were 24,510 patients who received surgery for six types of cancer with a high postoperative mortality rate in the first half of 2012 at 260 hospitals. Simple logistic and GEE multiple logistic regression analyses were used. After adjusting for the patient and hospital characteristics, a greater likelihood of dying was found in the nurse staffing level 2-3 group (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.00-2.11) and in the level 6-7 group (OR, 3.28; 95% CI, 1.87-5.74) compared to the level 0-1 group. The likelihood of in-hospital infection increased with each additional bed per nurse, being 6.63 times higher (95% CI, 3.00-14.62) in the level 2-3 group, 5.79 times higher (95% CI, 1.88-17.78) in the level 4-5 group, and 8.4 times higher (95% CI, 1.82-38.84) in the level 6-7 group, as compared to the level 0-1 group. A lower nurse staffing level was associated with higher in-hospital death and infection levels. This shows that an appropriate nurse staffing level is associated with superior postoperative cancer patient outcomes. Policies for providing adequate nurse staffing should be maintained for the sake of ensuring improved care quality and patient safety.

• Applied Chemistry for Engineering
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• v.22 no.4
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• pp.429-432
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• 2011

The feasibility of applications of the char obtained from a gasification process of municipal-waste refuse derived fuel (RDF) as an auxiliary fuel was evaluated by combustion experiments. The higher heating value of the RDF char was 3000~4000 kcal/kg and its chlorine content was below the standard requirement demonstrating its potential as an auxiliary fuel. In the combustion exhaust gas, the maximum $NO_x$ and $SO_2$ concentrations were 240 ppm and 223 ppm, respectively. If an aftertreatment is applied, it is possible to control their concentrations low enough to meet the air pollutant emission standard. The HCl concentration was relatively high indicating that a care should be taken for HCl emission from the combustion of RDF. Based on the temperature distribution within the reactor, the concentration change of $O_2$ and $CO_2$, and the amount and the loss on ignition of solid residue, it was inferred that the combustion reaction was the most reliable when the excess air ratio of 1.3 was used.

• Korean Circulation Journal
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• v.53 no.3
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• pp.170-184
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• 2023

Background and Objectives: Several cases involving severe right ventricular (RV) failure in advanced cancer patients have been found to be pulmonary tumor thrombotic microangiopathies (PTTMs). This study aimed to discover the nature of rapid RV failure syndrome with a suspected diagnosis of PTTM for better diagnosis, treatment, and prognosis prediction in clinical practice. Methods: From 2011 to 2021, all patients with clinically suspected PTTM were derived from the one tertiary cancer hospital with more than 2000 in-hospital bed. Results: A total of 28 cases of clinically suspected PTTM with one biopsy confirmed case were included. The most common cancer types were breast (9/28, 32%) and the most common tissue type was adenocarcinoma (22/26, 85%). The time interval from dyspnea New York Heart Association (NYHA) Grade 2, 3, 4 to death, thrombocytopenia to death, desaturation to death, admission to death, RV failure to death, cardiogenic shock to death were 33.5 days, 14.5 days, 7.4 days, 6.4 days, 6.1 days, 6.0 days, 3.8 days and 1.2 days, respectively. The NYHA Grade 4 to death time was 7 days longer in those who received chemotherapy (7.1 days vs. 13.8 days, p value=0.030). However, anticoagulation, vasopressors or intensive care could not change clinical course. Conclusions: Rapid RV failure syndrome with a suspected diagnosis of PTTM showed a rapid progressive course from symptom onset to death. Although chemotherapy was effective, increased life survival was negligible, and treatments other than chemotherapy did not help to improve the patient's prognosis.

• Journal of Home Health Care Nursing
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• v.5
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• pp.84-99
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• 1998

The objectives of this study are to identify the actual educational contents of management for head nurse and to propose the educational subjects according to identity the needs of head, charge, and staff nurses. The subjects were investigated the actual Management Development Programs and educational needs of head nurses and prospective nurse manager(charge nurse, staff nurse with a lot of clinical experiences) in general hospitals. The tools were composed of two questionnaires: One was developed from the literature review for making items to measure actual situation. The other was revised Katz's model for measurement of educational needs. The first respondents of actual situation were 27 general hospitals with over 400 beds in Seoul and the second respondents were 89 head nurses, 67 charge nurses and 136 nurses at 3 hospitals by convenient sampling out of 27 general hospitals. Data were collected by telephone interview, mail questionnaire and visiting from 7th of October through 30th of November in 1997. In data analysis, general characteristics of the respondents and actual status of Management Development Programs were analyzed by frequency and percentage. Educational needs according to general characteristics were analyzed by ANOVA The results were as follows: 1. Actual situation of Management Development Program 1) Seven hospitals(26%) had Management Development Program for prospective managers and 14 hospitals (52%) for head nurses. 2) Education Department existed in 14 hospitals (52%). 3) One hospital(4%) had top level managers took part in the Management Development. 4) Two hospitals selected head nurse, who had finished courses of Management Development. Eight hospitals(30%) assessed educational needs. The assessment tools consisted of making a question via questionnaire(75%), determining at department meeting(12%) and interview(13%). 5) Educational programs had 3 types: 10 lecture type, 7 discussion type and 4 role play type programs. 6) One hospital evaluated the change of learner's attitude. 7) Four hospitals scored educational point, but that was measured only by attending. 8) Actual Management Development Programs were as follows. parenthesis indicates the number of hospitals. (1) Management Development Programs for Prospective manager. Role perception of Middle level Manager (1) . Role reconstruction of Nurse Manager (1). Workshop for Charge Nurse (1). Nursing Delivery System and Nursing Process (1). Communication (1). Motivation (1) (2) Management Development Programs for Head nurse.. Head nurse's Role (5). Administrative Work (7). Service Education (4). Prevention and Countermeasure of Nursing Incidence (3). Appraisal (3) 2. The results of needs on Management Development subject 1) The educational needs of all respondents on 3 skill domains showed positive agreement to strongly positive agreement. 2) High priority(more than 4.5) items were 12 of 24 Human skill items(50%), 1 of 6 Technical skill items(16%), and 2 of 13 Conceptual skill items (15%). 3) Out of high priority items, 8 items were instituted. 4) All respondents showed high needs on 3 skill domains regardless of 3 positions (head nurse, charge nurse, and nurse). Educational needs of Human skill domain, according to position were 108. S, 108.7, 106.8 (mean score = 72) , needs of Technical skill domain were 26.5, 26.6, 26.I(mean score=18), and needs of Conceptual skill domains were 56.9,56.7, 55.1(mean score=39). 5) Needs of 3 skill domains according to clinical career showed significant difference. Out of respondents, nurses with career of over 16years showed lowest degree of needs in Human skill domains(F=4.47, P=.004) and Conceptual skill domain(F=2.93, P=.034). 6) Educational needs according to educational background were not significant difference. But out of respondents, nurses educated at 3-year junior college relatively showed lowest needs in all of the 3 skill domains. With the above-mentioned findings, further study is necessary for generalization of this study at hospitals with different bed size and location. Also it is needed to study about management skill of nurse and charge nurse, and effective educational method.

• Journal of Korean Academy of Nursing
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• v.23 no.3
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• pp.467-486
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• 1993

Today, more chronically ill and handicapped people are being cared for at home by a family member caregiver. The task of caring for a family momber may mean that the caregiver has less time and money and more work which may result in increased fatigue and symptoms of illness. This study was done to examine the well-being of family caregivers. Fifty three family caregivers were interviewed. Concepts were measured using existing tools and included : Burden(25 item 5 point scale), Social sup-port (21 item 7 point scale), Health status defined by a symptom checklist(48 item S point scale), and Well -being defined by a quality of life scale (14 item 7 point scale) and caregiving activities. Data collection was done by interview and Q-sort. Social support and well - being were positively correlated as were symptoms and burden. Symptoms and burden were negatively correlated with social support and well-being. Items on the quality of life scale had a mean score range from 3.09 to 4.96. Quality of life related to income was lowest (3.09) but the desire to use more money for the patient was rated 2.90 on the burden scale where the item means ranged from 0.73 to 3.55. The high mean of 3.55 was for obligation to give care and the low 0.73 was (or not feeling that this was helping the patient. Mean scores for symptoms ranged from 0.26 to 2.15 with the 2.15 being for “worry about all the things that have to be done.” Over half of the patients were dependent for help with some activities of daily living. The caregivers reported doing an average of 3.40 out of five patient care activities including bathing (77.4%), shampooing (67.9%), and washing face and hands (49.1％), and 3.74 out of seven home maintenance activities including laundry (98.1％), cooking (83.0%), and arranging bed-ding(75.5%). The caregivers reported their spouse as one of the main sources of social support, including in times of loneliness and anger The mean score for loneliness as burden was 2.15 and ranked fourth and 31 (58.5％) of the sample reported being lonely recently and not being satisfied with the support received. Similarly anger caused by the patient was given a mean score of 2.13, and anger was reported to have been present recently by 38 (71.7%) of the sample and satis-faction with the support given was low. Having someone to help deal with anger ranked twelfth out of 21 items on the social support scale and had a mean score of 3.98 (range 3.49 to 5.98). Spouses were reported as a major source of social support but the fact that 50% of the caregivers were caring for a spouse, may account for the quality of this source of social support having been affected. These caregivers faced the same problems as others at the same stage of life. but because of the situation, there was a strain on their resources, particularly financial and social. In conclusion it was found that burden is correlated negatively to quality of life and positively to symptoms, but in this sample, symptoms and bur-den were scored relatively low. Does this indicate that the caregivers accept caregiving as part of their destiny and accept the quality of their lives with burden and symptoms just being a part of caregiving\ulcorner Does the correlation between the bur-den and symptoms indicate they are a measure of the same phenomenon or that the sample was of a more mobile, less burdened group of caregivers\ulcorner Quality of life was the one variable that was significant in explaining the varience on burden. Further study is needed to validate the conclusions found in this study but they indicate a need for nurses to ap-proach these caregivers with a plan tailored to each individual situation and to give consideration to interventions directed at improving quality of life and expanding social support networks for those caring for spouses.

• Health Policy and Management
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• v.11 no.2
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• pp.141-168
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• 2001

Healthcare service organizations can apply the cost of quality(COQ) model as a method to evaluate a service quality improvement project such as Total Quality Management (TQM). COQ model has been used to quantify and evaluate the efficiency and effectiveness of TQM project through estimation between cost and benefit in intervention for a quality Improvement to provide satisfied services for a customer, and to identify a non value added process. For estimating cost of quality, We used activities and activity costs based on Activity Based Costing(ABC) system. These procedures let the researchers know whether the process is value-added by each activity, and identify a process to require improvement in TQM project. Through the series of procedures, health care organizations are service organizations can identify a problem in their quality improvement programs, solve the problem, and improve their quality of care for their costumers with optimized cost. The study subject was a quality improvement program of the department of radiology department in a hospital with n bed sizes in Metropolitan Statistical Area (MSA). The principal source of data for developing the COQ model was total cases of retaking shots for diagnoses during five months period from December of the 1998 to April of the 1999 in the department. First of the procedures, for estimating activity based cost of the department of diagnostic radiology, the researchers analyzed total department health insurance claims to identify activities and activity costs using one year period health insurance claims from September of the 1998 to August of the 1999. COQ model in this study applied Simpson & Multher's COQ(SM's COQ) model, and SM's COQ model divided cost of quality into failure cost with external and internal failure cost, and evaluation/prevention cost. The researchers identified contents for cost of quality, defined activities and activity costs for each content with the SM's COQ model, and finally made the formula for estimating activity costs relating to implementing service quality improvement program. The results from the formula for estimating cost of quality were following: 1. The reasons for retaking shots were largely classified into technique, appliances, patients, quality management, non-appliances, doctors, and unclassified. These classifications by reasons were allocated into each office doing re-taking shots. Therefore, total retaking shots categorized by reasons and offices, the researchers identified internal and external failure costs based on these categories. 2. The researchers have developed cost of quality (COQ) model, identified activities by content for cost of quality, assessed activity driving factors and activity contribution rate, and calculated total cost by each content for cost for quality, except for activity cost. 3. According to estimation of cost of quality for retaking shots in department of diagnostic radiology, the failure cost was ￦35,880, evaluation/preventive cost was ￦72,521, two times as much as failure cost. The proportion between internal failure cost and external failure cost in failure cost is similar. The study cannot identify trends on input cost and quality improving in cost of qualify over the time, because the study employs cross-sectional design. Even with this limitation, results of this study are much meaningful. This study shows possibility to evaluate value on the process of TQM subjects using activities and activity costs by ABC system, and this study can objectively evaluate quality improvement program through quantitative comparing input costs with marginal benefits in quality improvement.

• Journal of the Korean Institute of Traditional Landscape Architecture
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• v.31 no.3
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• pp.61-74
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• 2013

This study examined and analyzed ancient writing and poetry regarding cases of appreciating plants by using pots in a garden of a palace or private houses by ancestors, and examined shape and planting method of plant species and potted plants, arrangement and preference of potted plants. As for the method of the study, description research method which examines and interprets poem and painting based on potted plants. The results of this study is summarized like the following. First, the plants which were favorably used for potted plants include 19 kinds such as Prunus mume, Pinus densiflora, Pinus pumila, Phyllostachys spp., Camellia japonica, Punica granatum, and Gardenia jasminoidesa, and as for herbs, 12 kinds such as Chrysanthemum monifolium and Nelumbo nusifera . Second, the species which were specially arranged into artificial shapes include Prunus mume and Pinus densiflora. The two plants made the shape of severe curves of stems such as Wangpi. Gyuban, and Bangan, and there are Pinus densiflora dwarfed potted plant whose roots are stretched on Prunus mume grafted into a strange stump and an oddly shaped stone. For the beauty of the dwarfed tree shape, pine cones are added to an old Pinus densiflora or Parthenocissus tricuspidata is planted to stems, and additional method of making moss on the soil, which is called 'Jongbunchuigyeong'. As for planting method, water culture, planting on a stone, planting on a charcoal, and assembled planting are expressed in poetry. Third, as for external space for potted plants, a place where a king stays, a bed room for a king, surrounding areas and gardens of private houses, and step stones were used as a space which adds artistic effects. Potted plants are placed on a table in a library, on a desk, on a drawer, and near a pillow as a small items in a room, and scholars enjoyed original characteristics and symbolism of the potted plants. Fourth, at the time of flowering of Prunus mume, poetry event was held to enjoy the tree and writing poetry begun. And at the time of flowering of Chrysanthemum monifolium, the flowers were floated in a liquor glass or shadow play was enjoyed. Fifth, potted plants played the role of garden ornaments in elegant events of a palace, the gentry, wedding ceremony, and sacrificial rites. Sixth, potted plants were used as tributes between countries, donation to a king, or a gift of a king. In addition, there were many cases where scholars exchanged potted plants and there is the first record of giving a potted plant in 'Mokeunsigo' by Mokeun Isaek, scholar in the late era of Goryeo. Seventh, at the time of flowering Prunus mume, Chrysanthemum monifolium, Gardenia jasminoides, Nelumbo nusifera, and Narcissustazetta var. chinensis, they enjoyed the particular fragrance and express it into poetry. Eighth, plant species from southern parts such as Camellia japonica, Daphne odora, Gardenia jasminoides, Citrus unshiu, Phyllostachys spp., Punica granatum, Rosa rugosa, and Musa basjoo, or foreign plant species, and species weak against the cold were utilized as pot plants for enjoying green trees indoors in northern central province in harshly cold winter.

• Journal of Korean Academy of Nursing Administration
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• v.2 no.1
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• pp.35-56
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• 1996

Nowerdays, the increase of traffic accidents and old age population make the Femoral Neck Fracture(FNF) patients increase. By the improvement of education and standard of living the patients demand better medical service than before. This study is designed to give practical help for the FNF patients by observing their hospital life and establish practical nursing strategies for the FNF patients. For these purposes the Ethnographic Participant Observation was adopted. By this study is focused on the hospital life patient's view. For this end, the field study adopted orthopedic ward in the C University Hospital with 400 beds in Seoul. The object patients of the study were twelve patients. The patients experienced five stages : Embarrassment, Conflict, Stability, Independent, and Extension Stage. The findings and prepared nursing strategies are stated as follows. First, in the Embarrassment Stage they suffered embarrassment, anxiety, pain, they could not do ordinary things. The patients who accidental fractures had anxiety from unfamiliar tests and from hospitalization itself. They lamented that they could not ordinary things, and do nothing but obeying the hospital, and endure the pain. They recognized the changed environment and resigned themselves to life in the ward. In this stage, full openness by the nurses is needed. Second, the attribute of the Conflict Stage were conflict, fear, curiosity, belief, reflection. When they sign the consentment form, they experience conflicts about the possibility of complication, fear of recovery from anesthesia, curiosity about the operation procedure, post - operation state, reflection on their past life, and promise to care for their family members after discharge and keep their religious life faithfully. And they accepted the operation depending on God, believing in modern medicine, and the surgeon. Asking for their changed informations, they expected positive results from the operation. In this stage, an empathic attitude by the nurses is needed. Third, the attribute of the Stability Stage were relief, gratitude, difficulty with excretion, and pain. When they awoke from anesthesia, they felt relief because of a the end of the operation, but they experienced extreme pain, difficulty of excretion in bed. They accepted the changed environment and expected recovery. In this stage, support by the nurses is needed. Fourth, the attributes of the Independence Stage were freedom, exercise, nurturing, anxiety, and discomfort. When they ambulated and exercised, they experienced freedom. They showed exhibited weakness of the digestive organs and discomfort hospital's space, structure, and facilities, the delay of medical certificate issue the lack of prompt response by the medical agents. They ate nurturious food and felt anxiety on the end of hospital life and returning to their ordinary life. They showed the independence of overcoming their environment by increasing exercise and expected their discharges. In this stage, respect by the nurses is needed for the patients to, overcome their environment and prepare for their independence. Fifth, the attributes of the Extension Stage were pessimism, isolation, dissatisfaction, and pain. Accompanied injury and old age made their ward life extend to over seven weeks. They exhibited weariness, melancholy, skeptisis, general pessimistic feeling, and desperation caused by their isolated life. They experienced the digestive discomfort caused by the prolonged medication and psycological pain caused by long-time hospitalization. As a, result, their dissatisfaction on the human, physical, and systematic environments had been increased. They acquired critical power and sought for something to do spending their time. They expected vaguely about the returning of their ordinary life. In this stage, counseling is needed by the nurse to overcome positively their psychological, social, and physical problems. The process of the FNF patient's ward life starts from the dependent state, when they are hospitalized, and gradually progresses to self-fulfillment in order to keep independent life. As a result, the FNF patients showed "Response in Challenge" or "Adaptation in Conflict" through their experiences of social, physical, and psychological difficulties.

• Korean Journal of Health Education and Promotion
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• v.10 no.1
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• pp.34-60
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• 1993

This study was done for the improvement of dental health of rural villagers and the dental health education, through finding of the types of brushing teeth and dental treatment of 812 people in Sunsan, Kyungpook province for 35days from March 27 to April 30 in 1992. Summaries are as follows ; 1. 58.5 percent of respondents were women, 56.3 percent were 40′s, 28.0 percent were 30′s, 12.3 percent were 50′s, and the over 60′s were 3.4 percent Elementary school graduates were 36.1 percent and most of them were middle school graduates, 33.5 percent. In view of the occupation, farmers were 56.5 percent, factory workers were 17.9 percent, the middle class (monthly pay amounting to 500,000∼990,000 won) were 49 percent and the lower class(less than 500,000 won) were 30.9 percent. In the standpoint of religion, Buddhists were 42.5 percent. 2. In the number and times of respondents brushing, 35.5 percent is "after dinner", 25.6 percent is "Before going to bed", 15.8 percent is "After breakfast", 13.3 percent is "After every meal", 5.2 percent is "Before breakfast" and 4.7 percent is "The sometimes it occurs to them". 3. The acquirement process of knowledge on the dental health were clinics or health center dentists (27.6%), TV(24.5%), magazine(9.2%), school(7.8%), relatives(5.3%). and 25.6 percent has never acquired. 28.3 percent of the farmers learned something by clinics and 28.1 percent of them haven′t heard about dental health. 4. The rate of persons who experienced oral diseases during 1 year period was 76.1 percent, and that of the educated was 19.9 percent and that of the uneducated 80.1 percent. The authorities concerned with treatment were dentist′s(41.6%), health center(30.3%), and the unlicensed person(2.9%). The rate of negligence was 6.3 percent, farmers experienced oral disease was 75.2 percent and they utilized the health center most often(36.2%). 5. The rate of person who had experienced dental prosthesis during ten year period was 71.9 percent, and the final place or man for dental prosthesis was dental clinic(59.4%), the unlicensed person(27.1%), and health center(13.5%). The rate of farmers experienced dental prosthesis was 70.4 percent. They utilized the dental clinic, the unlicensed person and the health center with the rates of 51.5 percent, 32.2 percent, and 16.7 percent respectively. 6. As to the results of dental prosthesis using the dental clinic, "being satisfied now" was 72.4 percent, "being dissatisfied" 14.4 percent, "being unable to use it" 3.1 percent, "its being somewhat usable" 10.1 percent, "having some problem" 38.7 percent, and "there being no problems" 61.3 percent. About utilizing the unlicensed person, "being satisfied now" was 65.8 percent, "being dissatisfied" was 10.7 percent, "being unable to use it" 5.1 percent and "its being some what usable" was 18.4 percent. 7. The rate of missing teeth holders amounted to 89.8 percent, the rate of the educated to the uneducated was 19.2 percent to 80.8 percent The reasons of neglecting that illness were due to "Endurable"(28.3%), and "No money" (24.3%). In the case of farmers 89.1 percent of them were the missing-teeth holders, the "Endurable" were 29.8 7. percent, and "No money" lay in 27.4 percent. 8. Their hopeful centers for dental prosthesis were the dental clinics(76.6%), and the health center(16.9%).

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.5
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• pp.2293-2303
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• 2013

Objective: This study aims to determine whether national patient safety indicators (PSIs) can be calculated. Methods: Using PSI criteria from Organization for Economic Co-Operation and Development (OECD) Health Technical Papers 19 based on the Agency for Healthcare Research and Quality (AHRQ), PSIs were identified in the Korean National Hospital Discharge In-depth Injury Survey (KNHDIIS) database for 875,622 inpatient admissions between 2004 and 2008. Logistic regression was used to estimate factors of variations for PSIs. Results: From 2004 to 2008, 3,084 PSI events of 8 PSIs occurred for over 80 thousands discharges. Rates per 1,000 events for decubitus ulcer (PSI3, 4.88), foreign body left during procedure (PSI5, 0.05), postoperative sepsis (PSI13, 1.32), birth trauma-injury to neonate (PSI17, 7.92) and obstetric trauma-vaginal delivery (PSI18, 32.81) are all identified between ranges from maximum to minimum of OECD rates, respectively. However, rates per 1,000 events for selected infections due to medical care (PSI7, 0.22), postoperative pulmonary embolism or deep vein thrombosis (PSI12, 0.90) and accidental puncture or laceration (PSI15, 0.71) are below the minimum of OECD range. 7 PSIs except PSI 18 showed statistically significant relationship with number of secondary diagnoses. When adjusting patient characteristics, there are statistically significant different rates according to bed size or location of hospitals. Conclusion: This is the first empirical study to identify nationally number of adverse events and PSIs using administrative database. While many factors influencing these results such as quality of data, clinical data and so on are remain, the results indicate opportunities for estimate national statistics for patient safety. Furthermore outcome research such as mortality related to adverse events is needed based on results of this study.