• Journal of Construction Engineering and Project Management
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• 제5권1호
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• pp.11-19
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• 2015

This paper presents optimized artificial neural networks (ANNs) claims prediction and decision awareness framework that guides owner organizations in their pre-bid construction project decisions to minimize claims. The framework is composed of two genetic optimization ANNs models: a Claims Impact Prediction Model (CIPM), and a Decision Awareness Model (DAM). The CIPM is composed of three separate ANNs that predict the cost and time impacts of the possible claims that may arise in a project. The models also predict the expected types of relationship between the owner and the contractor based on their behavioral and technical decisions during the bidding phase of the project. The framework is implemented using actual data from international projects in the Middle East and Egypt (projects owned by either public or private local organizations who hired international prime contractors to deliver the projects). Literature review, interviews with pertinent experts in the Middle East, and lessons learned from several international construction projects in Egypt determined the input decision variables of the CIPM. The ANNs training, which has been implemented in a spreadsheet environment, was optimized using genetic algorithm (GA). Different weights were assigned as variables to the different layers of each ANN and the total square error was used as the objective function to be minimized. Data was collected from thirty-two international construction projects in order to train and test the ANNs of the CIPM, which predicted cost overruns, schedule delays, and relationships between contracting parties. A genetic optimization backward analysis technique was then applied to develop the Decision Awareness Model (DAM). The DAM combined the three artificial neural networks of the CIPM to assist project owners in setting optimum values for their behavioral and technical decision variables. It implements an intelligent user-friendly input interface which helps project owners in visualizing the impact of their decisions on the project's total cost, original duration, and expected owner-contractor relationship. The framework presents a unique and transparent hybrid genetic algorithm-ANNs training and testing method. It has been implemented in a spreadsheet environment using MS Excel$^{(R)}$ and EVOLVERTM V.5.5. It provides projects' owners of a decision-support tool that raises their awareness regarding their pre-bid decisions for a construction project.

• The Korean journal of internal medicine
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• 제39권4호
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• pp.625-639
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• 2024

Background/Aims: Intensive care unit (ICU) quality is largely determined by the mortality rate. Therefore, we aimed to develop and validate a novel prognostic model for predicting mortality in Korean ICUs, using national insurance claims data. Methods: Data were obtained from the health insurance claims database maintained by the Health Insurance Review and Assessment Service of South Korea. From patients who underwent the third ICU adequacy evaluation, 42,489 cases were enrolled and randomly divided into the derivation and validation cohorts. Using the models derived from the derivation cohort, we analyzed whether they accurately predicted death in the validation cohort. The models were verified using data from one general and two tertiary hospitals. Results: Two severity correction models were created from the derivation cohort data, by applying variables selected through statistical analysis, through clinical consensus, and from performing multiple logistic regression analysis. Model 1 included six categorical variables (age, sex, Charlson comorbidity index, ventilator use, hemodialysis or continuous renal replacement therapy, and vasopressor use). Model 2 additionally included presence/absence of ICU specialists and nursing grades. In external validation, the performance of models 1 and 2 for predicting in-hospital and ICU mortality was not inferior to that of pre-existing scoring systems. Conclusions: The novel and simple models could predict in-hospital and ICU mortality and were not inferior compared to the pre-existing scoring systems.

• 보험의학회지
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• 제27권2호
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• pp.68-74
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• 2008

Medical verification of cancer diagnosis in insurance claims is a very important procedure in insurance administrations. Claims staffs are in need of medical experts' opinions about claim administration. This procedure is called medical claim review (MCR) and is composed of verification and advice. MCR verification evaluates the insured’s physical condition by medical records and compares it with product coverage. It is divided into assessment of living assurance benefit, verification of cancer, and assessment of the cause of death. Actually cancer verification of MCR is applicable to coding because the risk ratio in product development is usually coded data. There are some confusing neoplastic diseases in assessing the verification of cancer. This article reviews gastrointestinal stromal tumors (GIST) and mucosa-associated lymphoid tissue tumors (MALToma) of the stomach. The second most common group of stromal or mesenchymal neoplasms affecting the gastrointestinal tract is GIST. Nowadays there are many articles about the pathophysiology of GIST. However there are few confirmative theories except molecular cell biology of KIT mutation and some tyrosine kinase. Therefore, coding the GIST, which has previously been classified as an intermediate risk group according to NIH2001 criteria, for cancer verification of MCR is suitable for D37.1; neoplasm of uncertain or unknown behavior of digestive organs and the stomach. The gastrointestinal tract is the predominant site of extranodal non-Hodgkin's lymphomas. B-cell lymphomas of the MALT type, now called extranodal marginal zone B-cell lymphoma of MALT type in the REAL/WHO classification, are the most common primary gastric lymphomas worldwide. Its characteristics are as follows. First, it is different from traditional stomach cancers such as gastric adenocarcinoma. Second, the primary therapy of MALToma is the eradication of H. pylori by antibiotics and the remission rate is over 80%. Third, it has a different clinical course compared to traditional malignant lymphoma. Someone insisted that cancer verification is not possible for the above reasons. However, there have been findings on pathologic mechanism, and according to WHO classification, MALToma is classified into malignant B-cell lymphoma and it must be verified as malignancy in MCR.

• 한방재활의학과학회지
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• 제29권1호
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• pp.75-83
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• 2019

Objectives Previous animal studies have shown that mixtures of Cynanchum wilfordii and Phlomis umbrosa extract (IPLUS-CWPU) increases femur length and insulin like growth factor-1 (IGF-1) secretion. IPLUS-CWPU may thus be a promising ingredient in functional foods aimed at growing child's height. The purpose of the study is to investigate the effect of IPLUS-CWPU on height growth in children with short stature. Methods For this purpose, we recruited 90 children aged 4 to 12 years who had heights ranging from the 5th to 25th percentiles of Korean children's growth curve and randomized to either the IPLUS-CWPU or the placebo group. Results The IPLUS-CWPU group showed a significant increase in the change of the height growth compared to the placebo group after 20 weeks of administration (p=0.02). The height growth velosity also showed a statistically significant difference in the test group compared to the placebo group at 10 weeks (p=0.04). The IGF-1 levels showed a tendency to increase in the IPLUS-CWPU group (p=0.08). Moreover, the IPLUS-CWPU significantly increased IGF-1/IGFBP-3 ratio (p=0.02). However, there were no significant differences in blood biochemical parameters including growth hormone, bone age, thyroid stimulating hormone, and osteocalcin levels. Conclusions In conclusion, the data of this trial indicate that IPLUS-CWPU is effective and safe, generally well-tolerated without severe adverse events, in the treatment of children with short stature over a 20 weeks period.

• 한국임상약학회지
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• 제21권2호
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• pp.90-99
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• 2011

Health Insurance Review & Assessment Service (HIRA) claims database has a high potential to detect signals of new drug interactions. The aim of this study was to evaluate the usefulness of information component (IC) and relative risk (RR) as a tool for signal detection, and to analyze the possible drug interactions caused by clopidogrel using HIRA claims database. This study was performed in elderly patients over 65 years of age who administered clopidogrel from January 2005 to June 2006 in South Korea. Serious Adverse Events (SAEs) as drug interactions of clopidogrel were defined as any ambulatory hospitalization for ischemic diseases within comcomitant medication period of clopidogrel. Information Component (IC) and Relative Risk (RR) were calculated to compare the proportion of drug-SAE pairs in order to select drug specific SAEs. IC and RR signals of clopidogrel drug interaction were screened when IC's 95% confidence interval was greater than 0 and RR's 95% confidence interval was greater than 1 respectively. All detected signals were compared to references such as $Micromedex^{(R)}$ and 2010 Drug Interaction $Facts^{TM}$. Sensitivity, specificity, positive predicted value and negative predicted value were used to evaluate usefulness of this method. Among 13,252,930 cases of elderly patients who co-administered clopidogrel and other drugs, 47,485 cases were detected as SAE. Of these, one-hundred nine cases were detected by the IC-based data-mining approach and ninety one cases were detected by the RR-based data-mining approach. Total One-hundred sixty three unrecognized signals were detected by IC or RR. Twelve signals from IC-based data-mining (57.1%) were corresponded with drug interactions from references and eight signals from RR-based data-mining (38.1%) were corresponded with drug interactions from references. These signals include proton pump inhibitors, calcium channel blockers and HMG CoA reductase Inhibitors, which were known to affect CYP450 metabolism. Further studies using HIRA claims database are necessary to develop appropriate data-mining measure.

• 보건행정학회지
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• 제34권2호
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• pp.163-177
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• 2024

연구배경: 본 연구는 부당청구 예방형 자율점검제 시범사업의 "개선요청 통보 및 모니터링" 중재활동이 의료기관의 중재 실시 전과 후 청구건수와 청구총진료비 청구행태에 있어서의 변화를 검증하고자 하였다. 방법: 자료는 건강보험심사평가원의 2021년 7월부터 2022년 2월까지 시범사업 항목인 '정맥 내 일시주사(KK020)'를 청구한 기관 중 예방형 자율점검제 대상기관으로 선정된 1,129개 의료기관의 청구자료와 신고 현황자료를 활용하였다. 비교 대상을 선정하기 위해 1:3 비율로 성향점수매칭을 사용하였고, 청구행태 변화를 검증하기 위해 대응표본 t-검정과 t-검정을 실시하였다. 또한 청구행태 변화에 차이가 있는 경우 이에 영향을 미치는 요인분석을 위하여 회귀분석을 시행하였다. 결과: 중재 실시 전과 후의 청구행태는 실험군의 모든 의료기관 종별에서 청구건수와 청구총진료비가 유의하게 감소하였고, 의원의 대조군에서는 유의한 증가를 보였다. 의료기관 및 의사 특성에 따른 중재 실시 전·후 청구행태는 실험군은 의원의 의사 연령 40세 미만을 제외하고 모든 종별에서 유의하게 감소하였다. 대조군은 종합병원과 병원은 개원기간에서, 의원은 표시과목에서 일부 유의한 감소가 있었고, 의사 50세 이상 남성에서 유의하게 증가한 것으로 나타났다. 실험군 대상 의료기관의 청구행태에 변화에 대한 회귀분석 결과, 모든 종별에서 중재 실시 전과 후에 청구건수와 청구총진료비가 유의하게 감소하였다. 또한 의료기관과 의사 특성에서 병원은 개원기간이 길수록 유의한 증가를 나타났고, 의원은 소재지역과 표시과목(기타)에서 유의한 감소를 보였다. 결론: 실험군의 부당청구 예방형 자율점검제의 중재 실시 이후 청구경향의 변화가 연구가설대로 감소하는 경향을 보였다. 이는 제도 시행 직후에 의료기관 스스로 청구행태를 개선하고, 교정하는 사전예방적 활동의 효과가 존재하는 것으로 나타났다. 또한 대조군에서도 통보 대상기관 위주의 제도운영방식에도 불구하고 일부 유의한 감소가 나타난 것은 예방형 자율점검제의 간접적인 효과로 볼 수 있다. 따라서 비대상기관에도 청구행태 개선활동이 이루어질 수 있도록 적극적인 홍보와 교육, 간담회 등의 추가적인 지원과 지속적인 모니터링이 필요하다. 이를 통해 부당청구가 감소될 수 있도록 예방형 자율점검제를 확대하는 것이 바람직하다.

• 대한인간공학회지
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• 제29권4호
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• pp.405-422
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• 2010

Occupational musculoskeletal disorders currently account for the largest proportion of the occupational illnesses in Korea. In this research, status of musculoskeletal disorders among the occupational illnesses was examined through workers' compensation claims data. Types and characteristics of musculoskeletal disorders were looked at other data set as well. The data sets included epidemiological investigation data reported by Occupational Safety and Health Research Institute, and data collected from occupational disease surveillance reports and Korean occupational health-related scientific journals. Number of cases, incidence rate and insurance benefits for occupational musculoskeletal disorders in Korea are increasing every year. In addition, musculoskeletal disorders occurrence is shifted from large enterprises group to small-and-medium group, from manufacturing to service sector, and from production workers to office and professional workers. Although low back pain is still most common, its occurrence characteristics is gradually shifted from traumatic to cumulative while musculoskeletal disorders are somewhat seemingly moved from lumbar to upper limb body part. Musculoskeletal disorders were observed to be more diverse and prevalent in epidemiological investigations or surveillance data rather in workers' compensation claims data. Musculoskeletal disorders occurrence is related to demographic factors, occupational psychosocial factors, and ergonomic risk factors at workplace for which appropriate preventive measures needed to be made accordingly.

• 한방안이비인후피부과학회지
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• 제34권2호
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• pp.21-37
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• 2021

Objectives : Allergic rhinitis(AR) is a common chronic disease that accounts for 10-40% of the world's population. This study aims to analyze the status of claims, prevalence, and medical utilization of allergic rhinitis patients using representative patients sample data. Methods : This study used the National Patients Sample(HIRA-NPS) of the Health Insurance Review and Assessment Service for 7 years(2010-2016). And we defined AR patients as all statements including J30 or a subcategory of J30 as the main disease, using the Korean Standard Classification of Diseases(KCD-7). The trend of AR patients by year was divided into Western medicine(WM) and Korean medicine(KM), and analyzed by subgroup analysis such as inpatient/outpatient, gender, age, insurance type, and care institution. Results : Patients with AR were mainly claimed for first sub diagnosis in WM and major diagnosis in KM, and the number of claims increased about 1.3 times and 1.4 times compared to 2010 in WM and KM, respectively. In addition, the total annual medical expenses in 2016 increased 1.3 times and 1.7 times compared to 2010, respectively. Conclusions : Both WM and KM are showing a steadily increasing trend in medical use due to allergic rhinitis. Further research is needed by considering genetic and environmental factors and individual characteristics, and linking with additional data.

• Journal of Chest Surgery
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• 제39권2호
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• pp.117-126
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• 2006

배경: 혈${\cdot}$기흉과 관련하여 우리나라에서 제기된 의료과오 소송들의 양상과 그 결과들을 살펴봄으로써 의사들이 혈${\cdot}$기흉 환자 처치에 있어서 의학적 적응증과 정확한 술기방법 외에 의료법학적으로 고려하여야 하는 부분을 밝혀 발생 가능한 소송에 대처하려 한다. 대상 및 방법: 혈${\cdot}$기흉과 관련된 의료소송 중 재판종결 후 판결문이 공개된 판례들을 대상으로 Lawnb site (www.lawnb.com)와 법원에서 제공하는 법고을 시디롬을 검색하여 혈${\cdot}$기흉 발생 원인, 환자 나이, 기저질환, 소송결과 및 배상금 등을 조사하여 검토하였다. 결과: 대법원 판례 3건, 고등법원 판례가 1건, 지방법원 판례가 3건으로 총 7건의 판결문이 검색되었고 소송결과 3건은 원고가 일부 승소하였고, 4건의 경우는 원고의 청구를 기각하여 파기 환송하였다. 사망 사고의 경우 소송의 원인이 된 사인 중 가장 흔한 원인은 긴장성 기흉이었다. 결론: 혈${\cdot}$기흉과 관련된 소송의 빈도가 높은 것은 아니지만, 환자의 사망 또는 발생한 후유증으로 인해 발생한 손해에 대한 배상액이 상당하다. 소송의 발생은 소아 환자에게 발생한 혈${\cdot}$기흉의 경우가 더 흔하다. 의인성 기흉의 경우 시술 후 방사선 촬영여부가 환자의 예후 및 소송에 있어서 의사를 방어하는 증거로 제시될 수 있고, 충분한 설명에 근거한 동의 역시 중요하다.

• 경영정보학연구
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• 제5권1호
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• pp.49-60
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• 2003

본 연구의 목적은 현재 심각한 사회 및 경제 문제로 대두되고 있는 보험사기를 효과적으로 적발하기 위하여, visualization 데이터마이닝 tool을 실제 사례에 적용하여 그 타당성을 검증하는데 있다. 이를 위하여 최근 가장 효과적인 visualization 데이터마이닝 tool로 인정되고 있는 i2사의 Analyst's Notebook을 활용하여 대량의 보험금 청구 자료로부터 보험사기의 혐의가 가는 거래를 찾고, 이를 근거로 보첩사기의 혐의를 입증하는 일련의 과정을 검토하였다. 그 결과 visualization 데이터마이닝 tool이 대량의 보험금 청구 자료에서 혐의가 가는 거래를 찾는 단순한 예측의 수준을 넘어, 관련 범죄를 추적하여 체계적, 계획적으로 기획된 보험사기단을 추적해내는 성과를 올렸다. 따라서 보험사기 둥과 같은 부정거래나 범죄 행위를 적발하는 데는 visualization 데이터마이닝 tool이적합한 것으로 판명되었다.