• Quality Improvement in Health Care
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• v.7 no.2
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• pp.218-228
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• 2000

Background : Among 'structure', 'process' and 'outcome' approaches, outcome evaluation is considered as the most direct and best approach to assess the quality of health care providers. Risk-adjustment is an essential method to compare outcome across providers. This study has aims to judge performance of hospitals by severity adjusted mortality rates of coronary artery bypass graft (CABG) surgery. Methods : Medical records of 584 patients who got the CABG surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups was used to quantify severity of patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex. For evaluation of hospital performance, we calculated ratio of observed number to expected number of deaths and z score [(observed number of deaths - expected number of deaths)/square root of the variance in the number of deaths], and compared observed mortality rate with confidence interval of adjusted mortality rate for each hospital. Results : The overall in-hospital mortality was 7.0%, ranged from 2.7% to 15.7% by hospital. After severity adjustment the mortality by hospital was from 2.7% to 10.7%. One hospital with poor performance was distinctly divided from others with good performance. Conclusion : In conclusion, severity-adjusted mortality rate of CABG surgery might be applied as an indicator for hospital performance evaluation in Korea. But more pilot studies and improvement of methodologies has to be done to use it as quality indicator.

• Quality Improvement in Health Care
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• v.10 no.2
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• pp.216-231
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• 2003

Objectives: To develop a model that predicts a death probability of acute myocardial infarction(AMI) patient, and to evaluate a performance of hospital services using the developed model. Methods: Medical records of 861 AMI patients in 7 general hospitals during 1996 and 1997 were reviewed by two trained nurses. Variables studied were risk factors which were measured in terms of severity measures. A risk model was developed by using the logistic regression, and its performance was evaluated using cross-validation and bootstrap techniques. The statistical prediction capability of the model was assessed by using c-statistic, $R^2$ as well as Hosmer-Lemeshow statistic. The model performance was also evaluated using severity-adjusted mortalities of hospitals. Results: Variables included in the model building are age, sex, ejection fraction, systolic BP, congestive heart failure at admission, cardiac arrest, EKG ischemia, arrhythmia, left anterior descending artery occlusion, verbal response within 48 hours after admission, acute neurological change within 48 hours after admission, and 3 interaction terms. The c statistics and $R^2$ were 0.887 and 0.2676. The Hosmer-Lemeshow statistic was 6.3355 (p-value=0.6067). Among 7 hospitals evaluated by the model, two hospitals showed significantly higher mortality rates, while other two hospitals had significantly lower mortality rates, than the average mortality rate of all hospitals. The remaining hospitals did not show any significant difference. Conclusion: The comparison of the qualities of hospital service using risk-adjusted mortality rates indicated significant difference among them. We therefore conclude that risk-adjusted mortality rate of AMI patients can be used as an indicator for evaluating hospital performance in Korea.

• Journal of Trauma and Injury
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• v.28 no.4
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• pp.248-255
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• 2015

Purpose: study of the mutual influence of the individual anatomical regions damage in patients associated with falls from heights. Methods: 561 medical reports of patients associated with falls from heights admitted to Republican Research Center of Emergency Medicine (RRCEM), in period of 2010-2013 yy, were analyzed retrospectively. Patient's age range was from 15 to 89. Treatment of these patients held in three stages: period of acute disorders of vital functions; relative stabilization period; stabilization of vital functions. The scope and content of medical diagnostic procedures performed on pre-hospital and intensive care stages. The severity of each injury was scored according to the AIS scale, the total severity of lesions was scored by points due to ISS. Digital material is treated by methods of mathematical statistics. Results: Falls from heights leads to associated injuries for 4 times more than isolated trauma, and increases according to height of fall and falling surface. Patients with TBI+chest trauma, are most serious contingent that has highest mortality and complications (36.8%). TBI+musculoskeletal system trauma are characterized by high blood loss, traumatic shock and fat embolism, forming a vicious circle. Conclusion: in patients associated with falls from heights clinical manifestations of injuries mutual aggravation syndrome will be seen. TBI leads to complication of chest trauma, delayed diagnostics of abdominal and chest trauma, aggravation of coma condition. Developing of high blood loss and fat embolism in musculoskeletal system trauma leads to shock and pulmonary embolism, which increases probability of death in the presence of abdominal or chest trauma, but abdominal trauma or chest trauma has no significant effect on the severity of the musculoskeletal system trauma.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.18
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• pp.8541-8551
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• 2016

Background: The coverage of breast and cervical cancer screening has only slightly increased in the past decade in Thailand, and these cancers remain leading causes of death among women. This study identified socioeconomic and contextual factors contributing to the variation in screening uptake and coverage. Materials and Methods: Secondary data from two nationally representative household surveys, the Health and Welfare Survey (HWS) 2007 and the Reproductive Health Survey (RHS) 2009 conducted by the National Statistical Office were used. The study samples comprised 26,951 women aged 30-59 in the 2009 RHS, and 14,619 women aged 35 years and older in the 2007 HWS were analyzed. Households of women were grouped into wealth quintiles, by asset index derived from Principal components analysis. Descriptive and logistic regression analyses were performed. Results: Screening rates for cervical and breast cancers increased between 2007 and 2009. Education and health insurance coverage including wealth were factors contributing to screening uptake. Lower or non-educated and poor women had lower uptake of screenings, as were young, unmarried, and non-Buddhist women. Coverage of the Civil Servant Medical Benefit Scheme increased the propensity of having both screenings, while the universal coverage scheme increased the probability of cervical screening among the poor. Lack of awareness and knowledge contributed to non-use of both screenings. Women were put off from screening, especially Muslim women on cervical screening, because of embarrassment, fear of pain and other reasons. Conclusions: Although cervical screening is covered by the benefit package of three main public health insurance schemes, free of charge to all eligible women, the low coverage of cervical screening should be addressed by increasing awareness and strengthening the supply side. As mammography was not cost effective and not covered by any scheme, awareness and practice of breast self examination and effective clinical breast examination are recommended. Removal of cultural barriers is essential.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.3
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• pp.2067-2070
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• 2013

Background/Aim: Stomach cancer is the second most common cause of death from all malignant tumors in the world (third in men, fifth in women), with a strong decreasing trend in most developed countries. The aim of this descriptive epidemiological study was to analyze mortality of stomach cancer in Serbia, excluding the Province of Kosovo, in the 1991-2009 period. Materials and Methods: In data analysis, we used mortality rates which were standardized directly using those of the world population as a standard. In order to analyze the mortality trend from stomach cancer, linear trend and regression analysis were used. Confidence intervals (CIs) for the average age-adjusted and age-specific mortality rates were assessed with 95% level of probability. Mortality data were derived from the data file of the Statistical Office of the Republic of Serbia. Results: During the 1991-2009 period, a significant downward trend in mortality of stomach cancer was recorded in Serbia (y=9.78 - 0.13x, p=0.000; average annual percent change was -6.3 (95%CI, -7.8 to - 4.8). During the same period, a significant decrease in mortality trend was found both in male (y=14.13 - 0.20x; p=0.000; % change was -7.7 (95%CI, -10.9 to -4.5) and female populations (y=6.27 - 0.08x; p=0.000; % change was - 4.4 (95%CI, -5.3 to -3.6). Conclusion: Decreasing trends in mortality from stomach cancer in Serbia are similar to those in most developed countries.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.3
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• pp.1039-1042
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• 2012

Aim: Tanscatheter arterial embolization irrespective of with or without an anticancer agent and lipiodol has been controversial with regard to survival benefit. Therefore, we conducted a prospective study to analyze the effect of transcatheter arterial lipiodol chemoembolization (TACE) on the survival of HCC. Methods: A prospective study was conducted, and a total of 326 patients with primary liver cancer who were newly diagnosed were collected from January 2004 to January 2005 in Zhejiang Provincial People's Hospital of China. A univariate Cox's regression analysis was used to assess the survival of the HCC cases receiving TACE. Results: The duration of follow-up for the HCC patients treated with TACE ranged from 3 months to 60 months. For the overall patients, survival rate at 5 years was 42%. Both HBV Ag and HCV Ab positive patients showed significantly low survival rate at 5 years. The multivariate analysis revealed The IV TNM stage was related to an heavy increased risk of death of HCC patients, and Child C grade group showed a significant moderate increased risk. Conclusion: Our study showed TACE is associated with a better prognosis of HCC patients, and the HBV infection, TNM stage, Child-Pugh grade and number of TACE may influence the survival probability. Further TACE studies should be assess the quality of life of HCC patients, so as to provide more information for treatment of HCC.

• Korean Journal of Construction Engineering and Management
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• v.8 no.2
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• pp.68-74
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• 2007

It has been recognized that safety management is activated during the construction phase to prevent accidents and fatalities of workers. However, It is revealed that about 15% of fatal death accidents is caused by the lack of management of planning and design phases. There is a crucial need of assessing safety risk during building design phase. This paper is aimed to develop a safety risk assessment checklist that can be used during building design phase, utilizing the concept of Design for Safety. In doing so, a broad literature survey on safety management of building Process, various safety risk assessment toolboxes being utilized in the HSE and the BAA of UK. The proposed checklist contains the followings: 1) classification structure for safety design on space, element, and trade work 2) hazard risk factor, probability and degree of intensity of accident occurrence, and 3) safety assessment criteria. It is expected that the checklist would be an effective tool of preventing and minimizing fatal accidents of building construction projects.

• Journal of the Korea Society of Computer and Information
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• v.23 no.6
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• pp.51-58
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• 2018

This study was conducted to investigate the relationship between drinking, smoking, meat intake, and exercise. The participants were 1,060 males and females who voluntarily responded to the survey by visiting the health promotion booth at the H Festival held in C city in 2014. Research data were collected in interview form using questionnaires on alcohol use, smoking, exercise, and meat intake. The data were analyzed by descriptive analysis, cross tabulation analysis, multinominal logistic regression after stratification of gender using the SPSS 24 program. The results of the study are as follows: Smokers had a significantly higher frequency of drinking ($x^2=163.33$, p<.001) than non-smokers. Meat intake was high when alcohol use was high ($x^2=35.13$, p<.001). The risk rates for smoking, meat consumption, and exercise related to alcohol use are as follows. The smoking was higher as the frequency of drinking increased. For men, smoking OR(odd ratio) was 6.26 (p=.001) and for women, smoking risk OR was 16.82 (p=.002). Meats intake showed a higher OR as the alcohol use increased. The OR of almost daily ingestion of meat at frequent drinking days was 4.40 (p=.002) for males and 4.52(p=.009) for females. As the frequency of drinking increased, the OR of days of exercise tended to decrease. In men, the OR was 0.36 (p=.003), the lowest in the probability of exercising more than 5 days when drinking high. In the case of women drinking less than once a week, the OR was 0.43 (p=.027), which was the lowest for exercise for 5 days or more. In conclusion, the higher the frequency of drinking, the higher the smoking and meat intake, and the less exercise. If drinking, smoking, and meat intake are high but there is a lack of exercise, a chronic disease can occur and cause premature death unless there is a change in the new health behavior. The results of this study suggest researches to understand the motives related to alcohol abstinence, smoking cessation, dietary control and exercise, and to develop programs.

• Journal of Korean Society of Industrial and Systems Engineering
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• v.40 no.4
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• pp.137-146
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• 2017

For the competitive business environment under purchase dependence, this paper proposes a new approximate calculation of order fill rate which is a probability of satisfying a customer order immediately using the existing inventory. Purchase dependence is different to demand dependence. Purchase dependence treats the purchase behavior of customers, while demand dependence considers demand correlation between items, between regions, or over time. Purchase dependence can be observed in such areas as marketing, manufacturing systems, and distribution systems. Traditional computational methods have a difficulty of the curse of dimensionality for the large cases, when deriving the stationary joint distribution which is utilized to calculate the order fill rate. In order to escape the curse of dimensionality and protect the solution from diverging for the large cases, we develop a greedy iterative search algorithm based on the Gauss-Seidel method. We show that the greedy iterative search algorithm is a dependable algorithm to derive the stationary joint distribution of on-hand inventories in the retailer system by conducting a comparison analysis of a greedy iterative search algorithm with the simulation. In addition, we present some managerial insights such as : (1) The upper bound of order fill rate can be calculated by the one-item pure system, while the lower bound can be provided by the pure system that consists of all items; (2) As the degree of purchase dependence declines while other conditions remain same, it is observed that the difference between the lower and upper bounds reduces, the order fill rate increases, and the order fill rate gets closer to the upper bound.

• Journal of the Korean Data and Information Science Society
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• v.28 no.2
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• pp.349-359
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• 2017

In this paper, we conducted survival analyses by fitting the Cox proportional hazards model to stage III proximal colon cancer data obtained from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute. We investigated the effect of covariates on the hazard function for death from proximal colon cancer in stage III with surgery performed and estimated the survival probability for a patient with specific covariates. We showed that the proportional hazards assumption is satisfied for covariates that were used to analyses, using a test based on the Schoenfeld residuals and plots of the Schoenfeld residuals and $log[-log\{{\hat{S}}(t)\}]$. We evaluated the model calibration and discriminatory accuracy by calibration plot and time-dependent area under the ROC curve, which were calculated using 10-fold cross validation.