• 보건행정학회지
• /
• 제23권1호
• /
• pp.35-43
• /
• 2013

Background: Diagnosis procedure combination (DPC) has recently been introduced in Korea as a demonstration project and it has aimed the improvement of accuracy in bundled payment instead of Diagnosis related group (DRG). The purpose of this study is to investigate that the model of end-stage liver disease (MELD) score as the severity classification of liver diseases is adequate for improving reimbursement of DPC. Methods: The subjects of this study were 329 patients of liver disease (Korean DRG ver. 3.2 H603) who had discharged from National Health Insurance Corporation Ilsan Hospital which is target hospital of DPC demonstration project, between January 1, 2007 and July 31, 2010. We tested the cost differences by severity classifications which were DRG severity classification and clinical severity classification-MELD score. We used a multiple regression model to find the impacts of severity on total medical cost controlling for demographic factor and characteristics of medical services. The within group homogeneity of cost were measured by calculating the coefficient of variation and extremal quotient. Results: This study investigates the relationship between medical costs and other variables especially severity classifications of liver disease. Length of stay has strong effect on medical costs and other characteristics of patients or episode also effect on medical costs. MELD score for severity classification explained the variation of costs more than DRG severity classification. Conclusion: The accuracy of DRG based payment might be improved by using various clinical data collected by clinical situations but it should have objectivity with considering availability. Adequate compensation for severity should be considered mainly in DRG based payment. Disease specific severity classification would be an alternative like MELD score for liver diseases.

• The Korean Journal of Pain
• /
• 제35권3호
• /
• pp.327-335
• /
• 2022

Background: The pathophysiology of fibromyalgia (FM) involves many mechanisms including central nervous system sensitization theory, autonomic nervous system (ANS) dysfunction, and recently small fiber neuropathy. While the small fiber neuropathy itself can cause ANS dysfunction and neuropathic pain (NP), it is still unknown whether ANS problems have an association with severity of disease and NP in patients with FM. The aim of this study was to evaluate ANS dysfunction in FM patients and to explore possible associations of ANS dysfunction with disease severity and NP. Methods: Twenty-nine FM patients and 20 healthy controls were included in this cross-sectional study. Participants were tested using sympathetic skin responses (SSR) and R-R interval variation analyses for sympathetic and parasympathetic ANS dysfunction, respectively. Disease severity and somatic symptoms of patients with FM were evaluated using the ACR-2010 scales and Fibromyalgia Impact Questionnaire, and NP symptoms were evaluated using the Pain Detect Questionnaire and Douleur Neuropathique questionnaire. Results: FM patients were found to have ANS dysfunction characterized by increased sympathetic response and decreased parasympathetic response. SSR amplitudes were found to be correlated with a more severe disease. Although nonsignificant, NP severity tended to be associated with a decrease in sympathetic and parasympathetic activities. Conclusions: ANS dysfunction may play a role in the pathophysiology of FM. The trend of decreased ANS functions in FM patients exhibiting NP contradicts the notion that FM is a sympathetically maintained NP and may be explained with small fiber involvement.

• Journal of Korean Biological Nursing Science
• /
• 제18권1호
• /
• pp.60-67
• /
• 2016

Purpose: The purpose of this study was to investigate the disease-related knowledge, stress and quality of life for the patients with varicose veins. Methods: Data were collected via questionnaire from 138 patients with varicose veins in C University Hospital in Korea from November in Korea 2012 to August 2013. Results: Knowledge of the symptoms and diagnosis was the lowest. The scores from patients with disease-related knowledge tended to be low for both subjects over the age of 60 and subjects with low education (less than high school). The score for stress over complications was the highest. The level of stress is higher for women, subjects without spouses, subjects with higher severity of disease and patients who had been taking hormones in the past or are still taking hormones. The disease-related quality of life tended to be lower for women and subjects without spouses. 21% of the variance in quality of life was explained by the level of disease-related stress, disease severity and knowledge. Conclusion: Education and the management of nurses to improve disease-related knowledge for patients with varicose veins is highly recommended. Intervention, by reducing stress, is necessary to improve the quality of life for women, subjects without spouses, and subjects with higher severity of the disease.

• 부모자녀건강학회지
• /
• 제19권1호
• /
• pp.9-16
• /
• 2016

Purpose: The disease specific self-efficacy of mothers caring children with atopic dermatitis is a crucial factor for adherence to recommended treatments. This study investigated factors associated with disease specific self-efficacy of mothers of atopic dermatitis children. Methods: A cross-sectional study was used. One hundred twenty five mothers recruited from the out-patient clinic of three hospitals completed self-administrative questionnaires, including the disease specific self-efficacy, general parenting efficacy, and severity of atopic dermatitis. Descriptive statistics, ANOVA, and multiple regression analysis were performed. Results: The degree of disease specific self-efficacy of mothers was significantly different according to the disease severity, and parenting efficacy. 26.0% of the variance of disease specific self-efficacy was explained by the severity of disease and parenting efficacy. Conclusions: Future studies need to focus on the development of educational programs that will help to improve mothers' disease specific self-efficacy as well as parenting efficacy.

• 한국작물학회지
• /
• 제43권4호
• /
• pp.239-244
• /
• 1998

Susceptibility of soybean cultivars to Calonectria illicicola was evaluated in a greenhouse by inoculating seedlings with mycelium in agar discs placed on the stems at the soil line. A range of responses was detected among cultivars following inoculation with a virulent isolate of C.ilicicola. Rankings of cultivars between greenhouse tests 1 and 2 were similar for disease severity and areas under the disease progress curves (AUDPC). In addition, rankings of cultivars for Final disease severity were highly correlated with AUDPC in test 1 ($r_s$ =0.88, t =5.48, p<0.001), test 2 ($r_s$ =0.99, t =22.10, p<0.001), and when tests were combined ($r_s$=0.89, t=5.82, p<0. 001). Final disease severity and AUDPC consistently identified Asgrow 7986, Braxton, Cajun, and Forrest as soybean cultivars least susceptible to red crown rot. In 1993 and 1994 field tests, a range in disease susceptibility was observed for tested cultivars but none was completely resistant. Soybean cultivars Braxton, Cajun, and Forrest, which were least susceptible to red crown rot in greenhouse tests, also ranked among cultivars with the lowest disease incidence and AUDPC in field tests. Comparisons .between rankings of the eight cultivars common to greenhouse and field tests showed a correlation between final disease severity from combined greenhouse tests and both final disease incidence ($r_s$=0.63, t =1.99, p<0.1) and AUDPC ($r_s$=0.60, t =1.82, p < 0.2) from the combined field tests. However, AUDPC from greenhouse tests did not correlate with either final disease incidence or AUDPC from field tests. The green-house screening method provided consistent results between greenhouse and field tests and successfully identified the least susceptible cultivars Braxton, Cajun, and Forrest.

• Journal of Korean Biological Nursing Science
• /
• 제25권3호
• /
• pp.172-182
• /
• 2023

Purpose: This study investigated the differences in physical function, self-efficacy (SE), and health-related quality of life (HRQoL) categorized by disease severity in community-dwelling patients with chronic obstructive pulmonary disease (COPD). Methods: This cross-sectional study included 182 patients with COPD selected from the pulmonology outpatient department of a tertiary hospital. Disease severity was measured using forced expiratory volume in 1 second (FEV1). Physical function, SE, and HRQoL were measured with the six-minute walking distance, Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE), and St. George's Respiratory Questionnaire (SGRQ). Disease duration, FEV1, and 12-month history of exacerbations were obtained from medical records. Patients were categorized by Global Initiative for Chronic Obstructive Lung Disease (GOLD) category. Data were analyzed using the χ² test, and one-way ANOVA. Results: Most of the participants were male and nonsmokers. The disease duration was 10.76 ± 10.03 years, the mean FEV1% was 62.13 ± 22.80, and 70.3% of the participants were in GOLD category 2 (moderate) or milder. Half of the participants reported modified Medical Research Council scores ≥ 2. Patients in GOLD categories 1 and 3 (mild and severe) exhibited significantly higher PRAISE scores than those in the other groups (F = 8.23, p < .001). The total SGRQ scores were highest in GOLD 4 (very severe), indicating the lowest HRQoL. Significant differences were identified among GOLD 1, GOLD 2 and 3, and GOLD 4 (F = 9.92, p < .001). Conclusion: We identified potentially useful variables to comprehensively assess disease severity and tailor management strategies, including airflow limitation, and to determine the consequences of COPD from patients' perspectives.

• 한국균학회지
• /
• 제11권2호
• /
• pp.99-101
• /
• 1983

Black root rot caused by Cylindrocladium crotalariae is one of the most serious soilborne disease in soybean. Plant height reduction of Hwangkeum Kong was 38% by the rotting of the whole main root and 9% by rotting of the half of the main root as compared with partial discoloration in the main root. Pod number per plant and seed weight were significantly reduced by the increase of the disease severity. Important yield components such as number of pods per plant and seed weight were negatively correlated with the soybean black root rot severity.

• 대한임상검사과학회지
• /
• 제53권3호
• /
• pp.201-207
• /
• 2021

The 2019 coronavirus outbreak poses a threat to scientific, societal, financial, and health resources. The complex pathogenesis of severe acute respiratory syndrome coronavirus centers on the unpredictable clinical progression of the disease, which may evolve abruptly and result in critical and life-threatening clinical complications. Effective clinical laboratory biomarkers that can classify patients according to risk are essential for ensuring timely treatment, and an analysis of recently published studies found cytokine storm and coagulation disorders were leading factors of severe COVID-19 complications. The following inflammatory, biochemical, and hematology biomarkers markers have been identified in COVID-19 patients; neutrophil to lymphocyte ratio, c-reactive protein, procalcitonin, urea, liver enzymes, lactate dehydrogenase, serum amyloid A, cytokines, d-dimer, fibrinogen, ferritin, troponin, creatinine kinase, and lymphocyte, leukocyte, and platelet counts. These factors are predictors of disease severity and some are involved in the pathogenesis of COVID-19. CRP is an acute-phase, non-specific serological biomarker of inflammation and infection and is related to disease severities and outcomes. In the present study, CRP levels were found to rise dramatically among COVID-19 patients, and our findings suggest CRP could be utilized clinically to predict COVID-19 prognosis and severity even before disease progression and the manifestation of clinical symptoms.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제23권5호
• /
• pp.439-446
• /
• 2020

Purpose: The evidence for an association between inflammatory bowel disease (IBD) and obesity is conflicting. Therefore, we set out to review the body mass index (BMI) at presentation of IBD to understand if the rise of the obesity rate in the general population, lead to an increase of obesity in patients with IBD at the time of diagnosis. Methods: Retrospective review of all patients with IBD seen at Children's Hospital and Medical Center from January 1st 2010 to December 31st 2014. From the initial visit and endoscopy, we obtained: age; sex; BMI; disease phenotype; disease severity. Results: We had a total of 95 patients, 35 patients were excluded due to incomplete data or referral being made after diagnosis was made. 28 were males and 32 were females, Age range was 2-17 years. A 37 had Crohn's disease, 19 ulcerative colitis, and 4 indeterminate colitis. Disease severity in 19 cases was mild, 29 moderate and 12 severe. BMI distribution was as follows-obese (5.0%), overweight (6.7%), normal weight (65.0%), mild malnutrition (8.3%), moderate malnutrition (15.0%), severe malnutrition (1.7%). Conclusion: Our data is consistent with other series. Showing most children had a normal BMI, regardless of disease severity or phenotypes. One confounding factor is the possibility of delay in referral to GI. This could mean some obese children may fall in the normal BMI range at the time of diagnosis due to ongoing weight loss. Future studies should include prospective cohort studies, comparing incidence of IBD in obese and non-obese patients, severity at presentation, duration of symptoms, and clinical outcomes.

• 한국산학기술학회논문지
• /
• 제13권6호
• /
• pp.2672-2679
• /
• 2012

본 연구는 급성심근경색증 환자의 사망률 측정을 위한 중증도 보정 모형을 개발하여 의료의 질 평가에 필요한 기초자료를 제공하고자 수행되었다. 이를 위해서 질병관리본부의 2005-2008년 퇴원손상환자 699,701건의 자료를 분석하였다. Charlson Comorbidity Index 보정 방법을 이용한 경우와 새롭게 개발된 중증도 보정 모형의 예측력 및 적합도를 비교하기 위해 로지스틱 회귀분석을 실시하였다. 새롭게 개발된 모형에는 연령, 성, 입원경로, PCI 유무, CABG 유무, 동반질환 12가지 변수가 포함되었다. 분석결과 CCI를 이용한 중증도 보정 모형보다 새롭게 개발된 중증도 보정 사망 모형의 C 통계량 값이 0.796(95%CI=0.771-0.821)으로 더 높아 모형의 예측력이 더 우수한 것으로 나타났다. 본 연구를 통하여 중증도 보정 방법에 따라 사망률, 유병률, 예측력에도 차이가 있음을 확인하였다. 향후에 이모형은 의료의 질 평가에 이용하고, 질환별로 임상적 의미와 특성, 모형의 통계적 적합성 등을 고려한 중증도 보정모형이 계속해서 개발되어야 할 것이다.