• Tuberculosis and Respiratory Diseases
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• v.78 no.4
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• pp.349-355
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• 2015

Background: The tuberculin skin test (TST) is the standard tool to diagnose latent tuberculosis infection (LTBI) in mass screening. The aim of this study is to find an optimal cut-off point of the TST+ rate within tuberculosis (TB) contacts to predict the active TB development among adolescents in school TB outbreaks. Methods: The Korean National Health Insurance Review and Assessment database was used to identify active TB development in relation to the initial TST (cut-off, 10 mm). The 7,475 contacts in 89 schools were divided into two groups: Incident TB group (43 schools) and no incident TB group (46 schools). LTBI treatment was initiated in 607 of the 1,761 TST+ contacts. The association with active TB progression was examined at different cut-off points of the TST+ rate. Results: The mean duration of follow-up was $3.9{\pm}0.9years$. Thirty-three contacts developed active TB during the 4,504 person-years among the TST+ contacts without LTBI treatment (n=1,154). The average TST+ rate for the incident TB group (n=43) and no incident TB group (n=46) were 31.0% and 15.5%, respectively. The TST+ rate per group was related with TB progression (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.001-1.050; p=0.037). Based on the TST+ rate per group, active TB was best predicted at TST+ ${\geq}$ 16% (OR, 3.11; 95% CI, 1.29-7.51; area under curve, 0.64). Conclusion: Sixteen percent of the TST+ rate per group within the same grade students can be suggested as an optimal cut-off to predict active TB development in middle and high schools TB outbreaks.

• Journal of the korean academy of Pediatric Dentistry
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• v.48 no.3
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• pp.313-323
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• 2021

The purpose of this study was to investigate trends in dental sedation of Korean children and adolescents. A retrospective study was conducted on patients under 20 years of age who received dental treatment under sedation using National Health Insurance Service-National Sample Cohort Database from 2002 to 2015. Based on the 1 million standard data, there were 436 cases of dental treatment under sedation in 2002, but 4002 cases in 2015, showing a trend increasing every year. The 3 - 5 year old group accounted for the largest portion (54.2%), while the 6 - 8 year old group increased recently. Nitrous oxide inhalation sedation is the most commonly used, accounting for 45.9% in 2002, but increased to 89.5% in 2015. Combination of nitrous oxide inhalation sedation, chloralhydrate and hydroxyzine was the most common, accounting for 5.7% in 2002, but decreased to 2.9% in 2015. There is a trend to use the sedation method more safely and in a way that reduces side effects.

• The Korean Society of Law and Medicine
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• v.24 no.2
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• pp.79-117
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• 2023

Among the healthcare-related judgments handed down in 2002, there was a significant ruling on the timing of the duty of explanation, stating that, in order to ensure the exercise of the patient's right to self-determination, the patient must be given time to consider and decide on the risks and side effects of a medical procedure in specific circumstances. In addition, in a case where an insurance company claimed unjust enrichment against a medical institution on behalf of its insureds, the court provided a clear standard by distinguishing between active and passive requirements regarding the need to preserve the right of subrogation of creditors. In the area of medical administration, there was a ruling that clarified that a medical institution's business suspension under the National Health Insurance Act is directed against the medical institution, a ruling that broadly recognized causation in a case of compensation for side effects of corona vaccination, and a ruling on the scope of a medical practitioner's license, such as the use of ultrasound devices by an oriental medicine practitioner. In a case involving a patient's claim for eviction from a medical institution, the court reviewed a ruling on just cause for termination of a hospitalization contract in relation to Article 15(1) of the Medical law.

• Korea Journal of Hospital Management
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• v.6 no.3
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• pp.109-129
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• 2001

The purpose of this study was the acquisition of the optimum scale of the apportionment of standard & high-class bed for the maximum profit representative of the desire of customers in a General Hospital with 1,100 beds located in Seoul. This investigation was proceeded by the analysis of the result of the simulation with the survey of both the patients' needs for bed and the degree of the medical service by the grade of the ward. And finally the consequence was obtained as follows: 1. The result of the investigation of the inpatients' preference for the grade of ward classes shows that a private ward reflected 4.3 percent, a semi-private ward 1.7 percent, a three-bed ward 0.1 percent, and a ward with six beds 93.9 percent each other. 2. A questionnaire poll was paralleled of service terms of a medical doctor and a nurse by ward class, the data were used for the standard of the allotment of labor cost by the ward class. The poll shows that the service tenn of a medical doctor and a nurse based on a ward with six beds by ward class showed 1.7 times in internal medicine and 1.9 times in surgery at a private ward; 1.4 times in internal medicine and 1.7 times in surgery at a semi-private room; and 1.2 times both in internal medicine and in surgery at a three-bed ward 3. The resultant findings revealed the most profit per bed and per patient in a private ward. However, an analysis of profit with a standard of unit area by ward class represented a higher profit in both the internal medicine and the surgery semi-private ward than other ward classes. 4. The result of the analysis through simulation based on the data of the prime cost per the ward class proved the optimum scale of the distribution of beds by class as follows: sixteen beds of the internal medicine and twenty three beds of the surgery in the private ward; two hundreds and two of the internal medicine and one hundred and ninety eight of the surgery in the semi-private room; three of both the internal medicine and the surgery each other in the three-bed ward; one hundred and ninety eight of the internal medicine and two hundred and fifty two of the surgery in the ward with six beds. The result of this research exhibits that the income and expenditure of the hospital could be improved by changing parts of wards into private ones(containing the maximum profit per a unit of width) in case the scale of the number of beds is reset with the consideration of the profit per the unit width. In the near future it's strongly expected that the research for the more scientific standard of the allotment of labour cost by ward class and for definition of the optimum scale of the number of beds that actualize the maximum profit with the change of the three elements of the prime cost: cost of materials; labor costs; management expenses.

• Journal of agricultural medicine and community health
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• v.33 no.1
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• pp.82-89
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• 2008

Objective:　We compared the prevalence of injury and poisoning in the agricultural and fishery population with that of the general population.Methods: The national health insurance data and agricultufor this study. The age-adjusted standardized morbidity ratio was used to compare the prevalence of all injuries and poisonings of the agricultural and fishery population with that of the general population for the year 2002, as well as the prevalence of certain injuries and poisonings common to the agricultural and fishery population. The age-adjusted standardized morbidity ratio and 95% confidence intervals were attained by using the general population as the standard population group.Results: The age-adjusted standardized morbidity ratio of total injuries and poisonings was significantly high in the agriculture and fishery population. The standardized morbidity ratio was 137.6 in the male agriculture and fishery population and 123.3 in the female agriculture and fishery population. In terms of injuries and poisonings common to the agriculture and fishery population, the age-adjusted standardized morbidity ratio was significantly high regarding the dislocations and strains of lumbar spine/pelvis, shoulder and neck, the fracture of rib/thoracic spine/sternum and pesticide poisoning.Conclusions: The overall prevalence of injury/poisoning was significantly higher in the agriculture and fishery population than in the general population. Various forms of research should be conducted on the injuries of the agriculture and fishery population in the future. In order to compare the differences in the prevalence rates of injuries according to time and region, standard definitions of injuries and occupation related injuries are required.

• Journal of Gynecologic Oncology
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• v.29 no.6
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• pp.83.1-83.10
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• 2018

Objective: We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan. Methods: A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected. Results: In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for 'cystoscope or proctoscope for stage IVA' to 98.8% for 'chemotherapy using platinum for stage IVB'. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively. Conclusion: Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.

• Research in Community and Public Health Nursing
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• v.22 no.3
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• pp.302-314
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• 2011

Purpose: This study aimed to validate instruments to classify the frailty of Korean elderly people in community. Methods: For this study, 632 elders were selected from community-based elderly houses and home visiting registries, and data on frailty were collected using three instruments during November, 2008. The Korean Frail Scale (KFS) was composed of 10 domains with the maximum score of 20. The Edmonton Frail Scale (EFS) had 10 domains with the maximum score of 17. The 25_Japan Frail Scale (25_JFS) was composed of 6 domains with the maximum score of 25. Internal consistency was measured with Cronbach's ${\alpha}$. Sensitivity, specificity and area under the curve (AUC) of ROC were measured to see validity with long.term care insurance grade as a gold standard. Results: The Cronbach's ${\alpha}$ was .72 for KFS, .55 for EFS, and .80 for 25_JFS. Sensitivity, specificity, and AUC were 70.0%, 83.2%, and .83, respectively, at cutting point 10.5 for the KFS, 50.0%, 80.9%, and .66, respectively, at 8.5 for EFS, and 80.0%, 85.9%, and .86, respectively, at 12.5 for 25_JFS. Conclusion: KFS and three JFS showed favorable internal consistency and predictive validity. Further longitudinal studies are recommended to confirm predictive validity.

• The Journal of Korean Medicine
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• v.37 no.1
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• pp.135-150
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• 2016

Research Methods: This research analyzed the data on those aged 20 and older from the Report on Korean Medicine Usage Research, which was conducted in 2011. The definitions of toxicity were defined by the presence of toxicity listed in the survey. The questions used in analysis were sex, age, household income, health insurance, medical fees, satisfaction rates on treatments, as well as the types of diseases and the presence of toxicity from treatments. The analysis was done through frequency analysis using SAS 9.2 and Fisher's Exact Test. Results: Toxicity occurred in 2.1% patients out of the 3518 studied. The types of toxicity were skin problems, such as hives and pruritus (34.7%), gastrointestinal problems (20.8%), neurological diseases (4.2%), liver(1.4%), kidney toxicity(1.4%), and others (22.2%). There were no differences in toxicity by sex, age, household income and the types of health insurances. However, toxicity were positively correlated with the increase in standard of education (p=0.0124). In addition, as treatment costs increased (p<0.0001) and satisfaction rates decreased, toxicity increased (p<0.0001). Toxicity increased in patients with low back pain (p=0.0429), hwabyung (p=0.0392), lumbar sprain (p=0.0004), correction body type (p=0.0118), growth (p=0.0045), and from motor accidents (p=0.0448). In logistic regression analysis, Toxicity were positively correlated with medical fees, and cancer treatment and negatively correlated with satisfaction rate on treatments. Conclusion: The toxicity that occurred in outpatients who used Korean medical clinics mostly happened in skin, digestive organs, nerves, livers, and kidneys toxicity. The occurrences differed by the Educational lengths, expensive costs of treatments, low satisfaction rates of the treatments, and cancer.

• Quality Improvement in Health Care
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• v.10 no.2
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• pp.204-215
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• 2003

Background : ICD-10 Classification, which is used domestically as well as internationally, has limited use in the clinical practice since it is developed for at disease statistics and epidemiology. Therefore, the purposes of this study were to improve the quality of diagnosis by constructing a new disease classification based on the diagnoses doctors currently make in the clinical setting and connecting this classification with OCS and EMR, and to meet the demands of doctors for high quality medical study data in medical research. Methods : The specialists in each ophthalmic subfield collected clinical diagnoses and abbreviations based on the ophthalmology textbooks and confirmed the classifications. Total number of clinical diagnoses collected was totaled 672, for which ideal diagnoses had been selected and a new model of disease classification model in connection with ICD-10 was constructed. The constructed classification of clinical diagnoses consisted of six steps: the first step was the classification by ophthalmic subspecialty field; the second to fifth steps were the detailed classification by each specialty field; the sixth step was the classification by site. Results : After introducing the new disease classification, research on the use and a pre-post comparison was conducted. The result from the research on the use of the clinical diagnoses in inpatient and outpatient care has shown a gradually increasing tendency. From the pre-post comparison of EMR discharge summary diagnoses, the result demonstrated that the diagnosis was stated correctly and in detail. Since the diagnosis was stated correctly, code classification became correct as well, which makes it possible to construct high quality medical DB. Conclusion : This construction of clinical diagnoses provides the medical team with high quality medical information. It is also expected to increase the accuracy and efficiency of service in the department of medical record and department of insurance investigation. In the future, if hospitals wish to construct a classification of clinical diagnosis and a standard proposal of clinical diagnosis is presented by a medical society, the standardization of diagnosis seems to be possible.

• Journal of Korean Clinical Nursing Research
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• v.17 no.2
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• pp.123-137
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• 2011

Purpose: This study was conducted to develop standards ensuring nursing process-based care of patient admission and discharge, to develop a performance measurement tool evaluating the care applied according to the standards, and finally to determine validity of the standards and the tool. Methods: The standards and the tool were reviewed by a panel of experts and refined based on the panel's suggestions. Validity of the standards and the tool were examined through surveying a total of 302 hospital nurses. Results: The mean validity scores of the performance measurement standards and the tool were 4.11 and 4.09, respectively, out of 5.00. So the performance measurement standards and the tool in this study were found to be acceptable in evaluating quality of nursing care provided at patient admission and discharge. Conclusion: This result indicates that the performance measurement standards and the tool developed in this study are valid instruments to monitor and improve quality of nursing care for patient admission and discharge.