• 보건행정학회지
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• 제23권2호
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• pp.103-111
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• 2013

Seven diagnosis-related groups (DRGs) prospective payment system is going to expand to all hospitals including university hospitals this year. However there are few studies on the change of practice pattern under prospective payment system in the university hospital setting. So This study was intended to predict the practice pattern change after the introduction of 7 DRGs prospective payment system in a university hospital setting. To predict the change of practice pattern, this study used simulation technique. Five hundred and nineteen patients classified as 5 DRGs in a university hospital were selected for simulation. The change of practice pattern were predicted based on clinicians' opinion. We also predicted payment change by service items. Major findings of this study are as follows. First, the total medical payment was reduced by 14.4%. The drug payment change (8.8%) took most of total payment reduction. The followings are the change of treatment material cost (3.2%), the change of laboratory tests cost (1.8%), the change of room charge (0.5%), and other payment change (0.1%), respectively. Second, most of the reduction in total medical payment resulted from the decreased amount of medical services themselves. The transfer of medical services to outpatient setting took up only 4.9% of the total payment reduction. The change of unit price or composition took up 5.5% of the total payment reduction. In this study we found that it is possible to reduce the inpatient services through practice pattern change in university hospital setting. However, it needs to be careful to adjust DRG payment after the reduction of provided services, because most of reduction was not due to service transfer but to service volume reduction. It is desirable to utilize the saving from practice pattern change as incentive to improve quality of care.

• 한국콘텐츠학회논문지
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• 제11권7호
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• pp.259-274
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• 2011

이 연구는 2004년 KTX의 도입 이후 증가하고 있는 서울 지역 의료기관으로의 원거리 의료 이용 현상의 특성 및 그 영향 요인을 분석하였다. 설문조사를 통해 KTX로 서울지역 의료기관을 이용한 경험이 있는 203명에 대한 자료를 확보하여 이들을 대상으로 분석하였다. 분석 결과 최신 설비 및 의료장비의 보유 여부, 의료진의 수준 등이 원거리 의료 이용의 가장 중요한 이유로 나타났고, 질병 치료의 방문 목적, 40세 이상 연령, 전문대졸 이하 등의 요인이 서울지역 의료기관에서의 입원서비스 이용 가능성을 유의하게 높였다. 이는 지방 소재 상급종합병원의 중증질환 진료능력 제고와 이를 위한 정부 지원의 필요성, 그리고 의료 기관 인증 및 가감지급평가사업 결과 공시의 강화를 통한 합리적인 의료기관 선택 유도의 필요성을 시사한다.

• The Korean Journal of Pain
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• 제9권2호
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• pp.407-411
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• 1996

Stereotactic radiofrequency dorsal root ganglionotomy can be very useful procedures for the treatment of pain emanating from the lumbar segmental nerves. This procedure is reserved for patients who have failed conservative interventional treatments and in whom open surgical intervention is not an option. The advantages of the radiofrequency lesion method are presented, excellent control of the lesion process using temperature monitoring to quantify the lesion size, prevent boiling, and to produce differential destruction of neural tissue. The afferent fibers in the ventral root which are spared by dorsal rhizotomy but nerve fibers with their cells in the ganglion from either dorsal or ventral root can be destructed with stereotactic radiofrequency ganglionotomy. This technique is performed using a 100 mm cannula with a 5 mm active tip. Repeated lateral fluoroscopic view should be taken to make sure that cannlua still resides within the superior, dorsal quadrant or the foramen. With the cannula in this position, electrostimulation is performed and good paresthesia on the leg should be noted with 0.3 and 0.5 volt at 50 Hz stimulation. At 2Hz stimulation distinct dissociation between motor and sensory should be shown. Percutaneous lumbar ganglionotomy have carried out under local anesthesia on inpatient basis in 6 patients. A series of 5 patients with metastatic cancer pain and a patient with compression fracture have been relieved of pain without serious complications.

• 대한물리의학회지
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• 제14권4호
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• pp.115-123
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• 2019

PURPOSE: This study compared the scores of the Mini-Mental State Examination-Korean version (MMSE-K) and Korean version Montreal Cognitive Assessment (K-MOCA), which assess cognitive function, the Fugl- Meyer Upper-Extremity Assessment (FMA), which assess the upper extremity function; and Modified Barthel Index (MBI), which that assesses activities of daily living among patients receiving inpatient treatment following a diagnosis of stroke to determine the correlations among MMSE-K, K-MOCA, FMA, and MBI. METHODS: The study assessed the cognitive function using the MMSE-K and K-MOCA, upper extremity function using FMA, and activities of daily living using MBI. The data were analyzed using Pearson's correlation analysis and multiple regression analysis. RESULTS: An analysis of the differences in the MMSE-K, K-MOCA, MBI, and FMA scores according to the affected side, revealed differences in the, K-MOCA scores according to the affected side, where patients with right hemiplegia showed better cognitive function (p <.05). Correlation analysis among MMSE-K, K-MOCA, FMA, and MBI Showed significant correlations (p <.05). The results indicate that those with higher cognitive and upper extremity functions had higher performance of activities of daily living. CONCLUSION: The cognitive and upper extremity functions were correlated with the activities of daily living in stroke patients. Accordingly, applying physical therapy with a focus on improving the cognitive function and training activities of daily living could assist in the functional recovery of stroke patients significantly.

• Pediatric Infection and Vaccine
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• 제21권1호
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• pp.59-64
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• 2014

부비동염은 흔하고 일반적으로 소아에서는 양성질환인 경우가 많다. 경험적으로 사용하고 있는 항생제로 인해 소아의 부비동염의 두 개강 내 합병증은 드물지만, 발생할 경우 생명에 위협적일 수 있다. 두 개강 내 합병증은 정맥동 혈전, 안와 합병증, 뇌수막염, 뇌수막하 농양 등이 있다. 이러한 합병증은 소아에서 심각한 예후를 보일 수 있다. 따라서 뇌수막하 농양을 초기에 정확하게 진단하여 치료를 시작하는 것이 중요하다. 저자들은, 급성 부비동염 치료 중이던 15세 남아가 3일간의 발열, 두통을 동반한 편마비 증상으로 내원하여 뇌 전산화 단층촬영에서 뇌수막하 농양으로 진단되어 항생제 투여 및 신경학적 수술로 치료된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 한국산학기술학회논문지
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• 제12권6호
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• pp.2668-2676
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• 2011

손상입원환자의 재원일수 변이요인을 분석하기 위해 질병관리본부의 퇴원손상환자 자료를 이용하여 재원일수 중증도 보정모형을 개발하였다. 이 모형을 적용, 보정값을 산출하고 실측값과의 차이를 이용하여 재원일수를 표준화한 후 재원일수의 변이를 분석하였다. 입원손상환자의 중증도 보정 재원일수에 영향을 미치는 주요 요인은 중증도, 수술유무, 연령, 손상기전, 입원경로 등으로 나타났다. 의사결정나무 모형에 의하여 재원일수의 보정값을 산출하여 실측값과의 차이를 분석한 결과 병원규모(병상수)별, 보험유형별, 기관 소재지별로 통계적으로 유의한 차이가 있는 것으로 나타났다. 따라서 재원일수의 변이를 줄이기 위해 국가차원에서 진료행위프로토콜을 개발하여 의료기관에서 이를 활용하도록 유도하고, 더 나아가 이를 체계적으로 평가하여 지속적으로 노력하여야 할 것이다.

• 한국병원경영학회지
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• 제9권3호
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• pp.49-70
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• 2004

This study analyzes the effect of separation of dispensary from medical practice on hospital management performance. The results are as follow. The earning ratios of large size hospitals become deteriorated significantly after the separation of dispensary. The growth ratios of revenues from inpatient were unchanged, but the growth ratios of revenues from outpatient of large and middle size hospitals were decreased significantly. Hospitals can't sell the medicines to the outpatient after the separation of dispensary, but they can do to the outpatient. The labor cost ratios of small and large size hospitals are increased significantly after the separation of dispensary. There are two reasons for increase of labor cost ratios. One is the decrease of material cost ratio. The other is the increase of doctor's salary. The material cost ratios of every size hospital are decreased significantly after the separation of dispensary. Because medicines costs of outpatients are decreased. The labor cost and doctors' salary per patient of middle and large size hospitals are increased significantly after the separation of dispensary. And average treatment fees per day of inpatients of middle and large size hospitals are increased significantly after the separation of dispensary. But those of outpatients are decreased significantly. Average numbers of outpatients per bed of small and large hospitals are decreased significantly after the separation of dispensary. And average numbers of inpatients per bed of large hospitals are decreased significantly. In summary, as a consequence of separation of dispensary from medical practice, management performances of large size hospitals become deteriorated significantly.

• 대한한방소아과학회지
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• 제28권4호
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• pp.30-44
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• 2014

Objectives By analyzing data of the pediatric patients who had visited the emergency room of the oriental medical hospital, we can understand their characteristics and diseases. The purpose of this study was to introduce the excellence of the Oriental medicine, to develop various treatments, and to revitalize pediatric emergency care at the oriental medical hospital. Methods The study was composed of 334 pediatric patients who had visited the emergency room of the ${\bigcirc}{\bigcirc}$ university oriental hospital from January 2011 to December 2013. Results 1. It has showed that between 7 to 12 years old patients (27.8%) were the most common age populations. 2. The number of pediatric patients was increased during February. According to the weekly distribution data, the number of pediatric patients who had visited on Sunday was the highest (28.7%). Also, the number of pediatric patients who had visited the ER between 21 to 24 hours (29.0%) was the highest. 3. The two major reasons for inpatient hospitalization were digestive and nerve-related symptoms. Nerve-related symptoms were the most common in infants while digestive symptoms were the most common in other child development stages. 4. The duration of time interval from the onset of symptoms to the ER visit was most commonly within 6 hours (50.3%). An acupuncture and herbal medication treatment (70.1%) were the most common medical treatments. The majority of the pediatric patients (95.5%) were discharged after their medical treatments. Conclusions A serious acute illness was not the most common reason for the ER visit among the pediatric patients. The most common disease states that have preferred to be treated with the oriental medicine were dyspepsia, crying, facial palsy, and ankle sprain. We have to introduce the excellence of the oriental medicine. We also need to try developing other treatments such as magnetic acupuncture, aromatherapy, and revitalizing pediatric emergency care at the oriental medical hospital.

• Asian Pacific Journal of Cancer Prevention
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• 제17권9호
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• pp.4275-4279
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• 2016

Background: Cancer is a major health problem due to the aging population with increasing deaths. Family functioning is affected by cancer diagnosis and treatment. The aim of this study was to comparative analysis of the perception of family functioning by heads of families with and without cancer members during illness, focusing on changes or probable changes. Materials and Methods: This comparative study was conducted on two groups (families with a member of the cancer and controls without a family member with cancer). The families were of patients referred to the clinics and hospitals of Imam Khomeini, Taleghani and Omid of Urmia city, the number of samples being 148 for cases and 176for the control group. To collect the data, valid and reliable family functioning (FAD) was applied, a 60-item questionnaire with seven dimensions, with heads of families. To analyze the data SPSS- 23 Software was used for descriptive and analytical statistics. Significance level was defined p <0.05. Results: Among the seven items : problem solving, communication, roles, emotional response, emotional involvement, behavior control and overall functioning, only differences for average scores of problem-solving were statistically significant. Discussion: Contrary to common perception of severe damage for family functioning in families with cancer members, results of this study indicate that functioning in terms of family caregivers is more or less similar to that of the families with other diseases. Only in problem-solving item do these families experience more difficulty. Conclusion: According to the research findings, in nursing from families with cancer patient, it is recommended to focus more on the problem-solving item of the families.

• Clinical and Experimental Pediatrics
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• 제51권12호
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• pp.1359-1362
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• 2008

혈우병 환자에서 가장 효과적인 치료 방침은 응고 인자의 보충으로, 그를 위해 안전하고 오래 사용할 수 있는 정맥 확보가 필요하다. 그러나 중심 정맥으로의 port는 전신 마취와 일정한 입원이 필요하고, 혈우병 환자에서 시행할 경우 보험 삭감의 문제도 있다. 본 저자는 두 명의 중증 혈우병 항체 환자에게 말초 삽입 중심 정맥관을 삽입하였다. 환자들은 잦은 출혈 소견 때문에 응고 인자를 투여 받았으며, 그로 인하여 혈관 확보에 어려움이 있었다. 환자 나이는 7세와 11세였다. 제 8 응고 인자 활성도는 모두 1% 이하였으며, 제 8 응고 인자 항체 수치는 각각 160과 26.3 BU/mL였다. 말초 삽입 중심 정맥관은 초음파 인도 하에, 외래에서, 국소 마취로 쉽게 삽입되었다. 말초 삽입 중심 정맥관 삽입은 잦은 출혈을 보이는 혈우병 환자에게 사용해 볼 수 있는 방법이다.