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Impact of a 'Proactive Self-Audit Program of Fraudulent Claims' on Healthcare Providers' Claims Patterns: Intravenous Injections (KK020) (부당청구 예방형 자율점검제가 의료기관의 청구행태에 미치는 영향: 정맥 내 일시주사(KK020)를 중심으로)

  • Hee-Hwa Lee;Young-Joo Won;Kwang-Soo Lee;Ki-Bong Yoo
    • Health Policy and Management
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    • v.34 no.2
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    • pp.163-177
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    • 2024
  • Background: This study aims to examine changes in fraudulent claim counts and total reimbursements before and after enhancements in counterfeit claim controls and monitoring of provider claim patterns under the "Proactive self-audit pilot program of fraudulent claims." Methods: This study used the claims data and hospital information (July 2021-February 2022) of the Health Insurance Review and Assessment Service. The data was collected from 1,129 hospitals assigned to the pilot program, selected from the providers who filed a claim for reimbursement for intravenous injections. Paired and independent t-tests, along with regression analysis, were utilized to analyze changing patterns and factors influencing claim behaviors. Results: This program led to a reduction in the number of fraudulent claims and the total amount of reimbursements across all levels of hospitals in the experimental groups (except for physicians below 40 years old). In the control group, general hospitals and hospitals demonstrated some significant decreases based on the duration since opening, while clinics showed significant reductions in specified subjects. Additionally, a notable increase was observed among male physicians over the age of 50 years. Overall, claims and reimbursements significantly declined after the intervention. Furthermore, a positive correlation was found between hospital opening duration and claim numbers, suggesting longer-established hospitals were more likely to file claims. Conclusion: The results indicate that the pilot program successfully encouraged providers to autonomously minimize fraudulent claims. Therefore, it is advised to extend further support, including promotional activities, training, seminars, and continuous monitoring, to nonparticipating hospitals to facilitate independent improvements in their claim practices.

Eros, Seduction for Redemption (에로스, 구원을 위한 유혹)

  • Jeeyoun Kim
    • Sim-seong Yeon-gu
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    • v.33 no.1
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    • pp.1-60
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    • 2018
  • The paper was inspired by Jung's words in the Red Book "just as Christ tormented the flesh through the spirit, the God of this time will torment the spirit through the flesh." I propose that the new form of torment in this era could be eroticism as a way of the individuation process because it seems to be one of a very few ways left to modern men to grasp the sense of permanence, the essence of the divine, without religion because of its peculiar nature of transcendence. I suppose that it is not only a man who is tortured but also god is in torment since the divine needs a man as a womb for his incarnation. Therefore I suggest that man and god are fated to seduce each other to be redeemed by each other. I imagine that Eros with numinous sexuality seduces a man who has potentials for the god's incarnation and who would be willing to give in to the god's demand. This god needs a man who desires his essence of perpetuity, the eternal water of life, in ecstasy. Thus the purpose of the divine's seduction is to make a man awake from unconsciousness to pursue god himself, namely the individuation process. I call such divine seduction "eroticism of god" There seem to be a certain type of people who are destined to live eroticism as a way of individuation process. Through investigations, a melancholic tendency appears to be suitable for this type of individuation. Melancholia is deeply related to the poignant awareness of impermanence as the existential condition, which is a precondition for seeking permanence through eroticism. Melancholia essentially causes deep longing for eternity that bears fulfillment, which exists in eroticism, so melancholic agony seems inevitable for eroticism as the path for individuation in that, without knowing about deficiency, we never seek what is lacking in us. It can also be viewed that while a lover is driven to seduce lost love, what actually waits to become seduced for redemption is the god of love itself behind the human beloved. Man and god are fated to seduce each other for redemption. I suppose that the initiation to Eros implies how to seduce Eros. In a woman's psyche, psychological virginity is one of the essential qualities that her ego needs to attain. To the male it is vital to live his sensuality thoroughly and to experience his own and his lover's emotions to their limit. It cannot be an easy task because it demands us to give up our egotism entirely. Through eroticism, unconsciousness seduces us to make us live life as a whole. The god of love brings powerful sexuality as a means of "spiritual crisis" to redeem our lukewarm soul. Only a few can withstand the experience since it requires a strong will to bear the brunt of the sword despite the keen awareness that it may leave us bleeding in pain.

Improvement of a Black Soybean Line With Green Cotyledon and Triple Null Alleles for P34, 7S α' Subunit, and Lectin Proteins (P34, 7S α' Subunit 및 Lectin 단백질이 없는 녹색자엽을 가진 검정콩 계통 개발)

  • Sarath Ly;Sang In Shim;Min Chul Kim;Jin Young Moon;Jong Il Chung
    • Journal of Life Science
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    • v.34 no.5
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    • pp.313-319
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    • 2024
  • Cultivars or genetic resources with a black seed coat and green cotyledons are rich in lutein, which can promote eye health, and anthocyanin, known for its numerous health benefits. However, mature seeds also contain P34, 7S α' subunit, and lectin proteins, which are allergenic and degrade quality. Here, we report the breeding of a new soybean line with a black seed coat, green cotyledon, and free of P34, 7S α' subunit, and lectin proteins. A total of 157 F2 seeds with black seed coats and green cotyledons were selected by crossing a female parent with a brown seed coat, green cotyledon, and lacking the 7S α' subunit and lectin proteins with a male parent with a black seed coat, green cotyledon, and lacking the P34 and lectin proteins. The P34 and 7S α' subunit proteins were consistent with a ratio of 9:3:3:1, indicating that they are independent of each other. From 14 F2 seeds that were recessive (cgy1cgy1p34p34) for both proteins, one individual F2 plant (F3 seeds) with the desired traits-black seed coat, green cotyledon, and lacking P34, 7S α' subunit, and lectin proteins- was finally selected. The triple null genotype (absence for P34, 7S α' subunit, and lectin proteins) was confirmed in random F3 seeds. The selected line has a black seed coat and green cotyledons, and when sown on June 14 in the greenhouse, the maturity date was approximately October 3, the height was about 68 cm, and the 100-seed weight was about 26.5 g.

A Study on the Radioprotection Effect of Selenium and Arginine Mixtures for Reducing Radiation Damage to Police SOU (경찰특공대 요원의 방사선손상 감소를 위한 셀레늄과 아르기닌 혼합물의 방호효과 연구)

  • Geun-Woo Jeong;Hae-Suk Kim;Jae-Hyeong Park;Sung-Hyun Joo;Jae-Gyeong Choi;Se-Im Cheon;Byung-In Min
    • Journal of the Korean Society of Radiology
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    • v.18 no.2
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    • pp.119-125
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    • 2024
  • The purpose of this study is to examine the radioprotection effect of mixtures of selenium and arginine for development of radioprotection agents that can minimize radiation damage to police special operation unit in the event of radioactive terrorism. In this study 72 male rats were classified into 4 groups: normal group(NC Group), selenium and arginine mixtures administration group(SeAr Group), radiation exposure group(IR Group), and selenium and arginine mixture administration group followed by radiation exposure(SeAr+IR Group). The 7Gy of X-ray was irradiated to whole body of SD rats. And selenium and arginine were dministered orally at 3mg/kg and 150mg/kg once a day for 14 days. And then hematological and histological analyzes were performed on days 1, 7, and 21 after radiation exposure. In hemotological analysis, significant radioprotection wes observed in lymphocytes(p<0.05) on day 1, platelet(p<0.01) on day 7, red blood cell(p<0.01) on day 21 of radiation exposure in SeAr+IR group compared to IR group. In histological analysis, it was observed that the border of small crypt cells in the small intestine was less collapsed and the length of small crypts was relatively recovered on day 7 and showed that the number of cells and cell wall thickness were better in the prostate on day 21 in SeAr+IR group compared to IR group. Therefore, it is judged that selenium and arginine mixtures have radioprotection effect on blood and tissues due to radiation exposure. it will be helpful for research on radioprotection agents to reduce radiation damage to police special operation unit.

Re-validation of the Revised Systems Thinking Measuring Instrument for Vietnamese High School Students and Comparison of Latent Means between Korean and Vietnamese High School Students (베트남 고등학생을 대상으로 한 개정 시스템 사고 검사 도구 재타당화 및 한국과 베트남 고등학생의 잠재 평균 비교)

  • Hyonyong Lee;Nguyen Thi Thuy;Byung-Yeol Park;Jaedon Jeon;Hyundong Lee
    • Journal of the Korean earth science society
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    • v.45 no.2
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    • pp.157-171
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    • 2024
  • The purposes of this study were: (1) to revalidate the revised Systems Thinking Measuring Instrument (Re_STMI) reported by Lee et al. (2024) among Vietnamese high school students and (2) to investigate the differences in systems thinking abilities between Korean and Vietnamese high school students. To achieve this, data from 234 Vietnamese high school students who responded to translated Re_STMI consisting of 20 items and an Scale consisting of 20 items were used. Validity analysis was conducted through item response analysis (Item Reliability, Item Map, Infit and Outfit MNSQ, DIF between male and female) and exploratory factor analysis (principal axis factor analysis using Promax). Furthermore, structural equation modeling was employed with data from 475 Korean high school students to verify the latent mean analysis. The results were as follows: First, in the item response analysis of the 20 translated Re_STMI items in Vietnamese, the Item Reliability was .97, and the Infit MNSQ ranged from .67 to 1.38. The results from the Item Map and DIF analysis align with previous findings. In the exploratory factor analysis, all items were loaded onto intended sub-factors, with sub-factor reliabilities ranging from .662 to .833 and total reliability at .876. Confirmatory factor analysis for latent mean analysis between Korean and Vietnamese students yielded acceptable model fit indices (χ2/df: 2.830, CFI: .931, TLI: .918, SRMR: .043, RMSEA: .051). Lastly, the latent mean analysis between Korean and Vietnamese students revealed a small effect size in systems analysis, mental models, team learning, and shared vision factors, whereas a medium effect size was observed in personal mastery factors, with Vietnamese high school students showing significantly higher results in systems thinking. This study confirmed the reliability and validity of the Re_STMI items. Furthermore, international comparative studies on systems thinking using Re_STMI translated into Vietnamese, English, and other languages are warranted in the context of students' systems thinking analysis.

Prevalence and Associated Factors of Depressive Symptoms Among Elderly Individuals in Rural Areas of Jeju Island (제주 농촌 지역 노인들의 우울증상 유병률 및 관련 요인)

  • Hyun Ju Yang;Min Su Oh;Woo Young Im;Sung Wook Song
    • Korean Journal of Psychosomatic Medicine
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    • v.32 no.1
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    • pp.43-51
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    • 2024
  • Objectives : This study aims to explore the prevalence of depressive symptoms among elderly residents in the relatively stable rural areas of Jeju and to examine the relationships between levels of depression, sociodemographic factors, and health habits. Methods : The study site was within rural Jeju, where elderly individuals aged 65 and older were randomly selected from the 'Agricultural Cohort' registered at the Centers for Farmers' Safety and Health Center. Trained interviewers conducted surveys using the Short Form Geriatric Depression Scale (sGDS-K), defining those with scores of 6 or above as experiencing depressive symptoms for the analysis. Other variables such as sex, age, educational level, marital status, annual income, subjective health status, underlying disease, perceived stress levels, smoking, and drinking status were also recorded Results : Out of 533 subjects, the prevalence of depressive symptoms was 35.3%, with 28.5% in male and 45.6% in female (p<0.001). Factors significantly associated with the prevalence of depressive symptoms included marital status (p=0.014), educational level (p<0.001), annual income (p=0.034), subjective health status (p<0.001), perceived stress level (p<0.001), feeling of despair (p<0.001) and suicidal ideas (p<0.001). Multivariate logistic regression analysis revealed that subjective health status, perceived stress level, and feelings of despair were associated with the prevalence of depressive symptoms. Conclusions : The high prevalence of depressive symptoms among the rural elderly in Jeju highlights the need for targeted mental health interventions. Addressing sociocultural factors and improving early detection and intervention strategies can help reduce the socioeconomic impact of depression in this population.

The Spectrum of CT Findings of COVID-19 Pneumonia: Acute Alveolar Insult and Organizing Pneumonia as Different Phases of Lung Injury and Repair (COVID-19 폐렴의 다양한 CT 영상 소견: 급성 폐포 손상과 기질화 폐렴)

  • Yun Su Kim;Ung Rae Kang;Young Hwan Kim
    • Journal of the Korean Society of Radiology
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    • v.82 no.2
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    • pp.359-370
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    • 2021
  • Purpose To analyze the findings and serial changes in chest CT lesions in 123 symptomatic patients with coronavirus disease 2019 (COVID-19). Materials and Methods From February 19 to April 7, 2020, a total of 123 confirmed COVID-19 patients (male, 44; female, 79; mean age, 59.2 ± 18.6) were enrolled in this retrospective study. A total of 234 CT scans were reviewed for the following patterns: acute alveolar insult (AAI) patterns: ground-glass opacity (GGO), crazy-paving appearance, mixed pattern, and consolidation; organizing pneumonia (OP) patterns: perilobular patterns, band opacity, curvilinear opacity, reversed halo opacity, and small nodular consolidation; resolving patterns: pure GGO, remnant curvilinear, small nodular consolidation, and serial changes of lung abnormalities. We compared the proportions of AAI pattern, OP pattern, or resolving pattern with time progression and analyzed the association between the patterns and disease severity using Pearson chi-square and Fisher's exact test. Results Predominant CT patterns were AAI pattern (87%) in the early hospital period group (0-10 days, after the onset of symptoms), OP pattern (45.7%) in the later hospital period group (after 10 days), and resolving pattern in discharge and follow-up group (47.2% and 84.8%, respectively). The difference in the proportions of predominant CT patterns with time progression was statistically significant (p < 0.001, Pearson's chi-square test). No statistically significant association was observed between the patterns and disease severity (p = 0.055, Fisher's exact test). No fibrous changes in the lesions were observed on follow-up CT scans. Conclusion The serial CT scans of COVID-19 patients showed the spectrum of COVID pneumonia CT manifestations as different phases of lung injury and repair.

Bronchopleural Fistula after Surgery: Therapeutic Efficacy of Bronchial Occluders (수술 후 기관지늑막루: Bronchial Occluder Device의 치료 효과)

  • Young Min Han;Heung Bum Lee;Gong Yong Jin;Kun Yung Kim
    • Journal of the Korean Society of Radiology
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    • v.82 no.2
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    • pp.371-381
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    • 2021
  • Purpose To evaluate the usefulness and effectiveness of bronchial occluders in the treatment of postoperative bronchopleural fistula (BPF). Materials and Methods The subjects of the study were six out of seven postoperative BPF patients who underwent surgery due to tuberculosis or lung cancer between 2009 and 2019. Each patient had a bronchial occluder inserted to treat BPF that occurred after surgery. Of the six patients, five had lung cancers and one had tuberculosis. Five were male and one was female; their ages ranged from 59 to 74 years, with an average of 69 years. The diagnosis of BPF was based on findings from bronchoscopy and CT, and treatment was initiated approximately 1 to 2 weeks after diagnosis. The technical and clinical success of the bronchial occluders in the treatment of BPF was evaluated. The study assessed the postoperative clinical effects of the occluders, survival duration, and additional treatments. Results All six patients were successfully treated. Clinical success was achieved in five patients, while partial clinical success was achieved in one; there was no clinical failure. No complications during the migration of the device or device perforations were observed. Two patients were diagnosed with BPF by CT, while four were diagnosed by bronchoscopy. Lobectomy, bilobectomy, and pneumonectomy were performed on two patients each. The periods between surgery and diagnosis ranged from 1 to 34 months; the average was 10 months. Four patients (59-103 days; an average of 80.5 days) died and two (313 days, 3331 days) survived. The causes of death were aggravation of the underlying disease (n = 2), pulmonary edema and pleural effusion (n = 1), and pneumonia (n = 1). Additional catheter drainage was performed in one patient, and a chest tube was maintained in two patients. Conclusion Bronchial occluders are useful and effective in the treatment of BPF after pulmonary resection.

Traumatic Hemothorax Caused by Thoracic Wall and Intrathoracic Injuries: Clinical Outcomes of Transcatheter Systemic Artery Embolization (흉벽 및 흉곽 내 장기 손상으로 인한 외상성 혈흉: 전신 동맥 색전술의 임상 결과)

  • Chang Mu Lee;Chang Ho Jeon;Rang Lee;Hoon Kwon;Chang Won Kim;Jin Hyeok Kim;Jae Hun Kim;Hohyun Kim;Seon Hee Kim;Chan Kyu Lee;Chan Yong Park;Miju Bae
    • Journal of the Korean Society of Radiology
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    • v.82 no.4
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    • pp.923-935
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    • 2021
  • Purpose We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. Materials and Methods Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. Results Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. Conclusion TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency surgery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.

Light-Chain Cardiac Amyloidosis: Cardiac Magnetic Resonance for Assessing Response to Chemotherapy

  • Yubo Guo;Xiao Li;Yajuan Gao;Kaini Shen;Lu Lin;Jian Wang;Jian Cao;Zhuoli Zhang;Ke Wan;Xi Yang Zhou;Yucheng Chen;Long Jiang Zhang;Jian Li;Yining Wang
    • Korean Journal of Radiology
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    • v.25 no.5
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    • pp.426-437
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    • 2024
  • Objective: Cardiac magnetic resonance (CMR) is a diagnostic tool that provides precise and reproducible information about cardiac structure, function, and tissue characterization, aiding in the monitoring of chemotherapy response in patients with light-chain cardiac amyloidosis (AL-CA). This study aimed to evaluate the feasibility of CMR in monitoring responses to chemotherapy in patients with AL-CA. Materials and Methods: In this prospective study, we enrolled 111 patients with AL-CA (50.5% male; median age, 54 [interquartile range, 49-63] years). Patients underwent longitudinal monitoring using biomarkers and CMR imaging. At follow-up after chemotherapy, patients were categorized into superior and inferior response groups based on their hematological and cardiac laboratory responses to chemotherapy. Changes in CMR findings across therapies and differences between response groups were analyzed. Results: Following chemotherapy (before vs. after), there were significant increases in myocardial T2 (43.6 ± 3.5 ms vs. 44.6 ± 4.1 ms; P = 0.008), recovery in right ventricular (RV) longitudinal strain (median of -9.6% vs. -11.7%; P = 0.031), and decrease in RV extracellular volume fraction (ECV) (median of 53.9% vs. 51.6%; P = 0.048). These changes were more pronounced in the superior-response group. Patients with superior cardiac laboratory response showed significantly greater reductions in RV ECV (-2.9% [interquartile range, -8.7%-1.1%] vs. 1.7% [-5.5%-7.1%]; P = 0.017) and left ventricular ECV (-2.0% [-6.0%-1.3%] vs. 2.0% [-3.0%-5.0%]; P = 0.01) compared with those with inferior response. Conclusion: Cardiac amyloid deposition can regress following chemotherapy in patients with AL-CA, particularly showing more prominent regression, possibly earlier, in the RV. CMR emerges as an effective tool for monitoring associated tissue characteristics and ventricular functional recovery in patients with AL-CA undergoing chemotherapy, thereby supporting its utility in treatment response assessment.