• Radiation Oncology Journal
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• 제12권3호
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• pp.387-392
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• 1994

Purpose : This study was done to confirm the reference point variation according to variation in applicator configuration in each fractioation of HDR ICR. Materials and Methods : We analyzed the treatment planning of HDRICR for 33 uterine cervical cancer patients treated in department of therapeutic radiology from January 1992 to February 1992. Analysis was done with respect to three view points-Interfractionation A point variation, interfractionation bladder and rectum dose ratio variation, interfractionation treatment volume variation. Interfractionation A point variation was defined as difference between maximum and minimum distance from fixed rectal point to A point in each patient. Interfractionation bladder and rectum dose ratio variation was defined as difference between maximum and minimum dose ratio of bladder or rectum to A point dose in each patient, Interfractionation treatment volume variation was defined as difference between miximum and minimum treatment volume which absorbed over the described dose-that is, 350 cGy or 400 cGy-in each patient. Results The mean of distance from rectum to A point was 4.44cm, and the mean of interfractionation distance variation was 1.14 cm in right side,1.09 cm in left side. The mean of bladder and rectum dose ratio was $63.8\%$ and $63.1\%$ and the mean of interfractionation variation was $14.9\%$ and $15.8\%$ respectively. With fixed planning administration of same planning to all fractionations as in first fractionation planning-mean of bladder and rectum dose ratio was $64.9\%$ and $72.3\%$.and the mean of interfraction variation was $28.1\%$ and $48.1\%$ reapectively. The mean of treatment volume was $84.15cm^3$ and the interfractionation variation was $21.47cm^2$. Conclusion : From these data, it was confirmed that there should be adapted planning for every fractionation ,and that confirmation device installed in ICR room would reduce the interfractionation variation due to more stable applicator configuration.

• Clinics in Shoulder and Elbow
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• 제26권2호
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• pp.156-161
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• 2023

Background: We analyzed association between viewing two-dimensional computed tomography (2D CT) images in addition to radiographs with radial head treatment recommendations after accounting for patient and surgeon factors in a survey-based experiment. Methods: One hundred and fifty-four surgeons reviewed 15 patient scenarios with terrible triad fracture dislocations of the elbow. Surgeons were randomized to view either radiographs only or radiographs and 2D CT images. The scenarios randomized patient age, hand dominance, and occupation. For each scenario, surgeons were asked if they would recommend fixation or arthroplasty of the radial head. Multi-level logistic regression analysis identified variables associated with radial head treatment recommendations. Results: Reviewing 2D CT images in addition to radiographs had no statistical association with treatment recommendations. A higher likelihood of recommending prosthetic arthroplasty was associated with older patient age, patient occupation not requiring manual labor, surgeon practice location in the United States, practicing for five years or less, and the subspecialties "trauma" and "shoulder and elbow." Conclusions: The results of this study suggest that in terrible triad injuries, the imaging appearance of radial head fractures has no measurable influence on treatment recommendations. Personal surgeon factors and patient demographic characteristics may have a larger role in surgical decision making. Level of evidence: Level III, therapeutic case-control study.

• 대한방사선기술학회지:방사선기술과학
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• 제36권2호
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• pp.131-139
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• 2013

복부 전산화단층촬영 후 3차원 볼륨렌더링으로 재구성한 영상을 분석하여 복부대동맥에서 분지하는 복강축과 위창자간막동맥을 기준으로 해부학적 변위를 분류하여 평가하고자 하였다. 복부 전산화단층혈관촬영을 시행한 613명 환자의 3차원 볼륨렌더링 영상을 이용하여 해부학적 변위를 형태별로 분류한 결과 552명(Type I, II)은 정상 구조에 속하였고, 61명(Type III~XII)은 변위로 분류하였다. Type I이 339명 (55.31%), Type II가 213명(34.74%)으로 나타났으며 변위로 분류된 경우는 Type III은 18명(2.93%), Type IV는 12명 (1.95%), Type V는 11명 (1.79%), Type VI는 9명 (1.46%), Type VII는 6명 (0.97%)으로 나타났으며, Type VIII~XII는 각각 1명 (0.16%)으로 전혀 새로운 변위형태로 분류되었다. 결론적으로 복강축과 위창자간막동맥을 기준으로 변위를 분류한 결과 그동안 간동맥 중심의 해부학적 변위 분류에서는 관찰되지 않았던 9가지의 새로운 변위형태를 파악할 수 있었다. 이는 새로운 혈류지도를 만드는 중요한 자료로 이용될 수 있을 것으로 사료된다.

• 보건행정학회지
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• 제30권1호
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• pp.82-91
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• 2020

Background: This study investigates the influence factors of medical service variations using medical charge and the length of stay (LOS) for urinary incontinence surgery and uterine polypectomy. Methods: The National Health Insurance claims data and Medical Resource Report by the Health Insurance Review & Assessment Service in 2016 were used. Frequency analysis, one-way analysis of variance, and Bonferroni post-hoc tests were executed for each surgery. A multilevel analysis was executed to assess the factors to the medical charge and LOS for each surgery in patient, doctor, and hospital level. Results: Fifty-two point eight percent of urinary incontinence surgery and 87.1% of uterine polypectomy were distributed in general and tertiary hospitals. Among three levels, the patient level variation was 61.5% or 77.2% in medical charge and 93.9% or 96.3% in LOS, respectively. The doctor level variation was 29.6% or 22.6% in medical charge and 0.6% or 0.0% in LOS, respectively. The institution level variation was 8.9% or 0.2% in medical charge and 5.5% or 3.7% in LOS, respectively. Number of other disease and organizational type were main factors that affected the charge and LOS for urinary incontinence surgery and uterine polypectomy. Conclusion: Medical service variations of the urinary incontinence surgery and uterine polypectomy were the largest for the patient level, followed by doctor level for the medical charge, and the institution level for the LOS.

• International Journal of Quality Innovation
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• 제4권1호
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• pp.46-53
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• 2003

Under the strong leadership of Chinese Government to the anti-SARS struggle, the situation has been successfully controlled. Since May 1 of 2003, the Ministry of Health of China published daily the number of newly increased SARS patient of Beijing, the authors analyzed these data using $X_cs$$-R_scs$ cause-selecting control charts of Statistical Diagnosis(SPD) Theory. Data about number of newly increased SARS patient consists of two kinds of variation: random variation and tendency variation of SARS epidemic. It is concluded that SARS epidemic of Beijing was already controlled since May 9 of 2003.

• 보건행정학회지
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• 제29권2호
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• pp.220-227
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• 2019

Background: Potentially avoidable hospitalizations (PAH) contribute to an increased post-discharge mortality. Methods: To investigate the between-hospital variation and the relationship between all predictors and mortality after discharge among older adults with PAH, we studied 15,186 older patients with PAH in 2,200 hospitals included in the National Health Insurance Service-Senior claims database from 2002 to 2013. Multivariable multilevel logistic regression analyses were performed to analyze the variance at between-hospital for mortality after accounting for differences in patient characteristics. Results: The between-hospital variation in mortality that could be attributed to hospital practice variations were 37.6% at 1-week to 13.9% at 12-month post-discharge, after adjustment for individual patient characteristics and hospital-level factors. Hospital-level factors significantly explained mortality at 3 weeks after discharge. Clinics, compared with general hospitals, demonstrated a 2.75 times higher likelihood of deaths at 3-week post-discharge (p<0.001). Compared with private hospitals, public hospitals exhibited 1.61 times higher odds of 3-week mortality (p=0.01). Conclusion: This study demonstrates considerable between-hospital variations in PAH-related mortality that could be attributed to hospital practices. Monitoring of hospitals to identify practice variations would be warranted to improve the survival of older patients with PAH.

• 한국산학기술학회논문지
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• 제11권4호
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• pp.1511-1519
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• 2010

지역별 의료서비스 이용의 변이를 파악하고 이를 기반으로 지역주민들이 양질의 의료서비스를 적절하게 이용할 수 있도록 하는 정책 방안에 대한 연구가 필요하다. 이에 본 연구는 2005년 환자조사 자료를 이용하여 우리나라의 병원급 이상 의료기관을 이용한 입원환자의 지역별 의료이용의 변이와 이에 영향을 미치는 요인에 대해 살펴보았다. 지역별 의료이용의 변이에 성, 연령과 같은 지역별 인구구조의 차이에 의한 효과는 직접표준화 방법을 이용하여 보정하였다. 분석결과 시도별, 시군구별 표준화 퇴원율, 표준화 재원일수는 차이가 있었으며, 표준화 퇴원율, 표준화 재원일수에 영향을 미치는 요인은 도시규모, 인구10만명당 병상수로 나타났다.

• 보건행정학회지
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• 제16권2호
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• pp.77-95
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• 2006

The present study was conducted to examine the degree of variation in length-of-stay (LOS) among health care institutions participating in 17 diagnosis-related groups (DRGs) payment system and to find out hospital characteristics affecting the variation. Electronic medical claims data for treatments of severity classification '0' of 17 DRGs provided for two $years(2003{\sim}2004)$ were collected. For each DRG, the degree of variation in average LOS among health care institutions were analyzed using the random effect model. For DRGs showing significant differences in LOS, multiple regression analyses were performed to find out factors associated with LOS. Significant variations in LOS were observed 9 DRGs including unilateral/bilateral lens procedures, adult/child tonsilectomy, other anal procedures, bilateral adult/child herniorraphy, unilateral child herniorraphy, and hysterectomy, and hysterectomy using laparoscopic procedure. Among the 9 DRGs, five DRGs were selected to investigate the factors explaining for the variation. It was observed that the location of institution was significant predictors for all five DRGs. Within the same DRGs, LOS was significantly shorter among the institutions located in Seoul than those in other areas. As compared to clinics, hospitals and general hospitals/tertiary care institutions showed significantly longer LOS for DRGs of lens procedures, tonsilectomy, and other anal procedures. It is recommended that the institutions located in other than Seoul area benchmark the strategies of the institution in Seoul in efficiently managing LOS. Also, significant variation within the same severity classification such as other anal procedures implies the imminent need for improvement of patient classification system.

• Communications for Statistical Applications and Methods
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• 제13권3호
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• pp.701-718
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• 2006

In cancer microarray experiments, the experimenter or patient which is nested in each experimenter often shows quite heterogeneous error variability, which should be estimated for identifying a source of variation. Our study describes a Bayesian method which utilizes clinical information for identifying a set of DE genes for the class of subtypes as well as assesses and examines the experimenter effect and patient effect which is nested in each experimenter as a source of variation. We propose a Bayesian multilevel mixed effect model based on analysis of covariance (ANACOVA). The Bayesian multilevel mixed effect model is a combination of the multilevel mixed effect model and the Bayesian hierarchical model, which provides a flexible way of defining a suitable correlation structure among genes.

• 한국균학회지
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• 제6권2호
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• pp.15-18
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• 1978

The study was performed to investigate the inhibitory action on the growth rate of Candida albicans under the various immunological conditions, Candida albicans was grown in broth media containing 0.1ml. (in total broth volume 4.0ml.) of normal human serum, diabetic patient serum, albumin solution, artifical bulla content and nutrient solution as control subject. The inhibitory action of Candida albicans was indicated by mesurement of transparency rate with use of the spectrophotometer. The results are as follows: 1. Normal human serum shows inhibitory effect on the growth of the candida distinctly. 2. Albumin solution reveals almost similar to that of the effect of normal human serum. 3. Artificial bulla content which obtained by irradiation of ultraviolot ray after application of 1% 8-Methoxy-psolaren cream and the diabetic patient serum shows reduction of inhibitory effect as compared with that of the normal human serum. 4. It is estimated that the titer of negative effect of diabetic patient serum is not related with the variation of immunoglobulin titer in patient serum.