• 한방재활의학과학회지
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• 제25권3호
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• pp.11-26
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• 2015

Objectives The purpose of this study is to assess the quality of spinal disease focusing on Korean medical hospital admission patients. Methods The disease code related to spinal disease was selected based on the contents of development of clinical quality indicators for spinal disease. The assessment analysis of feasibility was conducted through medical history analysis that targets spinal disease patients, current development of clinical quality indicators for spinal disease, and relevant literature. Results The indicator items of structure, process, and results were classified and selected, and so were the detailed indicator entries. After that, the appropriate reference value was chosen. The final selected quality indicators were 3 items from structure, 9 items from process, 4 items from results, including 3 monitoring items, total 16 items was chosen. Conclusions Clinical research for the adequacy assessment should be conducted and the index entry and indicators should be reassessed through an expert group discussion. Training for the evaluation indicators and association with relevant society will motivate hospitals to voluntarily improve their quality.

• 한국보건간호학회지
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• 제19권1호
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• pp.129-138
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• 2005

As the patients who need to undergo liver transplant operation continues to grow. the number of livers that are donated can not keep pace with the demand. With the development of surgery skills, the necessity for operations from living donors is increasing. Nevertheless, satisfactory research has been conducted on the factors which generally affect the living donors. In this article. therefore. researchers focused on the factors which generally affect the donating liver donor in order to design a plan for recommending liver donation from living donors. The subjects were 91 living liver donors in C university hospital from October 1. 2000 to December 31. 2003. The results on the uncertainty of living donor, by test sheet. were analyzed with SAS program. The final results were as follows: 1. The uncertainty of the living donors was 51.54 marks per full credit 100. 2. The factor with the greatest effect on donation was the possibility of survival of the donor, followed by the admission period. marriage status and age. In recommending the living donation, the rate of donor survival after the operation was 5.2 times higher than death, 5.2 times higher when the admission period was under 20 days. 5.0 times higher when married. and 27.3 times higher when the family-related donation was very active at the age of 20s than in the 50s. These results suggest that all medical staffs should care for living donors with more interest and activity to give them the least complaints in admission and the lowest possibilities for complication. To enhance the survival rate and improve the surgical success rate. on-going monitoring should include regular health-checks. and continual efforts and education should be made to care for the health condition of the living donors after donation.

• 한국환경보건학회지
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• 제38권3호
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• pp.184-194
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• 2012

Objectives: We investigated the effects of air pollution on allergic diseases (allergic rhinitis, asthma, atopic dermatitis) in metropolitan cities in Korea, adjusting for meteorological factors. Methods: Data on daily hospital visits and hospital admissions for 2003-2010 was obtained from the National Health Insurance Cooperation. Meteorological data was obtained from the Korea Meteorological Administration. We then calculated daily mean temperature, daily mean humidity, daily mean air pressure at sea level, and diurnal temperature range. We used data on air pollution provided by the National Institute of Environmental Research. Maximum daily eight-hour average ozone concentrations and the daily mean $PM_{10}$ were used. We estimated excess risk and 95% confidence interval for the increasing interquatile range (IQR) of each air pollutant using Generalized Additive Models (GAM) that appropriate for time series analysis. Results: In this study, we observed an association between ozone and hospital visits for allergic rhinitis, asthma, and atopic dermatitis in all metropolitan cities, adjusting for temperature, humidity, air pressure at sea level, diurnal temperature range, and day of the week. Ozone was associated with hospital visits for allergic rhinitis, asthma, and atopic dermatitis across all metropolitan cities. However $PM_{10}$ was associated with allergic-related diseases in only select cities. Also, ozone and $PM_{10}$ were associated with hospital admission for asthma in all cities except Gwangju. Hospitalization for the other diseases failed to show consistent association with air pollutants. Conclusion: In the findings of this study, there was a significant association between air pollutants and allergic-related diseases. More detailed research subdivided age group or conducting meta-analyses combining data of all cities is required.

• 한국의료질향상학회지
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• 제7권1호
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• pp.118-131
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• 2000

Background : A continuous healthcare quality improvement is needed to provide high quality healthcare service as well as to maintain trust in terms of satisfying the needs of the patients. Recently it also became an essential issue. in hospital management, recognized for it's competitive potentiality among healthcare organization groups. This study was conducted to analyze patient complaints and issues received by the Quality Improvement Department. Its purpose is to improve healthcare qualities within the hospital, as well as establish policies and appropriate strategies in hospital management. Method : From July 1st to September 30th of the year 1999, we analyzed all complaints and issues made by various patients and their families, which were received through 24 hour phone consultation, numerous suggestion boxes, letters and E-mails, The issues were classified into 16 different categories based on a Patient Satisfaction Assessment Tool. All data were segregated according to the departmental frequencies and their contents. To come up with for environmental and patient satisfaction improvement, all complaints or issues were communicated with hospital administrators, medical and nursing staff and employees. Comprehensive customer satisfaction activities including improving phone etiquette were discussed in Customer Satisfaction Team, CQI Team and each Department. All opportunities for improvement were implemented. Feedback actions were discussed. Results : A total of 317 cases were collected. Issues regarding parking and other accommodation facilities were most common complaints that were 14.5% of total. Issues regarding admission rooms (10.7%), admission procedures (10.7%), waiting room environment (8.8%), nurses and nurse assistants (7.6%), physicians (6.6%) and others (23%) followed. Thirteen of 45 departments received more than 8 complaints. The Nursing Department had the most complaint, receiving 9.8% of total complaints. Complaints regarding the Nursing Department were predominantly related to the environment of patient rooms. The Department of Psychiatry for phone etiquette (4.7%), Department of Otolaryngology for the nursing staff's attitude and phone etiquette (4.4%), and the Admission Department followed. As a part of efforts to improve patient satisfaction, a new parking structure was built and reallocation of the parking space was done. Renovation of other accommodation facilities were carried out by hospital administration, Monthly phone call and answering attitude survey was done by QI Department. Based on this survey we made a phone etiquette manual and distributed throughout the hospital. Compare to the last year, Patient Satisfaction Index measured by Korea Productivity Center using National Customer Satisfaction Index was improved 7 points. According to our organization's own study, we confirmed the phone etiquette was improved 11% than last year. Conclusions : Issues related to parking and other accommodation facilities ranked first followed by complaints made regarding the patient care area, the admission and cashier process, and nurses' and doctors' attitude. The Nursing and Psychiatry Departments need improvement regarding phone etiquette. Results were shared and played a vital role in policymaking and strategic planning of the hospital. It is imperative that we keep our database updated by listening to and solving the needs of each patient. The CQI activities can be achieved only by full commitment of the hospital top management supported by related personal.

• 생물정신의학
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• 제19권3호
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• pp.115-120
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• 2012

Objectives : Event-related potentials have been suggested as an objective marker for brain functions in psychiatric disorders. This study was aimed to investigate the relationships between P300, the mismatch negativity (MMN), the loudness dependence of the auditory evoked potential (LDAEP), demographic and clinical variables including neurocognitive abilities in patients with schizophrenia. Methods : P300, the MMN, and the LDAEP were measured and the Korean Stroop color-word test (K-stroop test) and the Wisconsin Card Sorting Test (WCST) were performed in 43 patients with schizophrenia. The relationship of the latency and amplitude of P300 and the MMN as well as regression slope of the LDAEP with demographic and clinical variables were analyzed by t-test and correlation analyses for categorical and continuous variables, respectively. Results : After controlling for age, the latency of central (Cz) and parietal (Pz) P300 posivitively correlated with GAF at admission (Cz ; ${\gamma}$ = 0.385, p = 0.047, Pz ; ${\gamma}$ = 0.421, p = 0.029). The amplitude of parietal P300 correlated with the correction rate of the K-stroop test (${\gamma}$ = 0.575, p = 0.002). In addition, the frontal (Fz) P300 latency tended to negatively correlated with the correction rate of the WCST (${\gamma}$ = -0.371, p = 0.057). Conclusions : Our findings suggest that the values of P300 latency and amplitude might be correlated with GAF at admission and working memory measured by the K-Stroop test and the WCST. Meanwhile, the MMN and the LDAEP did not correlate with demographic and clinical variables. These results support the results of previous studies showing associations with P300 and impaired cognitive ability.

• 의학교육논단
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• 제18권2호
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• pp.90-98
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• 2016

Assessment tools for non-academic qualities such as ethics frequently employ hypothetical scenarios to lay out a contextual framework underlying the corresponding criteria of assessment. Due to the context-specific nature of the assessment criteria, details of the scenarios become very important in obtaining accurate results. This study aims to explore how medical school applicants differ in ethical decision making depending on the types of ethical dilemma scenarios, and how they correlate with academic achievements after admission. In 2014, all 82 applicants invited for an admission interview for a graduate-entry program were asked to complete a questionnaire comprised of 13 hypothetical scenarios. There were three domains (unethical business decisions, unethical academic decisions, and sexual quid pro quos) and participants were made to choose between the profitable-but-unethical choice or the unprofitable-but-ethical choice, using a four-point Likert-type scale. On average, tendencies toward unethical decisions were lowest for sexual favors ($1.34{\pm}0.46$), and highest for gaining academic advantages ($2.22{\pm}0.56$). Unethical decisions for academic advantages and sexual benefits showed significant correlation respectively with the female gender and those who graduated from overseas universities. In addition, the propensity for choosing unethical academic decisions was significantly correlated with high academic achievements in medical school (r=0.396). Not only does this study demonstrate that different levels of ethical decision making depend on the scenarios, but also those differences may be a determinant factor in subsequent academic performances in medical school. In conclusion, given the possible influence of the details of the hypothetical scenarios to the applicant's responses, careful consideration must be given during their development.

• Tuberculosis and Respiratory Diseases
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• 제70권1호
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• pp.28-35
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• 2011

Background: The aim of the study was to describe the characteristics, treatments, and outcomes of critically ill patients with pandemic Influenza A/H1N1 2009 at a major medical center in Korea. Methods: This retrospective observational study examined critically ill adult patients with pandemic Influenza A/H1N1 2009, who were admitted to the AMC between August and December 2009. Results: 27 patients with confirmed pandemic Influenza A/H1N1 2009 were admitted to the intensive care unit (ICU) at the Asan Medical Center (AMC). The median age (IQR) was 59 years (41~67), and 66.7% of the patients were older than 51 years. A total of 81.5% of the patients had 2 or more co-morbidities. The median time (IQR) from symptom onset to presentation was 2 days (1~4), and the median time from presentation to ICU admission was 0 days (0~1.5). All patients received oseltamivir (300 mg/day) and 13 patients received triple combination therapy (oseltamivir, amantadine, ribavirin). Twelve patients required mechanical ventilation on the first day of ICU admission. A total of 6 patients (22.2%) died within 28 days of admission. The patients who died had significantly higher acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores at presentation. There were no significant differences in age, co-morbidities, or antiviral regimens between survivors and non-survivors. Conclusion: Critical illness related to pandemic Influenza A/H1N1 2009 was common in elderly patients with chronic co-morbidities. All patients were given high-dose oseltamivir or triple combination antiviral therapy. Nonetheless, patients with critical illnesses associated with pandemic Influenza A/H1N1 2009 had a death rate of 22.2%.

• 한국의료질향상학회지
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• 제26권1호
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• pp.23-34
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• 2020

Purpose: This qualitative study was conducted to examine the current status and problems concerning the collection of present on admission (POA) indicators and determine how to use these indicators for evaluating the quality of care and degree of patient safety. Methods: A total of 11 health information managers were divided into two groups according to the size of their hospitals. Two focus group discussions (FGDs) were conducted, one for each group, which followed a pre-developed semi-structured guideline. The verbatim transcriptions of the FGDs were analyzed. Results: The majority of participants were concerned about entering POA flags honestly because they did not know how future POA indicators would be used. In particular, for some participants, POA N was a burden that could imply a signal of mismanagement within the medical institution. In addition, the lack of awareness and indifference of physicians regarding POA indicators were some of the difficulties for POA flag entry. Although medical institutions are making efforts to improve the accuracy of POA flagging, many participants mentioned the need to develop real case-oriented POA entry guidelines to improve the accuracy of POA flagging. Conclusion: To increase the validity of POA indicators, it is necessary to increase the level of awareness of POA indicators in physicians and other medical professionals. Furthermore, efforts related to POA indicators by individual medical institutions need to be reflected in the process evaluation.

• Journal of Korean Neurosurgical Society
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• 제29권4호
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• pp.574-579
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• 2000

Chordomas are rare central nervous system tumors that are found predominantly in the sacrococcygeal(50%) and basiosphenoidal region(35%). Most of the remainder are related to the vertebral bodies and only 1 to 2% of them are known to occur in the thoracic vertebrae. A 15-year-old girl was admitted because of paraparesis. Three months prior to admission, she underwent a lumbar laminectomy at other hospital for the treatment of herniated lumbar disc but paraparesis became rather aggravated after the operation. At admission, MRI showed a low signal T1WI, high signal T2WI mass compressing the cord at T2 vertebral body. The tumor was subtotally removed via costotransversectomy but as the tumor was proven to be a chordoma, a second stage operation via anterior route was followed. At second operation, T2 corpectomy and T1-T3 plate fixation with autogeneous ileac bone graft was performed. Shortly after the operation, preoperative paraparesis disappeared completely and no evidence of tumor recurrence was noticed both clinically and radiologically for next 2 years. Spine surgery at cervicothoracic junction may be technically demanding due to anatomical complexity and hindering large vessels. The authers reviewed this case with special emphasis on the surgical procedure in this region.

• Advances in pediatric surgery
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• 제12권2호
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• pp.147-154
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• 2006

One day surgery in children has been practiced for last 10 years in this institution. This study is to examine its safety and effectiveness for patients younger than 15 years old treated at the Department of Pediatric Surgery, Asan Medical Center, from September. 1996 to December, 2005. A total of 3,709 patients, 37 % of the total pediatric operations, are included in this retrospective study. The most prevalent ages were between 1 and 3 years olds (1,199 patients). Twenty patients were younger than 6 months, and they all had one day surgery safely. Operations were herniorrhaphy in 3,126 patients,followed by excisional biopsy, chemoport removal, and OK 432 injection. There were 12 cases (0.32 %) of unplanned admissions, 7 occurred within 6 months of one day surgery. Perioperative fever was the most common cause of admission in 4 cases. The related conditions of unplanned admission were bleeding in 2 cases and radical surgery in 2. One day surgery in this institution was easily accessible and safe. This is to the result of appropriate selection of patients, cooperation with anesthesiologists, adequate control of postoperative pain, and home care programs.