• Title/Summary/Keyword: the length of stay

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Cost Effectiveness of Clozapine and Risperidone in "Revolving Door" Schizophrenia (재발과 입원을 반복하는 만성 정신분열병 환자에서 비전형적 항정신병약물의 비용-효과)

  • Nam, Jong-Won;Lee, Min-Soo;Jeong, In-Kwa;Kwak, Dong-Il
    • Korean Journal of Biological Psychiatry
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    • v.7 no.2
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    • pp.198-205
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    • 2000
  • Objectives : Risperidone and clozapine belong to a new generation of antipsychotics that are reportedly more effective and better tolerated than conventional neuroleptics. However, each of these agents costs far more per unit than conventional neuroleptics. The purpose of our retrospective study was to ascertain the total cost and effectiveness of treatment before and after administration of risperidone and clozapine in "revolving door" schizophrenia patients. Method : Data collected on revolving door schizophrenics for 2 years before clozapine and risperidone treatment and for at least 2 years after clozapine and risperidone treatment. Direct cost of inpatient and outpatient treatment was measured. Effectiveness was scaled as "years of mild disability gained". Result : Both risperidone and cloazpine result in higher costs and additional benefits to patients, for example, increased mild disability, reduced number of relapse, and reduced hospital length-of-stay. An ICER of risperidone was less than Rc and ICER of clozapine was greater than Rc. According to decision-analytic this model, risperidone had favorable cost-effectiveness ratios relative to clozapine. Conclusion : We have assumed that risperidone is more cost-effective than clozapine.

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Inpatient Satisfaction and Dissatisfaction in Relation to Socio-demographics and Utilization Characteristics (입원환자의 사회인구학적 요인 및 의료이용 특성과 환자만족$\cdot$불만족간의 관련성)

  • Cho Sung-Hyun
    • Journal of Korean Academy of Nursing
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    • v.35 no.3
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    • pp.535-545
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    • 2005
  • Purpose: This paper reports a study exploring factors related to patient satisfaction and dissatisfaction with inpatient care. Method: A cross-sectional study design was used, employing data from the National Health and Nutrition Survey conducted in 2001. Socio-demographic factors, utilization, self-rated health status, and disease characteristics were assessed by employing univariate comparisons and multivariate logistic regression analyses. Result: Out of 37,769 respondents, 1,043 aged 20 years and over had been admitted to a hospital or clinic at least once during the past year. About a quarter of the respondents were discharged from tertiary hospitals and $21\%$ from clinics. The majority of patients ($58\%$) were satisfied with inpatient care received, whereas $11\%$ were dissatisfied. Greater satisfaction was found in patients aged 45-64 years and those having formal education, discharge from tertiary hospitals, national health insurance as a payer, medical expenses not being burdensome, good self-rated health status, and neoplasm. Living in non-metropolitan urban areas, shorter length of stay, and musculoskeletal diseases were associated with greater dissatisfaction. Conclusion: Different factors were related to patient satisfaction and dissatisfaction with care. Those factors need to be taken into account when evaluating and comparing satisfaction levels between health care institutions.

Outcome of Children with Severe Acute Malnutrition and Diarrhea: a Cohort Study

  • Bhatnagar, Sakshi;Kumar, Ruchika;Dua, Richa;Basu, Srikanta;Kumar, Praveen
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.22 no.3
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    • pp.242-248
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    • 2019
  • Purpose: Severe acute malnutrition (SAM) is an important public health problem which contributes to significant number of under five deaths. Protocol based management significantly decreases risk of deaths in children with medical complications. Methods: Outcome of children aged 2 months-5 years admitted and fulfilling definition of SAM having diarrhea (group A) was compared to children with SAM having medical complications other than diarrhea (group B). Both groups were managed according to standard recommended protocols and monitored and followed up for 12 weeks after discharge. Results: The average weight gain, defaulter rate, primary failure, secondary relapse rate and readmission rate were similar in both groups. Length of stay in group A was three days longer (p-value=0.039). Discharge rate was comparable with overall 68% of children successfully discharged and 50% of children reaching weight/height > -2 standard deviation at follow-up of 12 weeks. Conclusion: The current management protocol is equally effective for managing children with SAM having diarrhea. Good adherence to management protocol of dehydration and timely modification of therapeutic feeds in children with persistent diarrhea results in satisfactory weight gain.

Relationship Between Nursing Organizational Structure and Nursing Outcome (간호 조직구조와 간호결과의 관계)

  • Lee, Eun-Ju
    • Journal of Korean Academy of Nursing Administration
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    • v.10 no.1
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    • pp.37-48
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    • 2004
  • Purpose: This study was investigated to identify the relationship among hospital nursing organizational structure(decentralization, communication, bed/nurse ratio), process(nurses' job satisfaction, nurses' clinical experiences, nurses' unit experiences), and nursing outcome(patient satisfaction, physiologic adaptation, length of stay, number of complication). Method: The subjects consisted of 86 hysterectomy patients and 23 nurses in gynecology unit. Data were collected from May 16, 2002 to August 15. 2003 by the structured questionnaires and chart review. Data analysis was done with ANOVA, Pearson's correlation coefficient, path analysis. Result: Relationship between organizational structure and process ; Bed/nurse ratio was negatively related to nurses' job satisfaction(r=- .37, p<.05), and nurses' clinical experience(r=- .69, p<.00). Decentralization(r=.42, p<.05) and comunication(r=.61, p<.00) were positively related to nurses' clinical experiences. Relationship between process and nursing outcome ; There was a significant relationship between nurses' unit experiences and patient satisfaction(r=.63, p<.00), nurses' job satisfaction and physiologic adaptation(r= .44, p<.05), nurses' unit experiences and physiologic adaptation(r=.64, p<.00), Relationship between organizational structure and nursing outcome ; Decentralization and communication were positively related to patient satisfaction(r=.86, p<.00 ; r=.88, p<.00) and physiologic adaptation(r=,51, p<.01, r=.64, p<.00). Conclusion: Nurses' unit experience, communication, decentralization were significant variables for patient satisfaction. Nurses' unit experience, nurses' job satisfaction, communication were significant variables for patient physiologic adaptation.

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An Improved Stability Design of Cable-Stayed Bridges using System Buckling and Second-Order Elastic Analysis (활하중의 영향을 고려한 시스템 좌굴해석 및 2차 탄성해석을 이용한 사장교의 개선된 좌굴설계)

  • Kyung, Yong Soo;Kim, Moon Young;Chang, Sung Pil
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.26 no.3A
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    • pp.485-496
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    • 2006
  • Practical stability design method of main members of cable-stayed bridges is proposed and discussed through a design example. For this purpose, initial tensions of stay cables and axial forces of main members are firstly determined using initial shaping analysis of bridges under dead loads. And then the effective buckling length using system elastic/inelastic buckling analysis and bending moments considering $P-{\delta}-{\Delta}$ effect by second-order elastic analysis are calculated for main girder and pylon members subjected to both axial forces and moments, respectively. Particularly, three load combinations of dead and live loads, in which maximum load effects due to live loads are obtained, are taken into account and effects of live loads on effective buckling lengths are investigated.

Characteristics and Yield of Recommended Cultivars by Imported Forage Crop Yield Regional Trials in 2002 II. Mid-maturing, Good Quality, and High Yield of Forage Corn Hybrid, “Nc+4880”, “Garst 8396 IT” (2002年 사료작물 수입적응성 인증품종의 생육특성 및 수양성 II. 중숙 양질 다수성 사일리지용 옥수수 교잡종 “Nc+4880” 및 “Garst 8396 IT”)

  • Sung, B.R.;Lim, Y.W.;Lim, Y.C;Kim, K.Y.;Lim, K.B.
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.22 no.4
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    • pp.253-258
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    • 2002
  • NC+4880, a forage com hybrid, is bred by NC+hybrids Co. in US, and Gast 8396 IT is by Garst Seeds Co. We have tested these two cultivars in Suwon and Chonan over three years to test their regional yield trial. Through above experiments, the excellence is testified, in result, they are determined as new recommended cultivars by NACF. The main characteristics of these cultivars are as tallows ; 1. NC+4880 a. The seed coat is yellow, the mean tasseling date is 7th of July and it takes about 74 days from emergence to tasseling date. This hybrid is a day ahead and the culm length is 242 cm, moreless shorter comparing with a check hybrid, Suwon 19. The ear height 117 cm which is short and its stay green is moderate. b. It shows resistance to H maydis, and MBSDV is barely observed and its stay green is moderate. c. The fresh yield, dry matter yield, and TDN yield per a ha are 55.4 tons, 18.3 tons, 12.4 tons, respectively, which are increased by 6%, 7%, and 9%, respectively, comparing with a check hybrid, Suwon 19. The percent ear among total dry matter yield is 50.9%. 2. Garst 8396 IT a. The seed coat is yellow, the mean tasseling date is 9th of July and it takes about 76 days from emergence to tasseling date. This hybrid represent a day delayed compared with a check hybrid, Suwon 19. The Culm length and the ear height are 275 cm, and 138 cm, respectively. b. It resists moderately to H. maydis, and highly resists to lodging in the field conditions. MBSDV is barely observed and its stay green is moderate. c. The fresh yield per a ha is 64.9 tons, dry matter yield, 20.9 tons, and TDN, 13.8 tons, respectively, which are increased by 25%, 23%, and 22% comparing with a check hybrid, Suwon 19. The percent ear among total dry matters is 43.3%.

Study on Stress Recovery Length of 7-Wire Strand due to Local Damage (강연선의 국부적 손상에 따른 응력 회복길이 분석 연구)

  • Seo, Dong-Woo;Kim, Byung-Chul;Jung, Kyu-San;Na, Wongi;Park, Ki-Tae
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.12
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    • pp.150-156
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    • 2017
  • This study examined the stress recovery length due to the local damage of a 7-wire strand, which is applied widely to PSC (Post Tensioned Concrete) bridges and cable-stayed bridges. The 7-wire strand is a multiple stranded steel of PC prestressing strand. Owing to the nature of the material, it is damaged continuously after completion with corrosion being the main cause of damage. On the other hand, due to its structural characteristics, it is difficult to grasp the degree of damage inside the cable and the pattern of stress variation. In the case of cables applied to bridges, the parts that are susceptible to corrosion are generated depending on the water supply and installation shape, which may cause local damage. This study analyzed the tendency of performance degradation and stress recovery length according to local damage of a 7-wire strand, which is applied mainly to bridge post-tensioning or stay cables. This study developed a computer-based simulation model that was validated with experimental results. The model developed in this study can be used to evaluate the safety level and estimate the remaining life span of P SC bridges or cable-stayed bridges.

Comparison of the One-year Follow-up Results after Coronary Bypass Surgery versus Percutaneous Coronary Intervention with Drug-eluting Stents in Patients with Left Main Coronary Artery Disease (좌주간지 병변에 대한 약물방출스텐트시술과 관상동맥우회수술의 1년 추적결과 비교)

  • Choi, Jin-Ho;Lim, Cheong;Park, Kay-Hyun;Chung, Eui-Suk;Chung, Woo-Young;Chae, In-Ho;Choi, Dong-Ju
    • Journal of Chest Surgery
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    • v.41 no.2
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    • pp.210-215
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    • 2008
  • Background: Drug-eluting stents are contributing to the exponential growth of percutaneous coronary intervention, and even in the patients with left main coronary artery disease, owing to the decreased restenosis rate. Our study aimed at comparing the one-year results after coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents in patients with left main coronary artery disease. Material and Method: Those patients who underwent coronary bypass surgery or stenting at our hospital under the diagnosis of left main coronary artery disease were divided in two groups. The variables for comparison were the preoperative disease severity, the length of the hospital stay, the early mortality and the cumulative incidence of mortality, myocardial infarction and repeated revascularization. Result: There were 101 cases in the surgery group and 78 cases in the stent group. Age, gender, the risk factors, the left ventricular ejection fraction and the proportion of acute coronary syndrome showed no significant differences between the two groups. The surgery group showed a more severe condition according to the Euroscore, a greater incidence of urgency, a longer hospital stay and a greater incidence of multi-vessel disease. The early mortality and one-year cumulative mortality were not different between the groups. The Euroscore-matched comparison for the surgery group (41 patients) and the stent group (78 patients) showed no significant differences in the Euroscore, age, gender, risk factors and the proportion of acute coronary syndrome. The surgery group in the Euroscore-matched comparison showed more multi-vessel disease and a longer hospital stay. The surgery group showed lower early mortality and lower one-year cumulative mortality, but this was statistically insignificant (0% vs 2.6%, respectively, p=0.55; 0% vs 6.6%, respectively, p=0.30). The rates of repeated revascularization and major adverse events (death or myocardial infarct) were lower in the CABG group, but this was not statistically significant (13.3% vs 6.3%, respectively, p=0.48; 10.0% vs 0%, respectively, p=0.09). Conclusion: Percutaneous coronary intervention using drug-eluting stents in low-risk patients with left main coronary artery disease resulted in a shortened length of the hospital stay, as compared with that of the CABG group of patients. However, the patients who underwent percutaneous coronary intervention using drug-eluting stents showed a tendency for an increased rate of repeated revascularization and higher one-year cumulative mortality. Further studies with large populations and longer follow-up will be necessary to reaffirm our findings.

Annual Financial Impact of Thyroidectomies for Nodular Thyroid Disease in China

  • Liu, Xiao-Yun;Zhu, Li-Jun;Cui, Dai;Wang, Zhi-Xiao;Chen, Huan-Huan;Duan, Yu;Shen, Mei-Ping;Zhang, Zhi-Hong;Wang, Xiao-Dong;Chen, Jia-Wei;Alexander, Erik Karl;Yang, Tao
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.14
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    • pp.5921-5926
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    • 2014
  • A large proportion of patients with thyroid nodules in China undergo thyroidectomy in order to get confirmatory histology diagnosis. The financial impact of this modality remains to be investigated. To evaluate rationality of performing thyroidectomy without a routine FNA preoperatively from the economic perspective, we conducted a retrospective, observational study of all archival thyroidectomies with records of cost per stay (CPS), cost per day (CPD) and length of stay (LOS) from 2008 to 2013 in the First Affiliated Hospital of Nanjing Medical University. We compared all the parameters between cancer and non-cancer thyroidectomies. We recruited 6, 140 thyroidectomies with valid records of CPS, CPD and LOS in this period. The CPS of cancer thyroidectomy was significantly higher than non-cancer thyroidectomy. The percentage of cancer thyroidectomy increased from 26.5% to 41.6%. The percentage of annual cost of cancer thyroidectomies rose from 30.2% to 45.2%. The LOS for cancer and non-cancer thyroidectomy decreased while the CPD increased in the past six years. The estimated national cost in 2012 for all thyroidectomies would be USD 1.86 billion with USD 1.09 billion for non-cancer thyroidectomies. We have witnessed great improvement in the healthcare for patients with thyroid nodules in China. However, given limited healthcare resources, currently thyroid FNA for more precise preoperative diagnosis may help to curb the rapidly increasing demand in healthcare costs in the future for nodular thyroid disease in China.

An analysis of one-year experience of pediatric observation unit: The first report in Korea (소아 관찰병실 운영에 대한 분석)

  • Lee, Jee Young;Choi, Ui-Yoon;Lee, Soo Young;Lee, Ji-Young;Lee, Byong Chan;Hwang, Hui Sung;Mok, Hye Rin;Jeong, Dae Chul;Chung, Seung Yun;Kang, Jin Han
    • Clinical and Experimental Pediatrics
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    • v.50 no.7
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    • pp.622-628
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    • 2007
  • Purpose : While pediatric observation units (POU) have become a common practice in hospitals throughout developed countries, there has been no report about POUs in Korea so far. The aims of this study were to analyze our one-year's experience of the POU and to decide which disease entities are suitable for the POU. Methods : All children admitted from March 2006 to February 2007 to the POU at the Department of Pediatrics in Our Lady of Mercy Hospital were included in this study. Data were collected from retrospective reviews of their medical records. Results : There were a total of 1,076 POU admissions. Median age of patients was 2.4 years and median length of hospital stay 14.0 hours. The most common diagnoses were gastroenteritis (42.7%), pharyngotonsillitis (19.1%), bronchiolitis (7.8%), pneumonia (5.5%) and febrile seizure (5.2%). Overall, 7.5% of the POU patients required subsequent inpatient admissions due to hospital stays of longer than 48 hours. The disease entities that were most likely to require inpatient admission were pneumonia (17.0%), febrile seizure (12.5%) and asthma (11.5%). Diseases that allowed successful discharge from the POU were gastroenteritis (4.6%), upper respiratory tract infection (5.8%), such as otitis media and pharygnotonsillitis and seizure disorder (6.4%). Compared with the previous year when the POU was not in operation, there was a statistically significant reduction in the average length of hospital stays (from 4.69 to 3.75 days), as well as a rise in the bed turnover rate (from 78.8 to 98.2 patients/bed). Conclusion : Our study shows that the POU is efficient for the management of children with certain acute illnesses. Based on this study, we suggest that the POU be used as a new modality which links between the outpatient, inpatient, and emergency departments in the field of pediatrics in Korea.