• Journal of Korean Academy of Nursing
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• v.11 no.2
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• pp.33-54
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• 1981

The purposes of this study were to determine the relevant nursing needs of patients following discharge; to identify the degree of their nursing needs; to identify types and status of discharge order and information given to patients; and to determine their specific nursing needs according to their diagnosis. In addition, opinions toward home care services provided by hospitals or by public health nurses and appointment plans with their physicians were also asked in order to determine the necessity of follow-up care for the patient after discharge. Nine hundred and eighty eight subjects were collected among patients being discharged from one national university hospital and four city hospitals. Data were collected from June,1979 to December,1979 using questionnaires and interviews. On the bases of these data the following findings were observed; 1) Almost 40 percents of total subjects discharged from the hospital with some or great degree of nursing needs in general. The most problematic nursing needs were needs for comfort which include needs for releaving pain, for sound sleep and rest, because these needs can only be met by professional help. More than 50% of total subjects have this problem. 2) Needs for mental health, general metabolism, general hygiene and activities and safety were observed in more than 20 percent of subjects. 3) Discharge orders on diet and oral medication were recorded in patients' charts in 70% of all cases. However, more than fifty percents of patients have not been told these information from doctors or nurses. Even though some of them might have had appointment plans with their physicians, they would not keep the appointments unless they completely understood the necessity of the follow-up care. If they have not had any appointment or would not visit the out-patient clinic, there is no method of caring them and prerenting funther discomfort or complications. Even in injection, ski care, dressing and bath, only one thirds of the subjects having recorded discharge orders understood what they need after discharge. The rest of cases have not known what to do for their further care. 4) More than 80 percents and 70 percents of total subjects agreed to a system of home care services provided by hospitals or public health nurses respectively. That is, regardless of sources of medical expenses, most of patients wanted to be taken care of at home following discharge. 5) While more than half of the patients having benefit of medical insurance or paying fully by themselves had appointment plans with their physicians, only one thirds of the patients fully or partially paid by government had appointment plans with their physicians. These results ex-plain that the appointment plan is directly associated with their economic power. This indicates that the home care services are more needed to the people with lower economical status. 6) Those who have been in the hospital more than 24 days wanted !o have home care services more than those who had less hospital days. They also had more appointment plans than other groups. 7) More than 70 percents of the subjects who had been in a university hospital and approximately 30 percents of the subjects in the city hospitals had appointment plans with their physicians. 8) Those who had the cerebrovascular disease, cancer or hypertension demanded more nursing needs such as needs for comfort, for general metabolism and for mental health. 9) Factors which were associated with the degree of patients' nursing needs were age, duration of hospitalization, opinion toward home care services given by public health nurses, hospital appointments and types of hospital. That is, the older they were and the longer the periods of hospitalization were, the higher were their nursing needs. The more they had nursing needs, the more they wanted to have nursing services and had appointment plans. It can be concluded that there is a great demand for a positive and systematic home care services to the people who have been discharged from hospitals following critical care. This program is definitely demanded for the low income groups of people with less education with the financial assistance of the government or other funding agencies.

• Korean Journal of Occupational Health Nursing
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• v.4
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• pp.5-29
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• 1995

Occupational health services in Korea have been operated as dual types : one is operated by occupational health care manager and the other is health care agency without their own personnel. The performance of occupational health service should be different due to the variety of characteristics of health care manager and workplace, qualification of health care manager. This study is to analyze performance of occupational health care services with a particular consideration of job performance shape and efficiency, based on comparing those two types of health care management to show on the basic data for the settlement of more qualitative health care management system at workplace. For this study, total 391 places in Seoul and Inchon city area ; 154 places (39.4%) managed by designated health care manager and 237 places (60.6%) by the agency with their commission are selected as research samples. Tools for data collection are questionnares that have been investigated during the period of 20 September 1993-20 December 1993. Those data are compared with percentiles, mean, standard deviation and B/C ratio using SPSS PC program. Conclusions observed from the tests and each comparison could be summerized as follows : 1. Occupational health care have been accomplished at workplaces with designated people than with agencies people, and coverage rate of the occupational health care services has differences, due to management types. The reason of these results is due to visit only one or two times monthly by the agencies, while their own health care manager obsess, at the workplaces all the times. 2. Most of the expense for environmental control of all health care services expenditures shows that there is almost no fundamental improvement because more expenses are needed for procuring personal protective equipment and measuring work environment instead of environmental improvement. 3. It is investigated how much the cost of occupational health care services needs per worker, and calculated how much the cost needs per service hour per worker. The results from this show that the cost of occupational health services at workplaces with their own managers used less than the cost of health care agencies, eventually the former gives better services with less cost than the latter. 4. Benefit/Cost ratio is also produced by total benefit/total cost. The result from the above way reads 4.57 as a whole, while their own manager having workplaces reads 4.82 and the agencies do l.56. Even if their own manager performing workplaces spent more cost, this system produces more benefit than the agencies management. 5. The B/C ratio for medical organization such as local clinic, health care center and pharmacy shows more than or equal to at the workplaces controlled by the agencies. It is inferred that benefit would be much less than the cost used, with so being inefficient. 6. It is assumed that the efficiency ratio of health education is equal to reduction rate of workers medical organization visit. Estimated reduction rate 5%, 10%, 15%, show that the efficiency ratio of health education have an effect on producing benefits. It is estimated that more benefit can be produced if more qualitative education will be provided for enhancing health care efficiency. 7. Results of this study cannot be generalized because there are large scale of deviation in case of workplaces with less than 300 full time workers, but B/C ratio reads 2.69 as a whole and 3.25 at workplaces with their own health care manager are higher than 1.63 at the workplaces manged by the agencies. Finally, all the benefit concerning health care services could not be quantified, measured and shown on the value of money. This is a reason that a considerable part of benefits are so underestimated. This is also thought that measurement tools should be developed for measuring benefits of health care services with a comprehensive quantification. in the future. It is also expected that efficiency of occupational health care services should be investigated using cost-effectiveness analysis.

• Journal of Korean Academy of Nursing
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• v.28 no.1
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• pp.117-131
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• 1998

The purpose of this study was to develop a critical pathway for case management for patients who have received Coronary Artery Bypass Graft (CABG) because of Ischemic Heart Disease(IHD) which is a factor of rising medical expenses. For this study. a conceptual framework was developed through a review of the literature including six critical pathways which are currently being used in USA. In order to identify the overall service contents required by these patients and to draw up a preliminary critical pathway, 30 cases of medical records of patients who had CABG because of IHD between January, 1995 to June. 1996 at the Cardiovascular Center of Yonsei Medical Center in Seoul were analyzed. An expert validity test was done for the preliminary critical pathway and clinical validity test was also done using seven IHD patients with CABG between November 11 and 23, 1996. After these processes. the final critical pathway was developed. The results of this study are summarized as follows : 1. The vertical axis of the critical pathway includes the following eight items : tests, nutrition, medications, consultations, activity, assessments, treatments, education discharge planning and the horizontal axis includes the time from the start of hospitalization to discharge. 2. Analysis of the 30 medical records indicated that the average length of stay was 20.2days with the average length of stay from hospitalization day to operation day being 6.2 days, and the average length of stay from operation day to discharge day was 13. 9 days. Analysis of the service contents showed that the horizontal axis of the preliminary critical pathway was set from hospitalization to the 14th post operation day and the vertical axis was set to include eight items, the contents which ought to have occurred, according to the time frames of the horizontal axis. 3. As a result of the experts validity, it was found that among the total of 571 items. there was over 83% agreement for 482 items, less than 83% for 89 items, which were then deleted and a revision of the critical pathway was done. 4. A clinical validity test was done using seven IHD patients with CABG. During the process, three patients were deleted because they were out of the criteria the investigator set. Finally, four patients were used. The result of study indicated that only one patient was discharged on the tenth post operation day, which was one day later than the expected day. Three patients were discharged later than the expected day from three days to nine days. All the cases progressed on schedule until the operation day and the first post operation day, but from the second post operation days, there were differences between the critical pathway and the actual practice. The differences came from tests, assessments, and treatments. 5. On the basis of the results of the clinical validity test. the following revisions in the final critical pathway were made : the transfer from ICU to step down ward would be the second post operation day, and the transfer to a general ward, the fifth post operation day, for patients who complained of lack of sleep from the fifth post operation day to discharge, a sleeping pill would be prescribed, skin observations would be performed routinely from immediately after the operation until the third post operation day, and would continue if there was a sign of skin injury on the fourth post operation day, and assessment of chest pain would be done from the third post operation day, and the “stairs climbing” item, expected to be done on the ninth post operation day would be deleted. In conclusion, this critical pathway is partially applicable to the care of patients with CABG but there are some parts needed to be further investigated.

• Journal of agricultural medicine and community health
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• v.13 no.1
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• pp.19-25
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• 1988

It is very important to supply safe drinking water for rural area not only a prevention of entric diseases but also a promotion of health life. It is estimated that 6,981,000 rural inhabitants were covered by the simple piped water supply system at the end of 1987 in Korea. The programme for improvement of water supply system in rural villages was initiated by the government since 1967. But most of these systems have been operated carelessly by the hands of villagers who have no proper knowledge and experience. Since most of water sources were located nearby farmland, there might be a possibility that the sources could be contaminated by pesticides and fertilizers. For this reason, it is recommended to take underground water as a water source rather than surface water such as a pond or streamwater in rural areas. However, the system is supplied from the surface water, its water quality can be improved by using of simple sand filter and simple chlorinator inexpensively. On the basis of an on-site study, conducted during 1986-87, in San-Buk Village, Keum-Sa-Myon, Yeju-Gun, Kyong-Gi-Do, the new simple piped water supply system was designed by the Institute for Environmental Research, Yonsei University, and constructed by the villagers themselves in September 1987. This simple system which is protected by metal fences consists of three main parts, pump house, vertical sand filter and water tank. The pumped water from underground flows into the upper part of the sand filter, through the sand, and out the water tank which is connected to the bottom of vertical filter. And the simple plastic-bottle chlorinator was installed in the water tank for chlorination. The water quality was remarkably improved after completion of construction. The total bacterial count was not detected from the tap water in households distributed by this simple piped water supply system. The construction cost of this system which was connected 34 households in San-Buk Village, was 4,851,000 won (approximately 6,020 U.S. dollars : 1$=805.8 won) in 1987,77% of expenses was supported by the Community Development Foundation in Korea. This case study for simple piped water supply projects will be applicable to other programme for improvement of water supply system in rural areas of Korea, and other developing countries.

• Journal of Animal Science and Technology
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• v.52 no.1
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• pp.71-76
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• 2010

The aim of this study was to examine the effect of HACCP system implementation on the budget for medicine use, antibiotic utilization, and productivity of swine farms in Korea. Data were collected form thirty swine farms before and after implementation of HACCP system. Parturition rate, total number of piglets, number of initial weaning piglets, number of weaning piglets, survival rate of piglets after weaning, date of weaning piglets, piglet per sow per year, and market piglet per sow per year tended to be higher after HACCP system implementation. In contrast, price for medicine used per month, number of antibiotic used, the farm number of feeds containing antibiotics in each, growing stages added at the feed company, and the farm number of feeds containing antibiotics in each growing stages added at the swine farm were lower after HACCP system implementation. Due to increase in the feed cost recently, production cost for shipment in HACCP system implemented swine farms had increased in this study. In conclusion, our results indicated that the implementation of HACCP system might be effective in reducing medical expenses and improving the productivity.

• The Journal of Korean Academy of Prosthodontics
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• v.52 no.1
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• pp.18-26
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• 2014

Purpose: The purpose of this study was to estimate the cost of dental implant using the bottom-up approach with the current data from dental clinics. Materials and methods: In this study, direct and indirect costs required for each treatment were calculated using the bottom-up approach. In the bottom-up costing, the average monthly total cost of dental clinic includes labor and material costs, administrative expenses, medical malpractice costs, and opportunity costs of invested capital. For the dental implant cost components, those include direct costs (labor costs, laboratory costs, material costs, depreciation or other operating costs), indirect costs (administrative costs), and the opportunity costs of investment for dental clinic. Results: Dental implant costs of metal crown, porcelain crown and over-denture were 1,449,000 won, 1,583,000 won, and 2,471,000 won respectively. The proportion of cost components was as follows. The labor cost were 50%, and material, administrative and other cost were 33%, 15% and 2%, respectively. For direct, indirect and investment cost, the ratio were 83%, 15% and 2%, respectively. Conclusion: The labor costs were evaluated to comprise largest proportion (about 50%, 730,000 won). Dental implant cost using Bottom-up costing was 1,450,000 won for metal crown and 1,580,000 won for porcelain crown.

• Journal of Animal Science and Technology
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• v.53 no.2
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• pp.177-182
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• 2011

The objective of this study was to examine the effect of HACCP implementation on the medicine use, antibiotic utilization in each feeding stage and productivity of large scale swine farms (over 5,000 pigs) in Korea. Data were collected from ten swine farms before and after implementation of a HACCP system. Total number of piglets, number of initial weaning piglets, number of weaning piglets, survival rate of piglets, date of weaning piglets, number of piglets per sow per year and price for medicine used per month on HACCP implemented swine farms had a tendency to increase without any significant difference. However, parturition rate, market pig per sow per year, number of antibiotic used and farm number of feeds containing antibiotics at fattening stage added at the swine farm were significantly increased after HACCP implementation (p<0.05). Due to increase in the feed cost recently, production cost for shipment in HACCP system implemented swine farms had increased in this study. In conclusion, our results indicated that the implementation of HACCP system might have many effects including reduction of medical expenses and improvement of productivity of the pig farms.

• Journal of Families and Better Life
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• v.26 no.3
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• pp.37-52
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• 2008

The purpose of this study was to provide the valid data about residential-linked pension insurance development. The development was a part of national housing projects, which was an incentive for rural living of retired people, in order to relieve residential issues of elderly and revitalize rural communities by residents moving from cities. The insuring intent, decisive insuring factors and the residential service demand degree of people preparing retirement were analyzed. Data was collected in October, 2007. 364 Sample Subjects lived in Seoul Metropolitan area. Firstly, more than 90% of respondents had intention to purchase a residential-linked pension insurance and about 50% of them necessarily desired receiving premium for moving in. This indicated that it could be developed as an insurance which helped to meet housing expenses by housing-linked system, and in the mean time, it met the original purpose of pension insurance as the pension benefit could be guaranteed for all the insurance subscribers. Secondly, the respondents, whose income and private assets were higher, were able to pay more for insurance compared to average. Therefore, It was necessary to regulate monthly insurance bill and the payment period according to asset states of insurance subscribers after establishing certain amount of total insurance payment. Thirdly, by and large, it indicated the tendency that the less they prepare for older age the later they wanted to move into the pension insurance residence. It was inferred that in the case of insufficient preparation for older age, people preferred preparing behind time by postponing move in to moving in early to enjoy retired life, due to uncertainties. lastly, the respondents understood the significance of health, medical treatment and emergency management service and these two services were preferred as essential provided services. Because of the necessity of developing residential-linked pension insurance was found to be positive, further research to find the real cost, directives for operation and institutional support for this type of pension insurance might be needed.

• Journal of Society of Preventive Korean Medicine
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• v.2 no.1
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• pp.87-111
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• 1998

For the newly approach of policy with the old aged era at hand, the result which examines the 1,200 students attending professional colleges and upward in three small-to-medium sized cities, for two months, from October 1, 1996 to November 30, in order to know the change of consciousness of the growing modern young intellectual age group is as follows. 1. The objects of survey consist of 72.1% of women, 40.4% of 20 to 21 age, 49.1% of atheists, and people from big cities and fishing and agrarian village occupy equally 40.2%. Concerning the long-termed residents, 49% of them dwell in big cities. In case of the parents' age is more than 55, 31.5% in fathers, and 10.9% in mothers. 2. The types of housing in which they desire to reside in their getting older are : 72.8% of them hope to live in individual houses, 16.6% in apartments or villas, and 3.4% in social welfare facilities. Out of respondents, compared with other groups, man rather than woman, those who are 20 to 21 age group and from fishing and agrarian villages and have over 7 family members and live with their parents have a higher preference for independent houses. 3. The districts in which they hope to live when they are old are : 41.6% of them, with the highest percent, hope to live in farming villages, the older they are, the more they hope to live in agricultural district, and women of 21 years and upward hope to live in big cities. On the other hand, the preferable degree for social welfare facilities is higher each in people who are 24 years and upward, buddhists, self-boarding students, and the more poorly they are off, the higher the percent is. 4. The types of preferable welfare facilities for the elderly are : 58.2% of them think silver towns desirable, 28.4% think the charged (or free) elderly welfare facilities. Compared with other groups, the percentage which prefer silver towns is higher in women, people from big cities, residents of main family, long-termed city residents, people with higher income, people having grandparents alive, and people who had experience of taking lectures on hygienics or social welfare. 5. 50.3% of the respondents insist that provision of living expenses against old age should be insured by social security system, and 42.8% by the elderly themselves. The percentage of the former shows higher in people of 21 years and upward, women, residents of fishing and agrarian villages, christians, people in more needy circumstances and people who have experience of using a medical institution. 6. Compared with other nations, 54.5% of the respondents have an opinion that elderly welfare and welfare work in Korea stays in insufficient level and most of them are women, people from farming village, residents of head family, people having younger parents and people being worse health condition, and they have a more positive attitude about the elderly welfare work. 7. 92.3% of the respondents answered that a national budget for the elderly welfare is scarce, and the percentage is higher in people who are older, residents of big cities, people in lower living condition and people in worse health condition. 8. 35.2% of the respondents answered that the proper cost of their old age must be over 220mi11ion. The more a family's total income is, the higher the percentage is. 9. The factors which have an effect on the preference of silver towns are sex(p<0.01, the type of the present residence(p<0.05), and a family's total income(p<0.05). 10. From the survey result of the above, we comes to the conclusion that, for the sake of welfare of the increasing elderly population, government authorities and parties concerned must exert their utmost for the elderly welfare by increasing a budget of it and establishing a number of facilities of the elderly welfare and silver towns located in fresh and comfortable villages. In addition, they have to set up a course of hygienics in all the colleges and instruct the contexts on hygienic welfare as well.

• Journal of Korean Academy of Nursing Administration
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• v.3 no.1
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• pp.93-106
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• 1997

By the increase of the rate of existence of the hemodialyzing patients, they were required the long run treatment. Regardless of medical insurance expansion, hemodialyzing cost much expenses so that hospital has been considering the reuse of hemodialyzer and flowing euqipments along with the diverse study and progress of the ways of hemodialyzing and medical instruments. This study was aimed to provide the basic materials regarding the reuse of hemodialyzer which is used for the patients of chronic renal disease. The reusing program in the artificial kidney center of K hospital has been used for this study from 50 patients aften one year result from Sep. 1995 through Aug. 1996. Automatic equipment of DRS-4 made by Seratronic Co., was used as the equipment and it was retreated with the function test simultaneously. Compliaction and confirmation of the infection were by the records of the hemodialysis of the patients. SPSS was used for the analysis of the materials by computerization. The character of the patients and the rate of removal was by mistake and percentage, function test and rate of complication by Ftest(ANOVA) and the rate of complication per items by ${\chi}^2$ and Ftest. As the post test the Duncan's test was used for the statistically significant different variables in the standard of p<.05 after Ftest. The followings are the summary of the result : 1) In the function test of the new hemodialyzer and the reused one, and in all of CA110 and CF15.11, the dialyzer ultrafiltration coeffient(KUf) was appeared to have been higher in the reusing groups than the first use ones. This has been the normal limit showing no troubles with them. 2) In the function test of the new and reused hemodialyzer, in all of CA110 and CF15.11, the total blood volume was appeared to have been the less value in the reuse groups than the new ones. This was the price within 80% of the first price that both showed possible for use. 3) The result of reuse hemodialyzer of CA110 was $29.48{\pm}7.83$ in average in the test of leak test while $17.3{\pm}7.96$ in reuse of CF15.11. The normal limit of <60 was the leak test result. So both of the hemodialyzer was normal for reuse. 4) The rate of removal of Blood Urea Nitrogen(BUN) was 72.25% in CA110 hemodialyzer by reusing 16-20 times as the highest rate showing the better result in the reuse hemodialyzer, while in CF15.11 hemodialyzer showed 71.16% by highest rate in the first use by the highest rate with no difference from the reuse. 5) The rate of removal of serum creatinine of CA110 was 64.08% by highest rate in reuse of 1-5 times by showing better result in reuse hemodialyzer. While in CF15.11 66.47% the highest by reuse of 16-20 times showing no difference from each other. 6) No patients were admitted or precribed by antibiotics in relation with reuse dialyzer and no reports were shown about hepatitis $B{\cdot}C$. AIDS in fection. 7) Of the total 248 episods of complication due to the hemodialyzing, 86 by first use, 73 by 1-5 times, 35 by 6-10 times, 35 by 11-15 times and 19 by 16-20 times have been shown which have had no significant difference between the groups. 8) In the comparison of the expense for the hemodialyzer, there was the effect of saving 11,597.6 Won between the first and reuse hemodialyzer. And by decreasing the extracted materials, they did the great role of disposing the waste matters.