• Journal of Chest Surgery
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• v.35 no.11
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• pp.799-806
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• 2002

In spite of the establishment of chemotherapy and the gradual decrease in prevalence, pulmonary tuberculosis is still mainly treated with an operation. Through analyzing and examining some cases of surgical treatment, we hope to provide some help in treating of pulmonary tuberculosis in the future. Material and Method: By comparing four journals previously published in our department with 144 cases of lung surgery during ten years from January of 1991 to December of 2000 performed by the department of thoracic and cardiovascular surgery of the National Medical Center, we analyzed and reviewed the most recent trends and the results of the surgical treatment. Annual frequency of the operation, distribution of age, examination of sputum, adaptability and types of techniques, complications, and results of the postoperative follow-up were used as methods. Result: It was found that the annual frequency of operations had decreased. The ratio of men to women, 2:1 indicates that there are more incidences in men. Aging of patients could be speculated by the .results that the decrease in the incidence rate in the 20s age range and increase rate in the 50s age range. The range of preoperative lesions belonged mostly to far advanced and moderately advanced tuberculosis. By monitoring the period of use in preoperative antituberculosis drugs, cases for more than 3 years remarkably increased from 16.0 % to 55.6 %. The positive reactive rate for preoperative sputum examinations were drastically decreased from 91 % to 27 %. Total pulmonary destruction and partial destruction were the most common cases in terms of adaptability to the operations and there were significant increases in forming empyema accompanied by parenchymal lesions from 4.0 % to 20.1 %. Pneumonectomy and pulmonary lobectomy were the major type of operations. Especially, there were increases in the incident rate of empyema and recurrence of tuberculosis resulted. Post operative follow-up indicates that the rate of complete recovery was more than 70 % and the rate of gradual increase in treating with persistent antituberculosis drug was from 5.8 % to 18.0 %. Conclusion: In recent cases, there is an increasing number of patients showing tolerance to chemotherapy. Patients with pleural tuberculosis and severe lesions were typically increased. It is important to accurately analyze those complaints accurately that are mostly difficult to be treated medically. Surgical treatment is strongly recommended Before multiple drug resistance occurs.

• Korean Journal of Social Welfare
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• v.39
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• pp.350-373
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• 1999

The patient population of U. S. state mental hospitals has changed drastically since the 1960s, when the deintstitutionalization movement began. This paper is designed to look at what happened to the number of inpatients of state hospitals in California during the last 150 years and, from this, to explore implications for the future of the mental health system in Korea, especially for the viability of mental hospitals. The data had been collected by field research(visits to state hospitals and State Department of Mental Health, and interviews with mental health administrators) and accessing statistical publications and various reports. Since the first state hospital opened in 1851 the statewide inpatient population of individuals who were mentally disabled has grown and peaked at 37,489 in 1959. The number of patients in state hospitals, however, began declining in the early 1960s and was reduced to 10,874 by 1971, and to 4,973 by 1986. As of 1997, there were only 4, 263 inpatients remaining in the state hospital system. This dramatic decrease slowed down somewhat in 1980s and 1990s, but this trend seems irreversible except for the inpatients referred by the court. Now the beds in state hospitals are filled with more and more forensic patients, which constitutes nearly 70% of the total inpatient population. Based on these findings, it is well expected that the number of inpatients of mental hospitals in Korea will also be reduced in a significant way as the community-based mental health care system is gradually replacing the traditional one. Mental hospitals need to introduce more diversified programs for the care of the mentally ill, and concurrently more vigorous aftercare programs are required in the community.

• Korean Journal of Social Welfare
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• v.57 no.3
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• pp.223-249
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• 2005

This study examines the hazard rate of reemployment by conducting the Cox regression analysis. In addition, two gender groups are subjected to comparative analysis to identify the effect of the factors related to the human capital and human capability perspective on reemployment. For this purpose, 1,871 cases are selected from the 5th year data from Korea Labor and Income Panel Study. The results of study are as follows. First, the factors of human capital, such as education, appropriateness of skill level, and job tenure hold negative impact on the probability of reemployment, while factors of human capability, such as basic learning ability, health insurance, social insurance, residential area(living in the Seoul metropolitan area) hold positive on the probability of reemployment. It is interesting note that there are different sets of factors that affect the probability of reemployment in the two gender groups. This trend is even more apparent in the case of factors that pertain to human capability. The results of this study imply that the factors of human capability, which stress the socio-institutional characteristics, should be considered as comparably significant compared to the factors that pertain to human capital when it comes to the estimation of reemployment. Also, results of this comparative study teach us that various perspectives, such as dual labor market theory and gender-segmented labor market theory, should be factored in for reemployment discussion as well. In conclusion, this research delivers several significant messages since it introduces the concept of human capability perspective, subjected to few empirical analyses in the past, and also heralds the way for comparative analysis on the impact of the factors pertaining to human capability on reemployment.

• Tuberculosis and Respiratory Diseases
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• v.41 no.4
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• pp.405-412
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• 1994

Background: In Korea, the prevalence of tuberculosis and hepatitis is high, and combined therapy with rifampicin and pyrazinamide is used in tuberculosis, so drug induced hepatitis is not only problem of tuberculosis therapy but also cause of treatment failure. However most of recent reports on drug induced hepatitis during antituberculosis medication have dealt with its pathogenesis and have stressed the biochemical, and histopathological aspects of the disorder, whereas this study was designed primarily to provide information on the clinical features. Method: The subjects of study were 1414 patients treated with antituberculosis drugs on the department of chest medicine at National Medical Center during the 5-year 6-month period from January 1, 1988, to June 30, 1993. Retrospective analysis of clinical features for the 29 patients who developed drug induced hepatitis was done. Results: 1) The incidence of antituberculosis drug induced hepatitis was 2.1%. 2) Male to fema1e ratio of antituberculosis drug induced hepatitis was 2:1, but case rates among males and females were not significantly different. 3) Rates of drug induced hepatitis according to age distribution shows the most common incidence between 35 to 49 year old age group, but rates among groups of age were not significant1y different. 4) Drug induced hepatitis was most common in the case of moderate advanced pulmonary tuberculosis(rate is 2.78%), but rates among types of tuberculosis were not significant1y different. 5) 18 cases(62%) of antituberculosis drug induced hepatitis patients had no signs or symptoms. In remaining cases, they were nausea, vomiting, jaundice, hepatomegaly, icteric sclera, right upper quadrant tenderness in order. 6) 22 cases(76%) of antituberculosis drug induced hepatitis cases had occured within the first month. 7) The duration of abnormal liver function was $28{\pm}5$(Mean${\pm}$SD), ranged from 5 days to 180 days. 8) One case of antituberculosis drug induced hepatitis died. 9) The levels of abnormal GOT ranged from 64 to 1055U/L and GPT from 68 to 931U/L. Conclusion: There are no dicided predisposing factors of antituberculosis drug induced hepatitis, so it should be done biochemical monitoring as well as close monitoring for overt signs or symptoms of hepatitis to avoid the development of irreversible hepatic reaction, especially at the treatment of the first month.

• Tuberculosis and Respiratory Diseases
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• v.49 no.4
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• pp.432-440
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• 2000

Background : The prevalence of pulmonary tuberculosis among the elderly is increasing in Korea and in the developed countries due to the increased elderly population and their predispositions to chronic disease, poverty and decreased immunity. To define the characteristics of pulmonary tuberculosis in the elderly, we evaluated the clinical spectrum of pulmonary tuberculosis. Method : We analyzed 92 patients retrospectively that were diagnosed as active pulmonary tuberculosis over the age of 65. The analysis involved patient's profiles, clinical manifestations, coexisting diseases, diagnostic methods, anti-TB medications and their side effects, and treatment outcomes. Results : The results were as follows : - 1) The ratio of male to female was 2.1:1(62:30 cases) 2) Chief complaints were a cough (47.8%), dyspnea (40.2%), sputum (38.0%), chest pain (12.0%), anorexia (10.9%), and fever (9.8%). 3) 38 (41.3%) of cases had a past history of pulmonary tuberculosis. 4) The coexisting diseases were : -COPD, 25 cases (27.2%); pneumonia, 17 cases (18.5%); DM. 13 cases (14.1%); and malignancy, 10 cases (10.9%). 5) The positivity of Mantoux test (5 TU, PPD-S) was 82.7%. 6) Pulmonary tuberculosis was diagnosed using the following methods : sputum AFB (Acid Fast Bacillus) smear 42.4%, sputum TB (M. Tuberculosis) culture 15.2%, sputum TB PCR (Polymerase Chain Reaction) 10.9%, bronchial washing AFB smear 2.1%, chest radiology only 25.0%. 7) Locations of radiologic lesions were RULF, 50 cases; RLLF, 50 cases, mostly, then LLLF ; 26 cases were leastly involved. 8) The coexisting tuberculosis were endobronchial TB(8.7%), TB pleurisy(7.6%) miliary TB(5.4%), intestinal TB(2.2%), renal TB(1.1%) 9) The proportion of treatment regimen with 1st line drug and 2nd line drug were 92.3% and 7.6%, respectively. 10) The outcome of treatment were as follows : cured 31.5%, expired 13.0%, no return 47.8%, follow-up now 7.6%. Conclusion : The pulmonary tuberculosis in the elderly has atypical patterns with chronic coexisting diseases. Therefore, the possibility of pulmonary tuberculosis should be considered in elderly patients with pulmonary symptoms.

• Tuberculosis and Respiratory Diseases
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• v.49 no.3
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• pp.343-352
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• 2000

Backgrounds : Respiratory care for patients in intensive care units (ICUs) has been performed mainly by nurses in Korea. However, the current status of respiratory care in the Korea ICUs is not well known. Respiratory care and the methods of delivery in ICUs were surveyed. Method : A confidential questionnaire was distributed to the head nurses working the ICUs at 117 hospitals in Korea. One hundred hospitals returned the questionnaires, for a response rate of 85%. The hospitals were divided into three groups : Main university hospitals (MUH), university associated hospitals (UAH), and general hospitals (GH) Result : Eighteen units of 66 units in MUH and 35 units of 58 units in GH were organized as a general ICUs. The percentage of ICUs with full-time doctors was 47.1%. The nurses usually delivered respiratory care spending from 1 to 4 h during their 8 h of working time. Although the respondents felt that respiratory care should be delivered by trained respiratory therapists, these therapists were not found at the hospitals. Most of the units performed percussion, tracheal suctioning, and positional changes. However, vibration and IPPB were less frequently performed in GH. Among oxygen supply apparatus, venturi mask and T-piece were not frequently used in GH. GH applied a noninvasive ventilator mode less frequently than MUH and UAH. The percentage of Swan-Ganz catheter monitoring was only 21.4% in GH. Conclusion : Respiratory care for patients in the Korean ICUs was provided by nurses on the whole. In addition, there were many differences in the level of respiratory care according to the type of hospital. To overcome the current problems revealed, an effective in-hospital training program for the development of full-time respiratory care therapists should be established urgently in Korea.

• Tuberculosis and Respiratory Diseases
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• v.66 no.4
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• pp.300-308
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• 2009

Background: The quality of care for patients with community acquired pneumonia needs to be improved; the factors affecting this care need to be analyzed. The objectives of this study were used to measure the performance of care processes of for patients with pneumonia and to determine those patient and hospital characteristics are associated with quality care. Methods: The analysis was performed using data from 21 hospitals that had over 500 beds for 1,001 patients, who were sampled randomly. All patients were born before 31 December 1989, and discharged between the two months' August 2006 and October 2006. Performance process indicators were measured by respective hospital, and multivariate logistic regression was used to calculate associations between patients and hospital characteristics using 4 process indicators. Results: Performance rates in timely assessment of oxygenation assessments and blood cultures, correct administration of antibiotic medications, and blood culture performed prior to initial antibiotics were 69.4%, 79.1%, 82.5% and 60.5%, respectively. Age had a positive affect on oxygenation assessment within 24 hours. Bed number, number of nurses per bed, annual number of emergency department visits, average percentage of beds filled, location and arrival time, and site were factors associated with process indicators. Conclusion: It is necessary to make up for the weak points in the process of care for patients with community acquired pneumonia, by enforcing quality assurance. To reduce performance rate variation among hospitals, improvement in care protocols is required for hospitals that have poor quality of care levels.

• Tuberculosis and Respiratory Diseases
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• v.64 no.4
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• pp.266-271
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• 2008

Background: Estimation of the probability of a patient having an acute pulmonary embolism (PE) for patients with a suspected PE are well established in North America and Europe. However, an assessment of the prediction rules for a PE has not been clearly defined in Korea. The aim of this study is to assess the prediction rules for patients with a suspected PE in Korea. Methods: We performed a retrospective study of 210 inpatients or patients that visited the emergency ward with a suspected PE where computed tomography pulmonary angiography was performed at a single institution between January 2005 and March 2007. Simplified Wells rules and revised Geneva rules were used to estimate the clinical probability of a PE based on information from medical records. Results: Of the 210 patients with a suspected PE, 49 (19.5%) patients had an actual diagnosis of a PE. The proportion of patients classified by Wells rules and the Geneva rules had a low probability of 1% and 21%, an intermediate probability of 62.5% and 76.2%, and a high probability of 33.8% and 2.8%, respectively. The prevalence of PE patients with a low, intermediate and high probability categorized by the Wells rules and Geneva rules was 100% and 4.5% in the low range, 18.2% and 22.5% in the intermediate range, and 19.7% and 50% in the high range, respectively. Receiver operating characteristic curve analysis showed that the revised Geneva rules had a higher accuracy than the Wells rules in terms of detecting PE. Concordance between the two prediction rules was poor ($\kappa$ coefficient=0.06). Conclusion: In the present study, the two prediction rules had a different predictive accuracy for pulmonary embolisms. Applying the revised Geneva rules to inpatients and emergency ward patients suspected of having PE may allow a more effective diagnostic process than the use of the Wells rules.

• Korean Journal of Health Education and Promotion
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• v.6 no.2
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• pp.23-39
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• 1989

There have been a lot of considerable. discussion and debate surrounding the management model in the health insurance management system and opinions regarding the management operating cost. It is a well known fact that there have always been dissenting opinions and debates surrounding the issue. The management operating cost varies according to the scale of the management organization and component members characteristics of the insurance carrier. Therefore, it is necessary to examine and compare the management operating cost to the simulated management models developed to cover those eligible for the health insurance scheme in this country. Since the management operating cost can vary according to the different models of management, four alternative management models have been established based on the critical evaluation of existing theories concerned, as well as on the basis of the survey results and simulation attempts. The first alternative model is the Unique Insurance Carrier Model(Ⅰ) ; desigened to cover all of the people with no classification of insurance qualifications and finances from the source of contribution of the insured, nationwide. The second is the Management Model of Large-scale District Insurance Carrier(Ⅱ) ; this means the Korean society would be divided into 21 large districts; each having its own insurance carrier that would cover the people in that particular district with no classification of insurance qualifications arid finances as in Model I. The third is the Management Model of Insurance Carrier Divided by Area and Classified with Occupation if Largescale (Ⅲ) ; to serve the self-employed in the 21 districts divided as in Model Ⅱ. It would serve the employees and their dependents by separate insurance carriers in large-scale similar to the area of the district-scale for the self-employed, so that the insurance qualifications and finances would be classified with each of the insurance carriers: The last is the Management Model of the Multi - insurance Carrier (Ⅳ) based on the Si. Gun. Gu area which will cover their own self- employed people in the area with more than 150 additional insurance carriers covering the employees and their dependents. The manpower necessary to provide services to all of the people according to the four models is calculated through simulation trials. It indicates that the Management Model of Large-scale District Insurance Carrier requires the most manpower among the four alternative models. The unit management operating costs per the insured individuals and covered persons are leveled with several intervals based on the insurance recipients. in their characteristics. The interval levels derived from the regression analysis reveal that the larger the scale of the insurance carriers is in the number of those insured and covered. the more the unit management operating cost decreases. significantly. Moreover. the result of the quadratic functional formula also shows the U-shape significantly. The management operating costs derived from the simulated calculation. on the basis of the average salary and related cost per staff- member of the Health Insurance Societies for Occupational Labours and Korean Medical Insurance Corporation for the Official Servants and Private School Teachers in 1987 fiscal year. show that the Model of Multi-insurance Carrier warrants the highest management operating cost. Meanwhile the least expensive management operating cost is the Management Model of Unique Insurance Carrier. Insurance Carrier Divided by Area and Classified with Occupation in Large-scale. and Large-scale District Insurance Carrier. in order. Therefore. it is feasible to select the Unique Insurance Carrier Model among the four alternatives from the viewpoint of the management operating cost and in the sense of the flexibility in promoting the productivity of manpower in the human services field. However. the choice of the management model for health insurance systems and its application should be examined further utilizing the operation research analysis for such areas as the administrative efficiency and factors related to computer cost etc.

• Korea Journal of Hospital Management
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• v.12 no.1
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• pp.1-30
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• 2007

The study carried out a survey with employees of hospitals located in Daejeon, Chungnam, and Chungbuk from Sep. 12 to Sep. 30, 2005 in order to derive primary elements that affect the improvement of hospital's competitiveness. The study investigated and analyzed the employees' recognition on the change of competitive environment caused by the change of medical environment. The study also analyzed the elements that affect the hospital's competitiveness and the competitive strategies of the hospitals. The conclusion of this study can be summarized as follows. 1. Summary 1) Most of the employees responded that there is a rival in the competitive environment and the competitive is intense. Especially when the employees are married, live in urban areas, have an education level of university graduate or are managers, they tend to think the competitive is very intense. Also, they said that the competitive is based upon the quality of medical service. They mentioned the element that has the biggest effect on the competitiveness is the element of medical consumer and they recognized that the medical services in university and general hospitals have more competitiveness than the one-department hospitals. 2) It was investigated that the medical technique service has the most effect on the hospital's competitiveness. Also, the external service of medical techniques also has a large effect on the hospital's competitiveness. 3) When they were asked for the factors that affect the patients' decision on selecting a hospital, most of them responded "capability and technique of the medical staffs." Also, they said that "sufficient explanation from doctors" and "special center and clinic" are the factors that have big effects on the patients' decision. 4) In the SWOT analysis, most of them responded that the strength is the hospital's characteristics and the weakness is insufficient and obsolete equipment. They said the opportunity is the demands for professional medical service and the risk is the intense competitive among the hospitals. 5) In the SWOT strategy, they emphasized the strategy that uses the opportunity and the strength and the strategy that uses the opportunity while overcoming the weakness. 6) As for the basic competition strategy, most of them thought of the strategy of professionalizing the medical service most importantly. Next, they focused on the strategy of distinct service and the strategy of lower prime cost. 2. Conclusion 1) Because service competition between hospitals is happening seriously, need competitiveness security through right awareness transfer and satisfaction upgrade about medical consumer. 2) For medical technique service upgrade that equip Hospital's competitiveness but affects most, must solidify the countermeasure because professionalizing the medical service and newest medical technique induction should be achieved first, and compose task force for the external service of medical techniques improvement. 3) To improve SWOT of hospital, opportunity and the strength strategy choice that rescue hospital's characteristics heightening professionalizing the medical service level is fancied. 4) As for the basic competition strategy, will have to try in phase triangular position of hospital which is trusted medical level upgrade and excellent manpower security and finance independence through upgrade. The study was only done with hospitals in Daejeon, Chungnam and Chungbuk. Also, it is a study from the side of suppliers of medical service so there are limitations. However, the significance of the study is to present the basic data for improvement of hospital's competitiveness by examining the importance of medical techniques and external service of medical techniques that are the main effects on the improvement of hospital's competitiveness.