• Health Policy and Management
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• v.18 no.4
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• pp.148-169
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• 2008

As the Korean Government began to perceive healthcare as one of foundational industries for national dynamics, there has been mounting advocacy for the introduction of for-profit hospitals with a view to bringing efficiency in healthcare services industries and improvement of their international competitiveness. The Government is now considering the issue from all angles in favor of permitting for-profit hospitals. However, There have been few precedent studies on this subject to provide helpful data for the discussion and in the health policy making. This study used private hospitals - for-profit and nonprofit - in Florida, USA as study subjects to accumulate basic data that may be utilized for those involved in debates and health policy making relating to the introduction of for-profit hospitals in Korea. Among all the private general hospitals in Florida, those surveyed by AHA(American Hospital Association) for four consecutive years from 2001 and 2004 and others reported about to MCR(Medicare Cost Report) included in the collected data for analysis. In total 139 private general hospitals consisting of 73 for-profit hospitals and 66 nonprofit hospitals were included in the collected analysis data. Results of analysis revealed no significant difference between for-profit hospitals and nonprofit hospitals in the usage aspects of healthcare services including the average length of stay and the ratio of Medicare vs Medicaid patients. However, financial performances indicated by such factors. as the pre-tax return on assets and the pre-tax operating margin showed to be significantly higher in for-profit hospitals compared with nonprofit hospitals. And the ratio of personnel expenses and the turn period of total assets showed to be significantly lower in for-profit hospitals. Based on the hypothesis that arguments about the introduction of for-profit hospitals have considerably different viewpoints depending on the size of hospital represented by the number of bed, these two hospital types were compared again using the number of beds as a controlled factor, but the results were similar. We, therefore, could conclude that the for-profit hospitals in Florida included in this study could, in their for-profit operation, improve their financial performance by pursuing cost reduction and effectively utilizing their assets without limiting the amount and the range of their services or avoiding less medically protected groups such as Medicare and Medicaid patients.

• Korean Journal of Child Studies
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• v.37 no.6
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• pp.83-94
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• 2016

Objective: The purpose of this study was to investigate differences in self-leadership and job involvement based on the education levels, majors, and teaching experiences of multicultural family home-visit instructors and the influence of self-leadership on job involvement. Methods: 668 home-visit instructors participated in the online survey from 140 multicultural family support centers in Seoul, 6 metropolitan cities, 9 provinces, and other cities and counties. Data were analyzed through frequency, percentages, Pearson's correlations, one-way ANOVA, $Scheff{\acute{e}}$ post-hoc test, and stepwise multi-regression using SPSS 21.0. Results: The main findings are as follows. First, instructors who were high school graduates had significantly higher scores in self-leadership than the other groups. There was only a significant difference in self-reward of self-leadership based on their majors. There were no significant differences in job involvement based on the education level and major. The greater their home-visit teaching experiences, the higher their scores in self-leadership and job involvement. Second, the stepwise multiple regression model showed that self-expectation, self-goal setting, constructive thinking, and rehearsal of self-leadership explained 49% of the total variance in job involvement. Conclusion: Even though the high school graduates had significantly higher scores in self-expectation, rehearsal, and constructive thinking of self-leadership than the other groups, over-generalization should be avoided because the sample size was relatively small. Based on the finding that greater home-visit teaching experiences was associated with higher self-leadership and job involvement, it would be necessary to improve working condition to prevent instructors from changing jobs. These findings stress the importance of providing opportunities for home-visit instructors to develop leadership, thus improving job involvement.

• Clinical and Experimental Pediatrics
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• v.57 no.3
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• pp.125-134
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• 2014

Purpose: The aim of this study was to characterize Korean patients with Fanconi anemia (FA), which is a rare but very challenging genetic disease. Methods: The medical records of 12 FA patients diagnosed at Chonnam National University Hospital from 1991 to 2012 were retrospectively reviewed. Results: The median age at diagnosis was 6.2 years. All patients showed evidence of marrow failure and one or more physical stigmata. Chromosome breakage tests were positive in 9 out of 11 available patients. The median follow-up duration was 69.5 months. The Kaplan-Meier (KM) survival of all patients was 83.3% at 10 years and 34.7% at 20 years, respectively. Seven patients underwent 9 stem cell transplantations (SCTs). Among them, 5 were alive by the end of the study. Ten-year KM survival after SCT was 71.4% with a median follow-up of 3.4 years. All 5 patients treated with supportive treatment alone died of infection or progression at the median age of 13.5 years, except for one with short followup duration. Acute leukemia developed in 2 patients at 15.4 and 18.1 years of age. Among 6 patients who are still alive, 3 had short stature and 1 developed insulin-dependent diabetes mellitus. Conclusion: We provide information on the long-term outcomes of FA patients in Korea. A nation-wide FA registry that includes information of the genotypes of Korean patients is required to further characterize ethnic differences and provide the best standard of care for FA patients.

• Journal of Korean Academy of Nursing
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• v.27 no.2
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• pp.401-410
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• 1997

An acute pain is the common experience following surgery. Pain is a most miserable experience in person and most preoperative patients have fear o! postoperative pain. In nursing, it is very important to understand and relieve the pain of post oprative patients as much as possible. This study was designed to compare the descriptive patterns of pain between group of Patient Controlled Analgesia and group of traditional Muscular Injection in surgcal patients. This information can be utilited as data of understanding nursing care and treatment planning for pain in surgical patients. The subjects in this study were 45 post-hysterectomy patients in Gynecology ward in C. N. U. H., in Taejon. Data was collected from May 12 to June 27. 1996. The instrumants used for this study were subjective Visual Analog Scale, Objedive nonverbal pain scale composed of Facial Apperance. Vocal Sound Change, and Sweating score. and the Melzack's Mcgill pain Qusetionaire. nine Items of Developmental Pain Intensity Scale by Lee En Ok. Analysis of data was done by using S. P. S. S. percentage, t-test, x²-test. ANOVA, and Repeated measure ANOVA. Results were obtained as follows. 1. Hypothesis 1 : There was very highly statistically significant difference in subjective self-report pain score(Visual Analog Scale) between PCA Group and IM Group(P=0.0001). 2. Hypothesis 2 : There was very highly statistically significant difference in muscle strength score (Visual Analog Scale) between PCA Group and IM group(P0.0001). 3. Hypothesis 3 : There was very highly statistically significant difference in facial appearance score between PCA Group and IM group(P=0.0001). 4. Hypothesis 4 : There was very highly statistically significance difference in vocal sound change score between PCA Group and IM group(P=0.0001). 5. Hypothesis 5 : There was no statistically significant difference sweating scores between PCA group and IM group(F=2.50, P=0.1220). But, postoperation time of 12, 24 was statistically difference between two groups(P=0.0001). So, it was partially supported. 6. Hypothesis 6 : There was very highly statistically significant difference in vocabulary pain score between PCA Group and IM group. 7. Hypothesis 7 : There was very highly statistically significant difference in amounts of total analgesic between PCA Group and IM group. There was very highly statistically significant difference in Visual Analog Pain Score, Facial Appearance Score, Vocal Sound Change Score, Vocabulary Score, amounts of total analgesic between PCA group and IM group. So, It is verified to asses of postoperative pain with VAS, Checklist of facia appearance, vocal sound change, and sweating, and Vocabulary Scale.

• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.665-671
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• 2007

Purpose : The purpose of this study was to investigate the clinical features and outcome in newborns undergoing cardiac surgery. Methods : Eighty two neonates underwent heart surgery for congenital heart defect at Kyungpook National University Hospital between March 2000 and February 2006. Patient characteristics (sex, age, diagnosis), pre-operative conditions, operation type, postoperative complications and mortality were reviewed retrospectively. Results : In 82 patients, 41 (50%) were male. The mean age and weight at operation were 12 days and 3.2 kg, respectively. The common cardiac anomalies were complete transposition of the great arteries (TGA), Tetralogy of Fallot (TOF), pulmonary atresia with intact ventricular septum, and single ventricle variants. Fifty seven operations were performed with cardiopulmonary bypass and corrective surgery was done on 54 patients. Arterial switch operation and modified Blalock-Taussig shunt were most frequently performed as corrective and palliative operations, respectively. The early hospital mortality rate was 7%; the late mortality was 3.9%. Complications were acute renal insufficiency, delayed sternal closure, wound infection, arrhythmia, and brain hemorrhage. Conclusion : During the last 6 years, the outcomes of cardiac surgery for congenital heart defects in neonates improved by progress in perioperative, anaesthetic, surgical, and postoperative care.

• Pediatric Infection and Vaccine
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• v.3 no.2
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• pp.154-162
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• 1996

Purpose : Adenoviruses(Ad) have been shown to play an important role in the etiology of severely acute respiratory diseases, particulary in infants and young children, and the occurrence of fatal outcome and chronic pulmonary sequelae in association with adenoviral infection has been a cause of great interest and concern. This report presents the resul of a retrospective analysis on 30 cases of lower respiratory infection from which adenovirus was isolated. Patients & Methods : The 30 patients in this study represent all detected cases of adenovial infection out of 240 children who were admitted to Sang Sung Medical Center between February to June 1996 showing signs and symptoms of lower respiratory tract infection. The diagnosis of adenovirus infection was based on microscopic visualization of typical cytopathic effect in HEp-2 tissue culture and used monoclonal Ab with nasopharyngeal aspiration. Results : The male/female ratio was 2:1 and the majority of age range was below 36months. Clinical diagnoses in all 30 patients were pneumonia(n=21), bronchitis and Bronchiolitis(n=5) and ARDS(n=4). We recieved the most of patients in the month of May. The chief complaints were fever(93.3%) and cough(80%) and extrapulmonary symptoms were diarrhea(n=5), seizure(n=4), abdominal pain(n=1). The mean duration of fever was $11.95{\pm}6.54$days. Physical examination on admission were crackles(73.3%), coarse breathing sounds(60%), hepatosplenomegaly(33.3%), decreased brething sounds(30%). In WBC counts, 8cases were below $4000/mm^3$ and 14 cases were above $10,000/mm^3$. In platelets counts, 4cases were below $150,000/mm^3$ and 10 cases were above $450,000/mm^3$. 21 cases were above 1 in CRP. GOT and GPT were abnormal in some cases. Chest X-ray revealed diffuse pulmonary infiltration(n=15), pleural effusion(n=6), consolidation(n=4) and hyperaeration(n=3). Seven patients were treated at the peditric intensive care unit with respiratory support and high dose of gammaglobulin. However, one patients died even through he was treated with NO ventilation and high frequency ventilation. Conclusion : Those with adenoviral pneumonia and respiratory infection having long fever duration and symptoms like bacterial pneumonia must be carefully differentiated in order to provide proper treatement and preventive measures due to possible fatal outcome.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.43-50
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• 2004

One of the major advantages of microsurgical reconstruction for defects of the hand is that these techniques allow for selection of the most ideal tissue to reconstruct a particular defect, thus optimizing the functional and aesthetic outcome. The dorsalis pedis free flap is an excellent reconstructive tool for various hand reconstructions. It has a reliable vasculature with vessels that are relative large on a long pedicle. It provides thin pliable tissue and be innervated by deep peroneal nerve. Coupled with its thinness and pliability, it is ideal for innervated cover of critically sensitive area, especially such as the hand. Thus it can be used as a cutaneotendinous flap, or an osteocutaneous flap. Otherwise, the major criticism with this flap is related to its uncertain vascularity and the donor defect. It is the purpose of this paper to outline our technique of flap elevation and donor site closure and to indicate our current use of this flap in hand reconstruction. We have treated 10 cases (6 burn scar contracture cases, 4 acute hand trauma cases) of hand reconstruction from Dec. 3, 1997 to Mar. 4, 2004 using dorsalis pedis free flap. The key points for sucess in terms of a viable flap and acceptable donor site are the preservation of the critical dorsalis pedis-first dorsal metatarsal vascular axis and the creation of a viable bed for grafting. In addition, we substituted preserved superficial fat skin graft for split thickness skin graft and wet environment was offered for good graft take. Preserved superficial fat skin is defined as composite graft containing epidermis, dermis and superficial fat layer. With sufficient care in flap elevation and donor site closure, a good graft take of preserved superficial fat skin under wet environment can be achieved with no functional disability and minimal cosmetic deformity in donor site. This flap has proved itself to be a best choice for hand reconstruction.

• Korea Journal of Hospital Management
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• v.20 no.3
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• pp.45-55
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• 2015

While the influence of healthcare accreditation system to the quality improvement of hospitals has more increased, regarding the preparation costs for healthcare accreditation, it has never been empirically studied about the costs that are actually invested by hospitals. This study is going to determine the difficulties in the preparation process of accreditation and details of accreditation preparation costs for hospitals that participated in the healthcare accreditation system and acquired accreditation. The survey was performed in a self-reported form from February 28 to March 21 2014 for 189 acute hospitals accredited as a hospital from 2011 to February 2014. Of all questionaries of survey participants, 98 were recovered; the response rate was 51.9%. A total of 40 questionnaires were used except for 58 containing insincere answers. Main findings are followings: Firstly, findings showed that advanced general hospitals spent the most statistically significantly highest in terms of equipments and total costs among cost items for accreditation preparation. When accreditation preparation costs items were classified according to classification of hospitals, advanced general hospitals spent the most statistically significantly highest in the equipments and total costs. Also in terms of regional, Gyeonggi, Incheon regions were found to spend statistically significantly higher costs in the equipments costs. Secondly, as a result of the survey in the distribution of the total accreditation preparation costs, advanced general hospitals have disbursed the most out of all. However, the result in hospitals does not show significant difference to the expense of advanced general hospitals and that especially other regional hospitals spent higher costs. As such, all hospitals are under a heavy burden of higher costs on accreditation preparation, especially hospitals. The build-up of infrastructures by hospitals through an accreditation system consequently led to a higher initial investment; if the accreditation system is effective in improving the quality of health care and patient safety, appropriate responses are needed. In other words, financial support for investment costs needs to be given to allow hospitals to actively participate in the accreditation system.

• The Korean Journal of Physiology and Pharmacology
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• v.14 no.4
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• pp.213-221
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• 2010

The hypothalamic-pituitary-adrenal (HPA) axis is the primary endocrine system to respond to stress. The HPA axis may be affected by increased level of corticotrophin-releasing factors under chronic stress and by chronic administration of monosodium glutamate (MSG). The purpose of this study was to investigate whether chronic MSG administration aggravates chronic variable stress (CVS)-induced behavioral and hormonal changes. Twenty-four adult male Sprague-Dawley rats, weighing 200~220 g, were divided into 4 groups as follows: water administration (CON), MSG (3 g/kg) administration (MSG), CVS, and CVS with MSG (3 g/kg) administration (CVS＋MSG). In addition, for the purpose of comparing the effect on plasma corticosterone levels between chronic stress and daily care or acute stress, 2 groups were added at the end of the experiment; the 2 new groups were as follows: naive mice (n=7) and mice exposed to restraint stress for 2 h just before decapitation (A-Str, n=7). In an open field test performed after the experiment, the CVS＋MSG group significant decrease in activity. The increase in relative adrenal weights in the CVS and CVS＋MSG group was significantly greater than those in the CON and/or MSG groups. In spite of the increase in the relative adrenal weight, there was a significant decrease in the plasma corticosterone levels in the CVS＋MSG group as compared to all other groups, except the naive group. These results suggest that impaired HPA axis function as well as the decrease in the behavioral activity in adult rats can be induced by chronic MSG administration under CVS rather than CVS alone.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.5 no.1
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• pp.107-124
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• 1998

Based on King's goal attainment theory, this research deals with applying nursing intervention of mutual goal settings to gastrectomy patients. It tests the effects of nursing intervention, according to the patients' health locus of control, suggested as external boundary criteria for the theory by employing a quasi-experimental design which consists of a pretest-posttest non-equivalent control and experimental groups. The subjects of this research were 62 gastrectomy patients hospitalized at Y medical center and the experimental and control groups consisted of 31 subjects. The experimental group received nursing intervention at the mutual goal setting of 5 times from the day before the surgery to the 5th day after the surgery, while the control group received only routine nursing care. Recovery indicators of both groups were measured and compared. Measurement variables included patients' characteristics, health locus of control, forced vital capacity, forced expiratory volume in one second, peak expiratory flow, bowel movement recovery, mobility recovery, level of pain, patients' stress and patients' satisfaction. Data were analyzed using SPSS statistical package and the hypotheses were tested by ANOVA and ANCOVA. Results of the analyses are summarized as follows : 1) Internal health locus of control had higher effects of the nursing intervention of mutual goal setting than external health locus of control on pulmonary ventilatory functions of forced vital capacity, forced expiratory volume in one second, and peak expiratory flow. 2) There was no statistically significant difference in the effects of nursing intervention of mutual goal setting on the bowel movement recovery between the internal and external health locus of control. 3) There was no statistically significant difference in the effects of nursing intervention of mutual goal setting on the mobility recovery between the internal and external health locus of control. 4) There was no statistically significant difference in the effects of nursing intervention of mutual goal setting on the level of pain between the internal and external health locus of control. 5) There was no statistically significant difference in the effects of nursing intervention of mutual goal setting on the level of stress between the internal and external health locus of control. 6) There was a statistically significant difference in the effects of nursing intervention of mutual goal setting on the level of satisfaction with provision of nursing information between the internal and external health locus of control, and there was no statistically significant difference in the effects of nursing intervention of mutual goal setting on the level of satisfaction with outcome of nursing between the internal and external locus of control. On the basis of the research results, the following are recommended : 1) Repeated research on responses to health locus of control is necessary. 2) Not only the effectiveness of nursing intervention in acute recovery periods, but also the long term effects are to be investigated. 3) The development of instruments is needed to accurately measure mutual goal setting regarding postoperative deep breath, coughing, early ambulation, etc. so that the relationship among the postoperative recovery indicators may be explored. 4) It is required that an instrument be developed to measure perception which facilitates goal attainment in the interactive setting between patients and nurses.