• Korea Journal of Hospital Management
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• v.22 no.4
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• pp.87-101
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• 2017

[Purpose] This study aims to classify of healthcare decline and analyze the corresponding health outcomes among cities in Korea. In pursuing the above, this paper gives the particular attention to draw policy implications. [Methodology/Approach] Public healthcare data of 81 cities between 2014 and 2015 was obtained from the National Medical Center of Korea. A matrix analysis, t-test, ANOVA and multivariate regression were applied. [Findings] The study results indicated that declining cities tend to have the most healthcare resources, compared to growing or maintaining cities. However, accessibility to healthcare appeared to be lower in declining cities. Based on the classification of cities on healthcare decline, 42 out of 81 cities were categorized as a maintain/improvement group, while 39 cities were characterized as decline/depression. The group with a decline/depression type has significantly more healthcare facilities than maintain/improvement type. In contrast, maintain/improvement cities indicated lower incidence of morbidity and mortality than decline/depression cities. Lastly, according to the multivariate regression analysis for the healthcare outcomes by the type of healthcare decline, incidence of morbidity and mortality tended to decrease as the number of healthcare workers, the proportion of people who have healthcare accessibility, and the Timely Relevance Index increased regardless of the number of medical facilities including hospital beds and special beds. [Practical Implications] In conclusion, focusing on the improvement of healthcare accessibility as well as staffing, rather than expanding facilities is essential to set the healthcare policies.

• Radiation Oncology Journal
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• v.32 no.3
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• pp.179-186
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• 2014

Purpose: To study the long-term outcomes and tolerance in our patients who received dose escalated radiotherapy in the early salvage post-prostatectomy setting. Materials and Methods: The medical records of 54 consecutive patients who underwent radical prostatectomy subsequently followed by salvage radiation therapy (SRT) to the prostate bed between 2003-2010 were analyzed. Patients included were required to have a pre-radiation prostate specific antigen level (PSA) of 2 ng/mL or less. The median SRT dose was 70.2 Gy. Biochemical failure after salvage radiation was defined as a PSA level >0.2 ng/mL. Biochemical control and survival endpoints were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox regression analysis were used to identify the potential impact of confounding factors on outcomes. Results: The median pre-SRT PSA was 0.45 ng/mL and the median follow-up time was 71 months. The 4- and 7-year actuarial biochemical control rates were 75.7% and 63.2%, respectively. The actuarial 4- and 7-year distant metastasis-free survival was 93.7% and 87.0%, respectively, and the actuarial 7-year prostate cancer specific survival was 94.9%. Grade 3 late genitourinary toxicity developed in 14 patients (25.9%), while grade 4 late genitourinary toxicity developed in 2 patients (3.7%). Grade 3 late gastrointestinal toxicity developed in 1 patient (1.9%), and grade 4 late gastrointestinal toxicity developed in 1 patient (1.9%). Conclusion: In this series with long-term follow-up, early SRT provided outcomes and toxicity profiles similar to those reported from the three major randomized trials studying adjuvant radiation therapy.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7401-7407
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• 2013

Aim: To compare survival outcomes after whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and WBRT plus SRS combination therapy in Korea, by performing a quantitative systematic review. Materials and Methods: We searched 10 electronic databases for reports on Korean patients treated with WBRT or SRS for brain metastases published prior to July 2010. Independent reviewers screened all articles and extracted the data. When a Kaplan-Meier survival curve was available, median survival time and standard errors were calculated. Summary estimates for the outcomes in each study were calculated using the inverse variance random-effects method. Results: Among a total of 2,761 studies, 20 studies with Korean patients (n=1,053) were identified. A combination of 12 studies (n=566) with WBRT outcomes showed a median survival time of 6.0 months (95%CI: 5.9-6.2), an overall survival rate of 5.6% (95%CI: 1-24), and a 6-month survival rate of 46.5% (95%CI: 37.2-56.1). For nine studies (n=412) on SRS, the median survival was 7.9 months (95%CI: 5.1-10.8), and the 6-month survival rate was 63.1% (95%CI: 49.8-74.8). In six studies (n=75) using WBRT plus SRS, the median survival was 10.7 months (95%CI: 4.7-16.6), and the overall and 6-month survival rates were 16.8% (95%CI: 6.2-38.2) and 85.7% (95%CI: 28.3-96.9), respectively. Conclusions: WBRT plus SRS showed better 1-year survival outcome than of WBRT alone for Korean patients with metastatic brain tumors. However, the results of this analysis have to be interpreted cautiously, because the risk factors of patients were not adjusted in the included studies.

• Radiation Oncology Journal
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• v.33 no.1
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• pp.21-28
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• 2015

Purpose: We analyzed outcomes of patients with prostate cancer undergoing either radical retropubic prostatectomy (RRP) +/- salvage radiation or definitive radiation therapy (RT) +/- androgen deprivation. Materials and Methods: From 2003-2010 there were 251 patients who underwent RRP and 469 patients who received RT (${\geq}7,560cGy$) for prostate cancer. Kaplan-Meier analysis was performed with the log-rank test to compare biochemical control (bCR), distant metastatic-free survival (DMPFS), and prostate cancer-specific survival (PCSS) between the two groups. Results: The median follow-up was 70 months and 61.3% of the men were African American. For low risk disease the 6-year bCR were 90.3% for RT and 85.6% for RRP (p = 0.23) and the 6-year post-salvage bCR were 90.3% vs. 90.9%, respectively (p = 0.84). For intermediate risk disease the 6-year bCR were 82.6% for RT and 59.7% for RRP (p < 0.001) and 82.6% vs. 74.0%, respectively, after including those salvaged with RT (p = 0.06). For high risk disease, the 6-year bCR were 67.4% for RT and 41.3% for RRP (p < 0.001) and after including those salvaged with RT was 67.4% vs. 43.1%, respectively (p < 0.001). However, there were no significant differences between the two groups in regards to DMPFS or PCSS. Conclusion: Treatment approaches utilizing RRP +/- salvage radiation or RT +/- androgen deprivation yielded equivalent DMPFS and PCSS outcomes. Biochemical control rates, using their respective definitions, appeared equivalent or better in those who received treatment with RT.

• Korean Medical Education Review
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• v.18 no.3
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• pp.119-124
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• 2016

The Korea Association of Medical Colleges (KAMC) has been developing learning outcomes for basic medical education (BME) since 2012. This initiative is designed to help medical schools implement competency-based medical education. KAMC divided the BME competencies into three domains (clinical practice, scientific concepts and principles, and human beings and society) with learning outcomes for each domain. KAMC plans to revise the learning outcomes to reflect feedback from medical schools, changes in social health needs, and changes in the healthcare environment and healthcare system in the near future. KAMC also plans to specify learning outcomes that integrate the three domains.

• Korea Journal of Hospital Management
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• v.24 no.4
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• pp.43-56
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• 2019

Purpose: Importance of patient satisfaction related to patient-centeredness has been emphasized, and it is known to have effect on various health outcomes including health resource utilization. However, the effect of patient satisfaction has been discussed mostly in terms of hospital marketing in Korea. This study aims to examine the effect of patient satisfaction in patient-physician communication on healthcare utilization in a nationally representative adult population of South Korea. Method: Patient satisfaction with physician communication is assessed using 4 items in the 2011 Korea Health Panel Survey. Generalized linear regression analysis is conducted using 9,325 adults' healthcare utilization in 2012. Findings: Adjusting for the socio-demographic, economic factors, individual health status, health behaviors and healthcare utilization in 2011, more satisfied individuals, more likely to utilize the outpatient service, especially in clinical setting. Practical Implications: The study findings suggests that in context of South Korea healthcare system such as insufficient medical consultation time and the absence of health delivery system, patient satisfaction as a subjective healthcare quality indicator would have effect on the individual's outpatient visit. This study contributes to stimulate patient satisfaction research and discussion in South Korea to further explore its relationship with potential and various health related outcomes. Further implications of the study are discussed.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.3
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• pp.292-300
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• 2023

Backgrounds/Aims: Current literature presents limited data regarding outcomes following conversion at the time of minimally invasive pancreaticoduodenectomy (MI-PD). Methods: The National Cancer Database was queried for patients who underwent pancreaticoduodenectomy. Patients were stratified into three groups: MI-PD, converted to open pancreaticoduodenectomy (CO-PD), and open pancreaticoduodenectomy (O-PD). Multivariable modeling was applied to compare outcomes of MI-PD and CO-PD to those of O-PD. Results: Of 17,570 patients identified, 12.5%, 4.2%, and 83.4% underwent MI-PD, CO-PD, and O-PD, respectively. Robotic pancreaticoduodenectomy (R-PD) resulted in a higher lymph node yield (n = 23.2 ± 12.2) even when requiring conversion (n = 22.4 ± 13.2, p < 0.001). Margin positivity was higher in the CO-PD group (26.6%) than in the MI-PD group (21.3%) and the O-PD (22.6%) group (p = 0.017). Length of stay was shorter in the MI-PD group (laparoscopic pancreaticoduodenectomy 10.4 ± 8.6, R-PD 10.6 ± 8.8) and the robotic converted to open group (10.7 ± 6.4) than in the laparoscopic converted to open group (11.2 ± 9) and the O-PD group (11.5 ± 8.9) (p < 0.001). After adjusting for patient and tumor characteristics, both MI-PD (odds ratio = 1.40; p < 0.001) and CO-PD (odds ratio = 1.24; p = 0.020) were significantly associated with an increased likelihood of long-term survival. Conclusions: CO-PD does not negatively impact perioperative or oncologic outcomes.

• Journal of The Korea Institute of Healthcare Architecture
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• v.18 no.1
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• pp.45-52
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• 2012

This study aims to examine the outdoor environment of a geriatric hospital and explore its stress-relief impact upon those who utilize it. Post Occupancy Evaluation is employed to assess the effectiveness of a healthcare setting. This study is based on survey questionnaire including the users' perception of outdoor environment, their perceived restorativeness, and quality of life. A total of one hundred and sixty individuals including patients, families and visitors, and healthcare staffs. As a result, it turns out that the therapeutic outdoor environment and its users' health outcomes, such as reststroativeness and quality of life are significantly correlated. In conclusion, the finding of this research seems to demonstrate the potential that the therapeutic outdoor environment has for the improvement of its users' health by enhancing.

• Journal of Preventive Medicine and Public Health
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• v.55 no.5
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• pp.415-423
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• 2022

Economic evaluations in the healthcare are used to assess economic efficiency of pharmaceuticals and medical interventions such as diagnoses and medical procedures. This study introduces the main concepts of economic evaluation across its key steps: planning, outcome and cost calculation, modeling, cost-effectiveness results, uncertainty analysis, and decision-making. When planning an economic evaluation, we determine the study population, intervention, comparators, perspectives, time horizon, discount rates, and type of economic evaluation. In healthcare economic evaluations, outcomes include changes in mortality, the survival rate, life years, and quality-adjusted life years, while costs include medical, non-medical, and productivity costs. Model-based economic evaluations, including decision tree and Markov models, are mainly used to calculate the total costs and total effects. In cost-effectiveness or costutility analyses, cost-effectiveness is evaluated using the incremental cost-effectiveness ratio, which is the additional cost per one additional unit of effectiveness gained by an intervention compared with a comparator. All outcomes have uncertainties owing to limited evidence, diverse methodologies, and unexplained variation. Thus, researchers should review these uncertainties and confirm their robustness. We hope to contribute to the establishment and dissemination of economic evaluation methodologies that reflect Korean clinical and research environment and ultimately improve the rationality of healthcare policies.

• Journal of Home Health Care Nursing
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• v.17 no.2
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• pp.85-94
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• 2010

Purpose: The study aimedto provide basic data to improve the quality of home healthcare nursing services by evaluating quality of care in representative nationwide sites. Method: The current quality of home care service in 104 nationwide sites was evaluated in terms of structures, processes, and outcomes based on published standards of the Joint Commission on Accreditation of healthcare Organizations. Results: The mean score for three dimensions of quality of home care service was as follows in descending order: structures (77.6), outcomes (60.4), and processes (38.7). Additionally, by specific item compared level of quality of home care servicein each site, the highest score was 97.3 and the lowest score was 42.3 out of 100, with a mean score of 74.7. Conclusions: These findings provide a base for establishing the quality management system and to develop a tool for evaluating the quality of home healthcare nursing. The result should be continuous management and improvement of home healthcare nursing quality.