• Archives of Plastic Surgery
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• v.35 no.4
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• pp.393-399
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• 2008

Purpose: Chronic infected wounds sustained over 4 weeks with exposed tendon or bone are difficult challenges to plastic surgeons. Vacuum assisted closure (VAC) device has been well used for the management of chronic wounds diminishing wound edema, reducing bacterial colonization, promoting formation of granulation tissue and local blood flow by negative pressure to wounds. But Commercial ready-made VAC device might have some difficulties to use because of its high expenses and heavy weight. So we modified traditional VAC device with silver dressing materials as topical therapeutic agents for control of superimposed bacterial wound infection such as MRSA, MRSE and peudomonas. Methods: We designed the modified VAC device using wall suction, 400 cc Hemovac and combined slow release silver dressing materials. We compared 5 consecutive patients' data treated by commercial ready-made VAC device(Group A) with 11 consecutive patients' data treated by modified VAC device combined with silver dressing materials(group B) from September 2004 to June 2007. Granulation tissue growth, wound discharge, wound culture and wound dressing expenses were compared between the two groups. Results: In comparison of results, no statistical differences were identified in reducing rate of wound size between group A and B. Wound discharge was significantly decreased in both groups. Modified VAC device with silver dressing materials showed advantages of convenience, cost effectiveness and bacterial reversion. Conclusion: In combination of modified VAC device and silver dressing materials, our results demonstrated the usefulness of managing chronic open wounds superimposed bacterial infection, cost effectiveness compared with traditional VAC device and improvement of patient mobility.

• The Korean Journal of Health Service Management
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• v.13 no.3
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• pp.115-125
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• 2019

Objectives: Korea has been practicing the separation of dispensary from medical practice since 2000 as a national policy to prevent misuse or overuse of medicines. This study aimed to investigate prescription patterns from except pharmacies in order to determine the appropriateness of drug usage among those patients. Methods: Thirty-two pharmacies in the Yeongdong area of Gangwon Province were examined in this study. The same simulated patient complaining of cold symptoms for 3 days visited each pharmacy to obtain a prescription for medication. Results: At pharmacies prescribing medicine, steroids (53.1%) and antibiotics (50.0%) were used to treat the common cold. Duplicate prescriptions of drugs, such as antihistamines (47.0%) and decongestants (31.3%) were common. The average number of drug prescriptions was 6.59, and 53.2% of pharmacies had prescribed more than seven drugs. The average total cost of the prescriptions was 6,093 won, and the daily cost was 2,544 won. Conclusions: Steroids and antibiotics were frequently abused among patients whose medications had been prescribed by pharmacies. Also, there were a considerable number of drugs and duplicate prescriptions. The prices of the drugs were somewhat high.

• Archives of Plastic Surgery
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• v.49 no.4
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• pp.531-537
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• 2022

Wide-awake, local anesthesia, no tourniquet (WALANT) is a technique that removes the requirement for operations to be performed with a tourniquet, general/regional anesthesia, sedation or an anesthetist. We reviewed the WALANT literature with respect to the diverse indications and impact of WALANT to discuss the importance of future surgical curriculum integration. With appropriate patient selection, WALANT may be used effectively in upper and lower limb surgery; it is also a useful option for patients who are unsuitable for general/regional anesthesia. There is a growing body of evidence supporting the use of WALANT in more complex operations in both upper and lower limb surgery. WALANT is a safe, effective, and simple technique associated with equivalent or superior patient pain scores among other numerous clinical and cost benefits. Cost benefits derive from reduced requirements for theater/anesthetic personnel, space, equipment, time, and inpatient stay. The lack of a requirement for general anesthesia reduces aerosol generating procedures, for example, intubation/high-flow oxygen, hence patients and staff also benefit from the reduced potential for infection transmission. WALANT provides a relatively, but not entirely, bloodless surgical field. Training requirements include the surgical indications, volume calculations, infiltration technique, appropriate perioperative patient/team member communication, and specifics of each operation that need to be considered, for example, checking of active tendon glide versus venting of flexor tendon pulleys. WALANT offers significant clinical, economic, and operative safety advantages when compared with general/regional anesthesia. Key challenges include careful patient selection and the comprehensive training of future surgeons to perform the technique safely.

• Journal of Korean Medicine Rehabilitation
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• v.33 no.2
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• pp.57-76
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• 2023

Objectives This study aims to develop Korean Medicine Clinical Pathway (CP) based on Clinical Practice Guideline of carpal tunnel syndrome to improve quality of treatment and reduce medical cost to maximize the quality of patient management. Methods A draft version of CP for carpal tunnel syndrome is developed by expert agreement and a prospective case study was carried out based on the draft CP. Twenty experts working at various medical institution answered validity verification survey of developed CP. Fifteen patients enrolled in the prospective case study answered survey on demand and satisfaction. Qualification and adjustment process of the draft CP was conducted based on results of both surveys. Results Final version of CP for carpal tunnel syndrome is confirmed after qualification and adjustment on the draft version. Conclusions CP for carpal tunnel syndrome will provide patients with standardized, high-quality Korean medicine treatment and also reduce financial burden of health insurance by reducing medical cost.

• Pediatric Infection and Vaccine
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• v.12 no.2
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• pp.124-134
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• 2005

Purpose : It has been known that the diagnostic confirmation of group A streptococcal pharyngitis is accompanied with the results of throat culture and/or rapid antigen detection test(RADT). This study was designed to evaluate the usefulness and cost benefits of the RADT in patients with a sore throat compared the empirical antibiotic treated group without using RADT or throat culture with the antibiotic treated group according to the results of RADT test and/or throat culture. Methods : From April 2003 to August 2003, total 369 patients were enrolled this study. They were redistributed into two groups. In one group, the RADT test and throat culture were used and the patients received antibiotic treatment according to the results of test and in the other group, no diagnostic examinations were used and the patients were treated with antibiotics which were chosen empirically. The flow sheet with questionnaire was drawing up and obtained the clinical symptoms, signs and the name of antibiotics that were administered. Results : A total of 244 patients were treated after the throat culture and/or RADT, and 125 patients were treated empirically. The prevalence of bacteriologically confirmed group A streptococcal pharyngitis was 20.1%. The sensitivity and specificity of RADT were 89.8% and 86.1%, respectively. Positive predictive value and negative predictive value were 62.0% and 97.1%, respectively. The rate of antibiotic use was high in both groups. Because the physician used the antibiotics even if the result of RADT was negative. So about 37% of reduction of antibiotics use might be possible if we used antibiotics according to the results of RADT. There were no cost differences between the RADT applied group and the empirically treated antibiotic group if we could reduce the price of RADT to 63% of the current price. Conclusion : The RADT could be applied for the easy and rapid diagnosis and prompt treatment for group A streptococcal pharyngitis, and RADT could reduced the number of antibiotics used if the price of RADT was reduced to 63% of current price. For accurate evaluation of efficacy and cost effect, further controlled study is needed.

• The Journal of the Korea Contents Association
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• v.17 no.4
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• pp.585-595
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• 2017

The purpose of this study is to analyze the difference of medical care between medical assistance and health insurance patients to evaluate the increase of medical care costs due to the moral hazard of medical care patients and to provide a basis for rational medical care policy decision. For this purpose, we compared health insurance benefit data for Seoul citizens by gender, age, and type of medical institutions. The results of the analysis are as follows. First, all of the hospitalized and outpatient use of the advanced general Hospitals, medical assistance patients were less than those of the health insurance patients, so that the medical assistance patients could not use the high cost medical services. Second, in general hospitals, patients with health insurance are often hospitalized. On the other hand, medical assistance patients use a lot of outpatient services because they are less burdened. Third, in hospitals and clinics, medical benefits patients often use inpatient and outpatient services. Therefore, medical assistance patients are likely to use unnecessary medical care of outpatient and hospitalization clinics and hospitals, outpatient of general hospitals. But, in hospitalization and outpatient use in advanced general hospitals and medical assistance patients can not use due to excessive medical burden. Therefore, the policy to reduce the burden of medical expenses for patients with severe illness will continue, and the medical care patients using clinics and hospitals should be careful not to use unnecessary medical services.

• Korea Journal of Hospital Management
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• v.4 no.2
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• pp.21-40
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• 1999

One Diagnosis Related Group(DRG) pilot study participating hospital was measured and analyzed to see if there were any changes after the DRG program. It was implemented in consideration of medical service utilization, hospital charges, and non-covered medical service charges by insurance in all Cesarean section cases by reviewing medical records for 3 years, including 1 year before pilot study as well as 1 and 2 years after, respectively. The results were as follows: First, the use of intramuscular antibiotics decreased statistically significantly, whereas intravenous use did not. Second, the administration period and charges of antianemic medication decreased significantly, where the prescription was appropriate. Third, the length of hospital stay decreased statistically significantly. Fourth, there were significant statistical differences in cost sharing between the insured and the insurer: cost sharing of the insured was reduced, whereas the share of the insurer increased. However, there was no change in the quality of care. Fifth, there were no statistically significant changes in the Cesarean section rate. As a result, if the fee schedule is reasonably high, hospitals can provide quality care. This DRG pilot study resulted expected outcomes: by paying a higher fee schedule than fee-for-service, then hospitals can provide quality care to their patients and increase hospital profits.

• Journal of the Korean Society of Radiology
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• v.82 no.2
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• pp.280-297
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• 2021

International guidelines recommended screening with ultrasonography (US) every 6 months for patients at risk for hepatocellular carcinoma (HCC). However, US demonstrates low sensitivity for the early detection of HCC. Magnetic resonance imaging (MRI) plays an important role in the noninvasive diagnosis of HCC, but it is not suitable for surveillance due to its lengthy examination and high cost. Therefore, several studies have been using various abbreviated MRI strategies, including noncontrast abbreviated MRI, dynamic contrast-enhanced abbreviated MRI, and abbreviated MRI using hepatobiliary phase image for HCC surveillance. In this article, we aim to review these various strategies and explore the future direction of HCC surveillance considering the cost-effectiveness aspect.

• The Journal of Korean Obstetrics and Gynecology
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• v.30 no.1
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• pp.85-94
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• 2017

Objectives: To explore experiences of treatment-related side effects and supportive care among Korean breast cancer survivors (BCS). Methods: Focus group interview was conducted with six Korean women with breast cancer. Participants were recruited through snow-balling. Interview was audio-recorded and transcribed verbatim. NVivo-11 was used to code the data into themes. Results: Two major themes were identified: (1) experiences of Western medicine, including treatment, side effects, needs and costs; (2) experiences of supportive care with Korean medicine, including the same as above. All participants experienced Western medicine in treatment phase and reported impairment of physical, emotional, and social functioning during and after Western medicine treatment. Only three participants used Korean medicine after treatments end. The negative responses from Western medicine doctors were the most important factor keeping participants from accessing Korean medicine when treatment-related side effects occurred. For this reason, some participants used Korean medicine without disclosure. Participants usually acquired information about Korean medicine from online community or other BCS, which was another important factor because it raised concerns about side effects and credibility of Korean medicine. High cost was also reported as barrier in using Korean medicine. During the cancer treatment, participants tended to endure their treatment-related side effects. Conclusions: Korean BCS may be at high risk of physical or emotional distress during treatment period. Findings suggest that there is a high need for supportive care to relieve treatment-related side effects and improve patients' quality-of-life. Furthermore, developing a systematic guidance or credible information sources should be warranted to help patients find the best supportive care options including Korean medicine.

• Journal of Periodontal and Implant Science
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• v.39 no.3
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• pp.375-381
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• 2009

Purpose: Root resection can be a valuable procedure when the tooth in question has a high strategic value. The prognosis of root resection has been well documented in previous studies, but the results focused on the palatal root resection have not been discussed in depth. I represent here the short term effectiveness of palatal root resection of maxillary first molars. Methods: Palatal root resection was performed on maxillary first molars of three patients. All the palatal roots were floating state on the radiographic finding and showed full probing depth and purulent exudation at initial examination. Reduction of palatal cusp and occlusal table was performed concomitantly. Endodontic therapy was completed after root resection. Results: Compromised maxillary first molars were treated successfully by palatal root resection in 3 cases. The mobility of resected tooth was decreased a little bit. The probing pocket depth of remaining buccal roots was not increased compared to initial depth. All the patients satisfied with comfort and cost effective results and the fact they could save their natural teeth. Conclusions: Within the above results, palatal root resection is an effective procedure treating compromised maxillary first molar showing advanced palatal bone loss to root apex with or without pulp involvement when proper case selection is performed.