• Journal of Preventive Medicine and Public Health
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• 제29권4호
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• pp.815-829
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• 1996

A physician survey was done by mailing for the purpose of performing hospital services evaluation and ranking. A slightly over one thousand samples were drawn from the list of professional societies, and 324 physicians(about 32 percent) replied. This study has focused on developing easy and simple method to evaluate hospital services, and providing patients with useful information. Hospital service structure and process were evaluated without outcome evaluation, because it is difficult to obtain reliable data regarding health services outcome indicators. Clinical specialty was targeted to evaluate, and three specialties were chosen, that is obstetrics & gynecology, cardiology, and proctology. Among 16 structural indicators, four indicators were finally chosen in each specialty by respondent specialists. And then using these indicators, structural score was calculated for study hospitals. For process evaluation, physicians were requested to nominate five most famous hospitals. The nomination score and structural score were summed up to produce final score and hospital ranking. This method is very easy to conduct rather than other hospital services evaluation methods prevailing in Korea. And it is more useful for patients to choose hospitals, according to his/her own purpose, because it gives high ranking hospitals with specific clinical specialty.

• Journal of Trauma and Injury
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• 제28권1호
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• pp.51-54
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• 2015

The incidence of foreign body insertion in the anorectum is rare, however, it is increasing, especially in urban populations. Foreign objects in the anorectum can be of different sizes, shapes and materials. Frangible objects like glass or beakers, and sharp foreign bodies that may easily injure the bowel mucosa are particularly dangerous. Physicians have to consider more innovative options on how to extract these foreign bodies without inciting injury; and, if injury would occur, consider different techniques to repair it, whether transanally or transabdominally, and opt for primary repair, or resection with either anastomosis or stoma creation. Here, I introduce our cases with colorectal foreign bodies and present several literatures to help physicians decide when presented with cases like these.

• Journal of Korean Medical Science
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• 제33권52호
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• pp.339.1-339.11
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• 2018

Background: Hip pain is a common musculoskeletal complaint in general practice. Although comprehensive diagnostic approach on hip pain is mandatory for adequate treatment, un- or mis-diagnosis is not rare in primary care. The aim of this study was to analyze descriptively un- or mis-diagnosed hip pain cases referred from primary care to a tertiary hospital, especially in young adults ${\leq}50years\;old$. Methods: We retrospectively analyzed a consecutive cohort of 150 patients (${\leq}50years\;old$) with chronic hip pain (${\geq}6weeks$), which was not diagnosed or misdiagnosed based on the information provided on the referral form. Results: Overall an average 32 cases/month were referred due to hip pain without a diagnosis or with an incorrect diagnosis. Among them, 150 patients were enrolled in this study and 146 (97.3%) could be allocated to a specific disease by using data from routine clinical practice. Four common final diagnoses were femoroacetabular impingement (FAI) syndrome (55.3%), hip dysplasia (HD, 13.3%), referred pain from the lumbar spine (9.3%), and spondyloarthritis (SpA, 7.3%). In patients with FAI syndrome, 37 (44.0%) had pincer-type FAI and 33 (39.8%) had combined-type. Although the pain site or gender was not tightly clustered, the distribution of final diagnosis was significantly different according to hip pain location or gender. Especially, SpA or HD was not observed in younger women subgroup or elder men subgroup, respectively, when stratified by the mean age of participants. Conclusion: Most (> 80%) young patients with hip pain, a difficult issue to diagnosis for many primary physicians, had FAI syndrome, HD, spine lesions, and SpA. This study could give a chance to feedback information about cases with un- or mis-diagnosed hip pain, and it suggests that primary physicians need to be familiar with the diagnostic approach for these 4 diseases.

• The Korean Journal of Pain
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• 제27권2호
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• pp.101-102
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• 2014

• 보건행정학회지
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• 제9권2호
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• pp.21-39
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• 1999

An increasing number of hospitals are seeking for new or mixed compensation strategies to improve the productivity of their medical staff in the struggle to provide high quality medical services at low costs amid the economic hardship. To motivate physicians toward the right direction, it is necessary to effectively evaluate their performance that provides a basis for compensation. However, productivity has been historically difficult to measure, particularly for physicians in academic medical centers who are expected to engage in research, education, and patient care simultaneously. The objectives of this study were to define performance measures of physicians and clinical departments in academic medical centers. to examine correlations between the measures. and to investigate factors affecting the measures. The performance data of 212 faculty physicians in 17 clinical departments in two university teaching hospitals affiliated to one medical school during the fiscal year 1994 was used for analyses. Patient care revenue, net profit. and adjusted number of patients were defined to measure the performance in patient care. and number of articles published in academic journals and research grant were defined for research activities. Both individual physicians' performance measures and per physician measures of clinical departments were analyzed. All measures defined to evaluate individual physicians' performance were positively related to each other. Clinical department and rank of faculty position were statistically significant predictors of revenue. and hospital. clinical department. and rank were significant predictors of net profit. journal publication. and research grant. Patient care measures defined to evaluate clinical departments were related to each other. so were research measures. and no significant correlations were found between patient care measures and research measures. Also found were large differences in department. ranks when clinical departments were evaluated by absolute per physician performance measures and evaluated by annual rate of changes in performance measures. These findings suggest that departmental performance measures opposed to individual performance measures are relatively free from problems of factors affecting the performance measures that are not in control of clinical departments or individual physicians. Results from the correlation analysis of departmental performance measures indicates that measures of research performance should be included in the evaluation to promote research activities in academic medical centers.

• Asian Pacific Journal of Cancer Prevention
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• 제17권7호
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• pp.3489-3494
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• 2016

Background: A major problem with cervical cancer screening in countries which have no organized national screening program for cervical cancer is sub-optimal participation. Implementation of self-sampling method may increase the coverage. Objective: We determined the agreement of cytological diagnoses made on samples collected by women themselves (self-sampling) versus samples collected by physicians (Physician sampling). Materials and Methods: We invited women volunteers to undergo two procedures; cervical self-sampling using the Evalyn brush and physician sampling using a Cervex brush. The women were shown a video presentation on how to take their own cervical samples before the procedure. The samples taken by physicians were taken as per routine testing (Gold Standard). All samples were subjected to Thin Prep monolayer smears. The diagnoses made were according to the Bethesda classification. The results from these two sampling methods were analysed and compared. Results: A total of 367 women were recruited into the study, ranging from 22 to 65 years age. There was a significant good agreement of the cytological diagnoses made on the samples from the two sampling methods with the Kappa value of 0.568 (p=0.040). Using the cytological smears taken by physicians as the gold standard, the sensitivity of self-sampling was 71.9% (95% CI:70.9-72.8), the specificity was 86.6% (95% CI:85.7-87.5), the positive predictive value was 74.2% (95% CI:73.3-75.1) and the negative predictive value was 85.1% (95% CI: 84.2-86.0). Self-sampling smears (22.9%) allowed detection of micro-organisms better than physicians samples (18.5%). Conclusions: This study shows that samples taken by women themselves (self-sampling) and physicians have good diagnostic agreement. Self-sampling could be the method of choice in countries in which the coverage of women attending clinics for screening for cervical cancer is poor.

• 보건행정학회지
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• 제23권3호
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• pp.289-300
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• 2013

Background: Patients' trust in their physicians or hospitals is important to guarantee the effectiveness of care and to encourage revisits. This study aimed to identify the relationship between the experience of requesting verification of healthcare benefit coverage via the Health Insurance Review Agency (HIRA) and patients' trust in their physicians or hospitals. Methods: For this population-based study, 800 adult respondents aged 20 to 65 years were recruited using random sampling and telephone surveys. Respondents were divided into two groups: 1) 400 people had experience in requesting the HIRA verification service for the purpose of confirmation of whether the costs they paid were appropriate among metropolitan habitants, and 2) 400 people comprised members of the public who had no experience requesting the verification service. Results: Experience with requesting verification services was likely to lower the patients' trust in medical institutions, but not in their physicians (p<0.05). In addition, patients who were satisfied with their physicians and hospitals were more likely to trust the physicians and hospitals than dissatisfied patients. Conclusion: Patients' trust might be an important factor influencing hospital success. Patients' trust in medical suppliers, such as physicians and hospitals, encourages a positive relationship between medical suppliers and patients. Therefore, medical suppliers must provide appropriate care to patients to improve patients' trust in them.

• 한국응급구조학회지
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• 제20권1호
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• pp.57-70
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• 2016

Purpose: This study aims to analyze the current state of emergency care for patients with anaphylaxis and to identify problems and areas for improvement in prehospital care. Methods: This study was conducted using 119 emergency running sheets and medical records of 109 patients diagnosed with anaphylaxis. Questionnaires were also given to emergency medical technicians (EMTs) and emergency physicians. The data were analyzed using SPSS 21.0. Results: Prehospital emergency care included oxygen administration in 64.2%, an intravenous line in 15.6%, and medication injection in 11.0%. The most commonly administered medications were antihistamines in 66.7% and epinephrine in 8.3%. Of EMTs surveyed, 47.0% suggested an epinephrine injection and using direct medical control, while 53.8% of the emergency physicians suggested an epinephrine injection and using indirect medical control. Most emergency physicians 88.8% responded that epinephrine could be administered by EMTs. Conclusion: The data support epinephrine injection of patients with anaphylaxis by EMTs, but a larger sample size of EMTs is required. Education about the treatment of anaphylaxis should be improved for EMTs. The scope of paramedic responsibilities should also be redefined.

• 중환자간호학회지
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• 제5권2호
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• pp.49-60
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• 2012

Purpose: The purpose of this study was to explore health care workers awareness and performance of standard precautions. Methods: Participants were 296 health care workers including nurses, physicians, and medical technicians. Awareness and performance of standard precautions were measured with 4-point Likert scales. The data were analyzed with t-tests and one-way ANOVA by using SPSS 18.0. Results: The mean scores of awareness were 3.72 in nurses, 3.62 in physicians, and 3.47 in medical technicians. There was a significant difference of awareness by occupational classification (F=12.39, p<.001). The mean scores of performance of standard precautions were 3.45 in nurses, 3.19 in physicians, and 3.23 in medical technicians. There was a significant difference of performance by occupational classification (F=10.98, p<.001). In addition, the score of performance of standard precautions was significantly lower than that of awareness (t=11.89, p<.001). Conclusion: The results of this study indicated that awareness and performance of standard precautions were different by occupational classification. To improve performance of standard precautions in hospitals, it is necessary to provide a distinct infection control program by occupational classification.

• Asian Pacific Journal of Cancer Prevention
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• 제14권10호
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• pp.6173-6180
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• 2013

Background: Our objective was to determine the knowledge and attitudes of Thai generalists (general physicians) toward palliative terminal cancer care (PC) in a primary care setting. Materials and Methods: We performed a cross-sectional descriptive survey using a self-administered questionnaire. The total number of completed and returned questionnaires was 63, giving a 56% response rate. Data analysis was based on these (Cronbach's alpha=0.82) and percentages and mean values were assessed using the Fisher's exact test to determine the correlation of variables. Results: Overall, attitude and knowledge levels were slightly satisfactory. Results indicated that general physicians had moderate scores in both attitudes (84.1%) and knowledge (55.7%) regarding palliative terminal cancer care. However, they had insufficient knowledge regarding truth telling, pain control and management with morphine, emergency management in terminal cancer care and treatment of fluid intake in terminal stages. Attitude and knowledge scores were statistically correlated (p=0.036). Knowledge scores were further positively associated with being taught palliative care in their medical curriculum (p=0.042). Conclusions: Formal education in palliative care and development of palliative care services are very much needed in Thailand to provide holistic care to terminally ill patients.