• Korea Journal of Hospital Management
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• v.25 no.4
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• pp.13-28
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• 2020

Purposes: The purpose of this study is to analyze the institutional and personal factors that affect the medical utilization of patients transferred to tertiary medical institutions. Methodology: We retrospectively analyzed the 2 weeks electronic medical records of 1,556 patients, who were referred to the tertiary hospital, from June 15 to 26, 2015. The patient's personal characteristics, referral hospital, referral path, medical experiences and expenses were analyzed for 6 months after the patient's first visit. Findings: The largest proportion (848; 54.5%) of referrals was referred from primary clinic but the referrals of the same tertiary hospital level were one in seven (228; 14.7%) of the patients. Most patients (1,401; 90%) were referred from the clinics and hospitals directly and only one in ten (155; 10%) of the patients utilized the medical referral center. Patients who had been referred from tertiary care institutions had significantly higher medical costs than those referred to primary care (7,560,000 vs 2,333,000 won). The institutional factors including the numbers of visits to outpatient clinic, previous history of hospitalization and operation, consultation to other medical departments and hospitalization fee significantly influenced on medical utility pattern. Personal factors including patient's medical diagnosis and department of disease have a highly correlation with patient's referrals. Practical implications: The medical utilization of medical expenses and experiences is influenced by institutional and individual factors, and it is important to establish a referral system considering the institutional factors of the type of referral hospital.

• Journal of the korean academy of Pediatric Dentistry
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• v.46 no.4
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• pp.362-368
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• 2019

The purpose of this study was to analyze outpatient referral patterns of children in Jeonbuk National University Dental Hospital. All patients under 16 years old who were consulted from the external facilities were reviewed based on the electronic medical record of Jeonbuk National University Dental Hospital from 2015 to 2018. Total 720 boys and 460 girls with an average age of 7.4 years were referred from local dental clinic (85.2%) for treatment severity (90.2%). 3.2% of patients has disability with the highest number of intellectual disabilities. The patients were usually referred at the pre-treatment stage with higher rates if they had disability or medical problem. Referral rate by chief complaints was highest in surgery, followed by reparative treatment and orthodontic treatment. 2^nd referrals in pediatric dentistry had a higher rate of referrals to minor surgery and pulp treatment than of first referrals. The time point of 2^nd referral was relatively delayed with increased ratio of 'during treatment'. These results suggest necessities of appropriate case selection and referral based reasonable criteria for pediatric dentist.

• Journal of Dental Rehabilitation and Applied Science
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• v.35 no.3
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• pp.143-152
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• 2019

Purpose: The aim of this study is to investigate the characteristics of patients and teeth referred to a university dental hospital for endodontic problem. Materials and Methods: From January, 2017 to December, 2018, patients who were referred to a university dental hospital for endodontic problem were collected from clinical records. A total of 1171 patient records were analyzed. The status of the referred teeth was divided into three groups according to whether they were treated endodontically based on radiographs and clinical records at the time of referred visit. Results: 69.9% of the referred teeth were maxillary and mandibular first and second molars. The average time from referral to actual visit is 9.03 days and 65.6% of the case referred with referring letter. The most primary reasons of referral were persistent clinical symptom (pain, swelling, and sinus tract) (37.9%), diagnosis difficulty (16.7%), blockage of canal space (13.8%) and difficult tooth anatomy (11.4%). In the case of referral before endodontic treatment, the most primary reason of referral was failure to make a proper diagnosis. If the teeth were referred in the middle of endodontic treatment, the most primary reason of referral was persistent clinical symptom and blockage of canal space. In the case of referral after root canal filling, the most primary reason of referral was persistent clinical symptom. Conclusion: In the case of molars, the rate of persistent clinical symptom and blockage of canal space were the most primary reason of referral, and the rate of apical surgery and management of trauma was high in the case of anterior teeth.

• Journal of Korean Academy of Nursing
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• v.48 no.5
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• pp.554-564
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• 2018

Purpose: This study aimed to construct a management model for patient transfer in a multilevel healthcare system and to predict the effect of counseling with nurses on the patient transfer process. Methods: Data were collected from the electronic medical records of 20,400 patients using the referral system in a tertiary hospital in Seoul from May 2015 to April 2017. The data were analyzed using system dynamics methodology. Results: The rates of patients who were referred to a tertiary hospital, continued treatment, and were terminated treatment at a tertiary hospital were affected by the management fee and nursing staffing in a referral center that provided patient transfer counseling. Nursing staffing in a referral center had direct influence on the range of increase or decrease in the rates, whereas the management fee had direct influence on time. They were nonlinear relations that converged the value within a certain period. Conclusion: The management fee and nursing staffing in a referral center affect patient transfer counseling, and can improve the patient transfer process. Our findings suggest that nurses play an important role in ensuring smooth transitions between clinics and hospitals.

• Journal of Korean Academy of Nursing Administration
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• v.13 no.1
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• pp.74-81
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• 2007

Purpose: This study focuses on doctors' role expectation and patients satisfaction with the referral centers to get necessary basic Method: There were 495 subjects in this study. 245 of them were doctors working in the 397 clinics and hospitals which have made contracts with the referral center in Y General Hospital located in J city, and 250 were patients who had been treated in it. The data were collected from Sep. 25 to Oct. 21, in 2006. Data analysis was processed with SPSS/WIN 14.0 electronically. Results: Concluding cooperative treaties with other clinics and hospitals, doctors expect the following effects: First, the improvement of the treatment quality of patients. The patients satisfaction ranking order for using referral centers is as follows: kindness of the staff, treatment reservation, doctor's satisfying explanation. providing one-stop service, reduction of waiting time for treatment, evasion of repetitive tests. Conclusion: Referral centers should provide various services totally and actively which reflect the role expectation and satisfaction of doctors and patients altogether.

• Korean Journal of Veterinary Research
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• v.48 no.1
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• pp.125-130
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• 2008

Mesenteric torsion was diagnosed in a 2-year-old, spayed female Miniature Schnauzer. The patient was presented with acute depression, vomiting, lethargy and hematochezia. On physical examination, severe dehydration, tachycardia, tachypnea, weak femoral pulse, delayed capillary refill time and pale mucous membrane were found and the dog was in shock. Radiography and ultrasonography revealed intestines distended with gas, ascites and the "C" shaped distended intestine. Medical treatments including fluid therapy, analgesics, antibiotics and lidocaine for reducing reperfusion injury were applied. And then, the mesenteric torsion was definitively diagnosed through exploratory laparotomy and intestinal resection and anastomosis were performed. The dog made an uneventful recovery and was free of clinical sign one week after surgery. Mesenteric torsion is an unusual and life-threatening disease in dogs. It has usually been described in the middle and large breed dogs, especially German Shepherds. However, the mesenteric torsion should be included in the differential diagnostic lists for acute abdomen even in small breed dog. The mortality rate of mesenteric torsion can be reduced through prompt diagnosis, proper preventive therapy for shock and reperfusion injury and emergency surgery.

• Korean Journal of Veterinary Research
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• v.47 no.3
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• pp.349-356
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• 2007

Isolated splenic torsion is a rare disease, which is usually produced in deep-chest large breed dogs. A five-year old Pitbull terrier and a four-year old Yorkshire terrier were diagnosed as isolated splenic torsion with chronic form. Leukocytosis, anemia and elevated hepatic enzyme level were found in blood test and a large amount of ascites was observed. Abdominal radiography revealed splenomegaly and ascites and ultrasonography showed diffuse hypoechoic change of spleen in case 1 and hyperechoic change of spleen with focal hypoechoic regions in case 2, thromboembolism of splenic vein and abnormal direction of spleen. To identify the underlying disease of isolated splenic torsion, the histopathologic examination of excised spleen is essential and splenic neoplasia was found in case 2. Chronic isolated splenic torsion shows nonspecific clinical signs and laboratory results. Through diagnostic procedure, particularly ultrasonography, prompt diagnosis may be achieved and improve the prognosis of the patient.

• Journal of Veterinary Clinics
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• v.28 no.1
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• pp.94-100
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• 2011

This study was performed to describe the radiographic and ultrasonographic features of retained surgical gauze known as gossypiboma in 9 dogs. Female dogs (n = 8) were at higher risk and seven out of the eight cases had a history of ovariohysterectomy. Seven dogs were symptomatic and the most common clinical signs were vomiting, anorexia, and inertia. A palpable abdominal mass was detected in six dogs. Radiographic signs included a localized abdominal mass with soft tissue density (n = 7) or a mass containing speckled gas (n = 1). Ultrasonography showed a hypoechoic mass with a hyperechoic center (n = 4), or a homogeneous hypoechoic mass (n = 3). The remaining dogs (n = 2) showed an intestinal wall surrounding a hyperechoic center. Regardless of the characteristics of a mass, an acoustic shadowing was accompanied from the center of a mass in all dogs. Ultrasonography also revealed complications such as adhesion between a mass and adjacent organs, and peritonitis and intestinal obstruction around a mass. The gossypiboma can be considered when a hypoechoic mass accompanying a hyperechoic center with acoustic shadowing is observed on ultrasound examination.

• Korean Journal of Veterinary Research
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• v.48 no.3
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• pp.375-379
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• 2008

Hips of the Golden and Labrador retrievers in Korea were evaluated with the University of Pennsylvania Hip Improvement Program (PennHIP) and the severity of joint laxity and degenerative joint disease (DJD) were compared to the PennHIP database. The distraction index (DI) of domestic Golden and Labrador retrievers was significantly higher than the DI of the PennHIP database. In the two breeds, the prevalence of DJD increased according to the DI. However, the severity of DJD did not show a positive correlation with the DI. Overweight dogs and dogs kept indoors showed more severe DJD and more prevalence of clinical signs. This report is thought to be the first case presentation of a large population of Golden and Labrador retrievers in Korea and the findings are representing the overall level of canine hip dysplasia (CHD) of domestic Retrievers, as the PennHIP method was not available in Korea until 2001. We can respect that the stock of retrievers can have a tighter hip joint through control of CHD using an accurate diagnostic method keyed to a phenotype especially concern for joint laxity using PennHIP method and an organized screening program. The clinical manifestation of dysplastic dog can be reduced through control of bodyweight and the environment with regular monitoring the hips with concern for joint laxity using PennHIP method.

• Korean Journal of Veterinary Research
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• v.48 no.2
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• pp.227-233
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• 2008

Portosystemic shunt (PSS) was diagnosed in 43 dogs by mesenteric portogram from January, 2002 to June 2007 in Haemaru referral animal hospital. PSS was found in various breeds including Maltese, Miniature Schnauzer and Yorkshire Terrier and there was no predisposition in gender. In laboratory parameters, mean cell volume was lower than normal value in single shunt and alanine aminotransferase was higher than normal range in multiple shunts with clinical significance. Cystic calculi were found in over 50% dogs with PSS and even in 70.8% dogs with single shunt. In 81% dogs with PSS, extrahepatic single shunt such as portocarval type and portoazygous type was identified. Extrahepatic multiple shunt and intrahepatic single shunt were observed in 4 dogs, respectively. Gradual attenuation using ameroid constrictor was applied to 35 dogs with extrahepatic single shunt and the prognosis of these dogs were good except two dogs, which showed poor prognosis because of acquired multiple PSS and renal disease unrelated with PSS, respectively.