• Health Policy and Management
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• v.6 no.1
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• pp.191-210
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• 1996

This study purported to acquire information necessary to improve the operational efficiency of general hospitals. It tried to determine major indices which represent managerial performance of general hospitals and to identify the managerial characteristics of general hospital which affect the major financial indices. 201 hospitals which were subject to standardization audit by the Korean Hospital Association were investigated and 80 hospitals were finally chosen for this study. Their financial and managerial data during the period between January 1991 and December 1991 were collected. Considering financial indices in this study were the ration of net income to total asset, income growth rate, and quick ration. The results of study are summarized as followings. First. The ration of net income to total assets and quick ration were highly related to managerial characteristics of general hospitals. Therefore, the standardization of three financial indices should be needed to systematically check the operational efficiency of general hospitals. Second, the sample hospitals can be classified as four groups on the basis of their financial indices' level. 4 of those hospitals(5.0%) showed high level of performance in terms of three financial indices and 27 of them(33.7%) showed that they are highly related to only two financial indices. 34 hospitals(42.5%) showed they have high level of relationship with only one indices and 15 hospitals(18.8%) showed very weak performance level with three indices. In addition, there is no hospitals to show mid-range level of managerial performance in relation to all three financial indices. Third, there is no significant relationship between three financial indices and the managerial characteristics of hospitals such as the number of beds, type of operation, location of hospitals, and etc. However, in the case of hospitals which have high level of managerial performance, they have more specialists and medical support personnel in comparison to low performance hospitals. They also have high level of bed occupancy rate and average length of stay(ALOS). In conclusion, the study showed the standardization of 3 financial indices are necessary to systematically evaluate the managerial performance of general hospitals and provide more accurate operational information for each hospital. To do so, it is necessary to focus on management side of hospital such as the effective human resource management and quality enhancement of medical treatment.

• Progress in Medical Physics
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• v.21 no.1
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• pp.120-125
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• 2010

For the measurements of an absorbed dose using the standard dosimetry based on an absorbed dose to water the variety of factors, whether big, small, or tiny, may influence the accuracy of dosimetry. The beam quality correction factor ${\kappa}_{Q,Q_0}$ of an ionization chamber might also be one of them. The cylindrical type of ionization chamber, the PTW30013 chamber, was chosen for this work and 9 chambers of the same type were collected from several institutes where the chamber types are used for the reference dosimetry. They were calibrated from the domestic Secondary Standard Dosimetry Laboratory with the same electrometer and cable. These calibrated chambers were used to measure absorbed doses to water in the reference condition for the photon beam of 6 MV and 10 MV and the electron beam of 12 MeV from Siemens ONCOR. The biggest difference among chambers amounts to 2.4% for the 6 MV photon beam, 0.8% for the 10 MV photon beam, and 2.4% for the 12 MeV electron beam. The big deviation in the photon of 6 MV demonstrates that if there had been no problems with the process of measurements application of the same ${\kappa}_{Q,Q_0}$ to the chambers used in this study might have influenced the deviation in the photon 6 MV and that how important an external audit is.

• Journal of Preventive Medicine and Public Health
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• v.24 no.4 s.36
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• pp.531-548
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• 1991

To assess the adequacy of medical manpower and medical fee for the newborn nursery care, the author visited 20 out of 24 hospitals with the pediatric training program in Youngnam area between July 29 and August 14, 1991. Total number of newborn, both normal and sick, admission and discharge in 1-30 June 1991 was obtained from the logbook of nursery. Head nurse and staff pediatrician of the nursery were interviewed to get the current staffing for the nursery and their subjective opinion on the adequacy of nursery manpower and the difficulties in recruiting manpower. Average medical fee charged for the maternity and normal newborn nursery care was obtained from the division of self-audit of medical insurance claim of each hospital. Average minimum requirement of nursing care time for one normal newborn per day was 179.5 (${\pm}58.6$) minutes; 202.3(${\pm}50.7$) minutes for the university hospitals and 164.2(${\pm}60.5$) minutes for the general hospitals. The ratio of minimum requirement of nursing care time and available nursing time was 1.42 on the average. Taking the additional requirement of nursing care for the sick newborns into consideration, the ratio was 2.06. The numbers of R. N. and A. N. in the nurserys of study hospitals were 31%, and 17%, respectively, of the nursing manpower for the nursery recommended by the American Academy of Pediatrics. These findings indicate that the nursing manpower in newborn nursery is in severe shortage. Ninety percent of the head nurses and 85% of the staff pediatrician stated that the newborn nursery is short of R.N. and 75% of them said that the nurse's aide is also short. Major reason for not recruiting R.N. was the financial constraint of hospital. For the recruitment of nurse's aide, short supply was the second most important reason next to the financial constraint. However, limit of quarter in T.O. was the mar reason for the national university hospitals. Average total medical fee for the maternity and newborn nursery cares of a normal vaginal delivery who stayed two nights and three days at hospital was 219,430won. Out of the total medical fee, 20,323won(9.3%) was for the newborn nursery care. In case of C-section delivery who stayed six nights and seven days, total medical fee was 732,578won and out of the total fee 76,937won (12.0%) was for the newborn care. Cost for a newborn care per day by cost accounting was 16,141won for the tertiary care hospitals and 14,576won for the all other hopitals. The ratio of cost and the fee schedule of the medical insurance for a newborn care per day was 5.0 for the tertiary care hospitals and 4.9 for the all other hospitals. Considering the current wage level of the medical personnel, capital investment for the hospital facilities and equipments, and the cost for hospital maintenance, it is hard to expect adequate quality care in the newborn nursery under the current medical insurance fee schedule.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.14
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• pp.5715-5719
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• 2015

Background: Breast cancer is the most common malignancy of women in the world. The disease is caused by infectious and non-infectious, environmental and lifestyle factors. Tobacco smoke has been one of the most widely studied environmental factors wiith possible relevance to breast cancer. The purpose of this study was to assess the impact of tobacco smoking in breast cancer patients in a hospital based cohort and to establish prognostic implications if any. Materials and Methods: A retrospective audit of 100 women with pathological diagnosis of invasive breast cancer was included in this study. The verbal questionnaire elicited information on current and previous history of exposure to smoking in addition to active smoking. All analyses were adjusted for potential confounders, including stage at presentation, alcohol intake, hormonal replacement therapy, oral contraceptive intake, obesity and menopausal status. Results: The mean age at presentation of breast cancer was $51.4{\pm}10.86$ years. Mean age of presentation was $53.1{\pm}11.5$ and $45.7{\pm}11.9$ years in never smokers and passive smokers, respectively. Age at presentation varied widely in patients exposed to tobacco smoke for >10 years in childhood from $40.3{\pm}12.0$ years to $47.7{\pm}13.9$ in patients exposed for > 20years as adults. Among passive smokers, 60.9% were premenopausal and 39.1% of patients were postmenopausal. In never smokers, 71.4% were post menopausal. Expression of receptors in non-smokers vs passive smokers was comparable with no significant differences. Metastatic potential in lung parenchyma was slightlyelevated in passive smokers as compared to never smokers although statistically non-significant. Conclusions: An inverse relationship exists between the intensity and duration of smoking and the age at presentation and poor prognostic factors. The results strongly suggest efforts should be taken to prevent smoking, encourage quitting and restrict exposure to second hand smoke in India.

• Korean Journal of Acupuncture
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• v.24 no.4
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• pp.13-24
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• 2007

Objectives : This article aims to give guidance on the conduct and reporting of case series and audits of acupuncture, based on common problems that have arisen in the past. This type of project, and particularly the prospective case series or pre- post-intervention study, may give valuable evidence of the overall effectiveness of acupuncture-for example in different situations and in different conditions- and provides one step in the research pathway before generating an hypothesis. Results & Discussion : The project should be designed with the aim of reducing bias as much as possible. Careful and detailed planning is essential for the project to produce worthwhile results that readers can evaluate and replicate. Ethical issues should be considered and formal approval may be necessary. The patient group should be recruited systematically and baseline data obtained. The treatment given should be systematic and decisions to change or end treatment made explicit. The outcome should be measured in ways that are known to be reliable and valid. Musculoskeletal problems can be evaluated with scales for pain and confirmed by measuring one other symptom such as stiffness or one other aspect such as bothersomeness. Global change scores also provide supporting information, and the MYMOP (Measure Yourself Medical Outcome Profile) measure is popular when patients with different conditions are included. The design of questionnaires for beliefs and attitudes is a specialised area that should not be attempted without expert help. Adverse events should also be recorded. Analysis of the data and the best way of summarising and presenting the results are also discussed.

• Proceedings of the KAIS Fall Conference
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• 2012.05a
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• pp.25-29
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• 2012

본 연구의 목적은 농어촌지역의 음주문제 관련 상담센타, 사업장 중심의 절주 프로그램이나 치료 서비스가 취약한 형편이어서 농어촌 지역 직장인의 음주문제에 대한 대책을 마련하고자 하는데 있다. 본 연구의 대상자는 일 농어촌 지역에 거주하는 20세 이상의 남녀 직장인 530명을 대상으로 하였고, 설문에 동의하여 회수된 설문지는 512부였으며 이중 부실하게 응답한 12명의 자료를 제외한 500명의 자료를 최종 분석대상으로 하였다. 자료수집은 2007년 6월 12일부터 2007년 8월 25일까지 시행되었으며, 설문지의 내용을 이해하며 의사소통이 가능한 자에게 본 연구의 취지를 설명하고 연구에의 참여를 동의한 대상자에게 구조화된 설문지를 이용해 자료를 수집하였다. 1. 본 연구에 참여한 대상자의 음주에 대한 인식은 긍정적 인식의 평균은 2.93, 부정적 인식의 평균은 3.18로 나타났다. 2. 음주행태에서 음주경험여부는 현재 음주자가 79.7%로 가장 많았고, 비음주자 13.1%, 과거 음주자 7.2%로 나타났다. 음주빈도는 음주경험이 있는 대상자 중 '월 2-4회 마시는 경우'가 38.2%로 가장 많았고, 평소 음주량은 '소주 10잔 이상'이 34.6%로 많았으며 '소주 3잔 이상'인 경우가 전체 대상자의 92.2%를 차지하였다. 3. 대상자의 문제음주 정도 및 특성은 전체 대상자 중 CAGE를 통해 선별된 알코올 의존자(4개 문항 중 2개 이상이 그렇다고 응답하면 알코올 의존으로 규정)의 비율이 96명(25.1%)이었고, AUDIT를 통해 선별된 문제성 음주자(8점 이상)의 비율은 241명(64.8%)으로 나타났다. 4. 대상자의 음주로 인한 질병은 위장계 질환이 31.3.%로 가장 많았다. 이상의 연구결과를 종합해볼 때, 농어촌지역 직장인의 음주문제에 관한 구체적인 해결방안으로는 음주 문화에 대한 인식개선과 산업체 중심의 절주사업이 필요하며 농어촌 직장인 중 문제음주자 및 알코올 의존자의 조기발견 및 관리를 위한 알코올중독 예방 교육 및 진단 치료에 관한 교육 프로그램 개발이 필요하다.

• Health Policy and Management
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• v.5 no.1
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• pp.132-160
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• 1995

This study purported to acquire information necessary to improve the management of general hospitals. It tried to determine major indices which represent managerial performance of general hospitals and to identify the managerial characteristics of general hospitals which affect the major financial indices. Eighty-eight hospitals were chosen from 188 hospitals which were subject to standardization audit by the Korean Hospital Association. The results of a discriminant analysis are summarized as followings. First, when a single index was used to measure managerial performance of the sample hospitals, the ration of net profit to total capital was the best index and its discriminant power was 58.14%. The ratio of the number of boardmen((M. D.) and average daily medical cost were highly related to this index. Second, when two indices were used, income growth rte and the ration of net profit to total capital had the highest discriminant distinction ability. Their discriminant power was 61.9%. In this case, the ratio of the number of boardmen(M. D.) was significantly and highly related to the indices. Third, when all three indices-income growth rate, the ration of net profit to total capital and quick ratio - were used together, a discriminant function was statistically insignificant. Therefore, using all three indices was not useful in measuring managerial performance of the sample hospitals. In conclusion, using two indices-income growth rate and the ration of net profit to total capital-was better in measuring manegerial performance of general hospitals than using a single index. The independent variable which affected these indices was the ration of the number of boardmen. The discriminant function was : $D_{GI}=2.77+4.832\times(the ratio of the number of boardmen)$ *G=growth index(income growth rate) *I=profit index(the ration of net profit to total capital)

• The Korean journal of internal medicine
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• v.39 no.3
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• pp.399-412
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• 2024

Antimicrobial stewardship programs (ASPs) can lower antibiotic use, decrease medical expenses, prevent the emergence of resistant bacteria, and enhance treatment for infectious diseases. This study summarizes the stepwise implementation and effects of ASPs in a single university-affiliated tertiary care hospital in Korea; it also presents future directions and challenges in resource-limited settings. At the study hospital, the core elements of the ASP such as leadership commitment, accountability, and operating system were established in 2000, then strengthened by the formation of the Antimicrobial Stewardship (AMS) Team in 2018. The actions of ASPs entail key components including a computerized restrictive antibiotic prescription system, prospective audit, post-prescription review through quantitative and qualitative intervention, and pharmacy-based interventions to optimize antibiotic usage. The AMS Team regularly tracked antibiotic use, the effects of interventions, and the resistance patterns of pathogens in the hospital. The reporting system was enhanced and standardized by participation in the Korea National Antimicrobial Use Analysis System, and educational efforts are ongoing. Stepwise implementation of the ASP and the efforts of the AMS Team have led to a substantial reduction in the overall consumption of antibiotics, particularly regarding injectables, and optimization of antibiotic use. Our experience highlights the importance of leadership, accountability, institution-specific interventions, and the AMS Team.

• Journal of Home Health Care Nursing
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• v.3
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• pp.53-66
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• 1996

Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

• Journal of Physiology & Pathology in Korean Medicine
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• v.23 no.5
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• pp.958-963
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• 2009

I Alcoholic hepatitis is a serious liver disease that may lead to cirrhosis and carcinoma, and the short-term mortality rate is fairly high in severe patients. This study was conducted to develop the instrument of pattern identification for alcoholic hepatitis. We made the pattern identification questionnaire and symptoms indicator through reviewing traditional oriental medical literatures and got advices from the advisor committee with Delphi technique. The advisor committee on this study was organized by 10 professors of internal medicine of oriental medical colleges nationwide. The questionnaire was composed of questions about 6 pattern identification - dampness, heat, liver, spleen, cold and dryness. We gave importance to each symptoms of 6 pattern identification which had been scored on a 5-point scale. We surveyed two groups: 36 male alcoholic hepatitis patients whose Alcohol Use Disorder Identification Test(AUDIT) scores were over 12 and who drank alcohol over 40 g per day were allocated to the hepatitis group. Forty three men who did not drink alcohol were allocated to the normal group. Alcoholic hepatitis had relativities to dampness, heat among cause of disease and liver, spleen among viscera. There were statistical significances between the hepatitis group and the normal group in dampness, heat, liver questionnaire. As a result of this study we suggest that the questionnaire would be effective instruments of pattern identification for alcoholic hepatitis.