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Analysis of factors affecting antibiotic use at hospitals and clinics based on the defined daily dose (병원 및 의원급 일일사용량 기준 항생제 사용량에 영향을 미치는 요인)

  • Lee, Eun Jee;Lee, GeunWoo;Park, Juhee;Kim, Dong-Sook;Ahn, Hyeong Sik
    • Journal of the Korean Medical Association
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    • v.61 no.11
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    • pp.687-698
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    • 2018
  • Inappropriate antibiotic use significantly contributes to antibiotic resistance, resulting in reduced antibiotic efficacy and an increased burden of disease. The objective of this study was to investigate the characteristics of prescribers whose antibiotics use was high and to explore factors affecting the use of antibiotics by medical institutions. This study analyzed the National Health Insurance claims data from 2015. Antibiotic prescription data were analyzed in terms of the number of defined daily doses per 1,000 patients per day, according to the World Health Organization anatomical-therapeutic-chemical classification and methodologies for measuring the defined daily dose. We investigated the characteristics of prescribers and medical institutions with high antibiotic use. Multivariate regression analyses were performed on the basis of characteristics of the medical institution (number of patients, type of medical institution [hospital or clinic], age of the physician, etc.). The number of patients and number of beds were found to be significant factors affecting antibiotic use in hospitals, and the number of patients, region, and medical department were significant factors affecting antibiotic use at the level of medical institutions. These findings are expected to help policy-makers to better target future interventions to promote prudent antibiotic prescription.

The Effects of Periovarian Adhesions on Follicular Development in Patients undergoing Controlled Ovarian Hyperstimulation for IVF-ET (체외수정시술 환자에서 난소 주위 유착이 과배란유도 중의 난소 난포 발달에 미치는 영향에 관한 연구)

  • Bai, Kwang-Bum;Kim, Seok-Hyun;Lee, Jin-Yong
    • Clinical and Experimental Reproductive Medicine
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    • v.15 no.2
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    • pp.119-128
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    • 1988
  • It has been suggested that the presence of periovarian adhesions might impair the ovarian response to gonadotropins. Total 136 patients who underwent IVF-ET from February to June 1988(88-1 and 88-2 series) at SNUH were classified into three groups according to total ovarian access score, sum of each ovarian availability, estimated by diagnostic laparoscopy : group I(N=43,0%-50%), group II(N=49, 50%-150%) and group III(N=44, 150%-200%). To evaluate the effects of periovarian adhesions on follicular development in controlled ovarian yperstimulation for IVF-ET, serum E2 levels on the day of hCG dministration (Day 0) and the day after hCG administration (Day+1), the number of ovarian follicles with mean diameter${\geqq}$12mm on Day 0, and the number of oocytes retrieved by transvaginal aspiration were measured and compared among groups. There were no significant differences in age of patients, cancellation rate due to inadequate ovarian response, serum E2 levels, the number of ovarian follicles, the number of oocytes retrieved, and oocytes retrieval rate per follicle. In the same patients(N=31) in group II in whom the difference in ovarian availability between two ovaries is more than 50%, there was also no significant difference in the number of ovarian follicles between them. These data suggest that pelvic adhesions including periovarian adhesions have no adverse effects on the ovarian response to gonadotropins stimulation and the outcome of IVF-ET.

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A Comparative Analysis of 119 Emergency Medical Service Operation of Korea and Japan (한국과 일본의 구급실태 비교연구)

  • Baek, Hong-Sok
    • The Korean Journal of Emergency Medical Services
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    • v.8 no.1
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    • pp.199-210
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    • 2004
  • Since the 119 fire department was legally permitted to serve in Emergency Medical Service(EMS)Operation of emergency patients in 1983, 119 EMS operation in general has made a big progress in serving the needs for emergency patients. Currently EMS operation is carried out by 119 EMS unit, private ambulance Co.,etc. But due to the public recognition and volunteers, 119 EMS operation carries the major share of the service. This observation is not surprising in that such a trends occured in Japan 20 years ago. This paper compared the 119 EMS operation conducted by the fire department in Korea with that of Japan in order to draw some inferences from the comparison. The results of the study compared to Japan were as follows: 1. Japan was higher 1.5 times in the number of EMS units per population(100,000), 1.1 times in the number of patient transports per unit. 2. Japan was higher 4.54 times in the number of the 119 EMS personnel per population(100,000), 30.6 times in that per square killometers, 30.6 times per 119 EMS unit, in per ambulance 2.48times. 3. Japan was higher 1.83 times in the number of ambulance per population(100,000), 1.26 times in that per square killo meters. 4. Japan was higher 1.7 times in the number of transport patients per population (100,000), but Korea was higher 2.68 times in the transport patients per EMS personal. 5. Compared to Japan, there was no emergency care related to ALS, for example, such as administering dugs orally and intravenously, interpreting elctrocardiograms, performing endotracheal tube or LMA insertion, using monitors and other complex equipments in Korea.

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Development and Effect of Pain Management Protocol for Nursing Home Patients with Dementia (노인 간호 요양시설에서의 치매환자 통증관리 프로토콜 개발 및 효과)

  • Chang, Sung-Ok
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.14 no.1
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    • pp.29-43
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    • 2007
  • Purpose: This study was done to develop a pain management protocol for nursing home patients with dementia and to examine effects of the protocol on pain assessments and interventions by the nurses and on pain relief signs in the patients. Method: The six steps in the protocol development and the examination of effect are outlined. Three rounds using the Delphi technique and one group pretest-posttest design experiment were developed. Design issues, such as sample selection and sample size, are addressed in relation to the study protocol. Results: After implementation of the pain management protocol, there were significant changes nursing actions including frequency of number of physical examinations, utilization of pain assessment tools, and request to doctors for discomfort management and there were significant changes in frequency in the number of verbal and physical expressions of pain, and emotional patterns. Conclusion: This is the first pain management protocol for patients with dementia in Korea. However, more study will be needed to determine the methodological strength and necessary revisions for the protocol.

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Factors Influencing on Use of Complementary.Alternative Therapy on Chronic Patients (만성질환자의 보완대체요법 이용에 영향을 미치는 요인)

  • Park, Hyeon-Shin;Hyun, Kyung-Sun
    • Journal of East-West Nursing Research
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    • v.17 no.1
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    • pp.1-8
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    • 2011
  • Purpose: The purpose of this study was to identify influencing factors of using numbers and period of complementary and alternative therapy (CAT) among chronic patients. Methods: The study employed a descriptive design. The participants were 221 chronic patients. Data were collected in a pharmacy near a general hospital from April to July, 2008. Results: Influencing factors on using number of CAT were age, numbers of disease, period of used CAT and monthly expenses on CAT (the ability to explain, 79.9%). Influencing factors on using period of CAT were the period of illness and using number of CAT (the ability to explain, 44.9%). Conclusion: The results of this study suggest that chronic patients need counseling and guides about using CAT especially for those are older and have many kinds and longer period of diseases.

The Study of The Hyperhidrosis Patient Treated with Yanggyuksanhwa-tang (양격산화탕(凉膈散火湯) 치험례를 바탕으로 한 소양인 다한증(多汗症)환자에 대한 소고(小考))

  • Lee, Jae-Hun;Shin, Mi-Ran
    • Journal of Sasang Constitutional Medicine
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    • v.23 no.4
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    • pp.526-532
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    • 2011
  • 1. Objectives This study was designed to investigate the effect of Yanggyuksanhwa-tang(凉膈散火湯) to twelve hyperhidrosis patients. 2. Methods From May, 2008 to August, 2010, we treated hyperhidrosis patients with Yanggyuksanhwa-tang(凉膈散火湯). We survey demographic characters, symptoms of patients and efficacy of Yanggyuksanhwa-tang(凉膈散火湯). 3. Results 1) Twenties, thirties and males were more suffer from hyperhidrosis. 2) The patients who had dysuria got treatment efficacy negatively. 3) Treatment efficacy was affected by number of herbal medicine positively. 4. Conclusions This study shows that Yanggyuksanhwa-tang(凉膈散火湯) has effect to hyperhidrosis in Soeyangin. Treatment efficacy was affected by number of herbal medicine significantly.

Clinicopathologic Features Predicting Involvement of Nonsentinel Axillary Lymph Nodes in Iranian Women with Breast Cancer

  • Moosavi, Seyed Alireza;Abdirad, Afshin;Omranipour, Ramesh;Hadji, Maryam;Razavi, Amirnader Emami;Najafi, Massoome
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.17
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    • pp.7049-7054
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    • 2014
  • Background: Almost half of the breast cancer patients with positive sentinel lymph nodes have no additional disease in the remaining axillary lymph nodes. This group of patients do not benefit from complete axillary lymph node dissection. This study was designed to assess the clinicopathologic factors that predict non-sentinel lymph node metastasis in Iranian breast cancer patients with positive sentinel lymph nodes. Materials and Methods: The records of patients who underwent sentinel lymph node biopsy, between 2003 and 2012, were reviewed. Patients with at least one positive sentinel lymph node who underwent completion axillary lymph node dissection were enrolled in the present study. Demographic and clinicopathologic characteristics including age, primary tumor size, histological and nuclear grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and number of harvested lymph nodes, were evaluated. Results: The data of 167 patients were analyzed. A total of 92 (55.1%) had non-sentinel lymph node metastasis. Univariate analysis of data revealed that age, primary tumor size, histological grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio, were associated with non-sentinel lymph node metastasis. After logistic regression analysis, age (OR=0.13; 95% CI, 0.02-0.8), primary tumor size (OR=7.7; 95% CI, 1.4-42.2), lymphovascular invasion (OR=19.4; 95% CI, 1.4-268.6), extracapsular invasion (OR=13.3; 95% CI, 2.3-76), and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio (OR=20.2; 95% CI, 3.4-121.9), were significantly associated with non-sentinel lymph node metastasis. Conclusions: According to this study, age, primary tumor size, lymphovascular invasion, extracapsular invasion, and the ratio of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes, were found to be independent predictors of non-sentinel lymph node metastasis.

Treatment Result of Photochemotherapy for Systemic Psoriasis Patients (전신성 건선환자의 광선치료 후의 임상적 특성에 대한 고찰)

  • Cho, Eun-Jung;Yi, Chung-Hwi
    • Physical Therapy Korea
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    • v.3 no.1
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    • pp.73-79
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    • 1996
  • Photochemotherapy(UVA with 8-methoxypsoralen) was given to 30 patients with systemic psoriasis. The results of clearing and long-term(6-month) interval maintenance were reported. Clearing requirements were in general similar to these reported by Melski and Burger. The skin of the 14 patients (46.6%) recovered good skin condition by a once weekly maintenance dose. This result was better than that reported by other authors. 1. During initial treatment period, average number of treatment was 27.3 and average duration treatment was 24.8 weeks. 2. The factors to quit treatment were motion decrease, moving to the remote area, complications, etc. 3. Number of patient who received maintenance treatment was 14. 4. The complications reported from the patients were hyperpigmentation, nausea, headache, pruritis, vomiting, gastritis.

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The determinants of the Profitability of University Hospitals in Korea (대학병원 수익성에 영향을 미치는 요인 분석)

  • Yang, Jong-Hyun;Chang, Dong-Min;Suh, Chang-Jin
    • Korea Journal of Hospital Management
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    • v.15 no.4
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    • pp.43-62
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    • 2010
  • This study provides an evidence on the determinants of the profitability of university hospital by analyzing university hospital-level data set of hospital performance during the year 2007 (32 university hospitals in total). For the study, a multiple regression model is employed in which profitability index obtained from the DEA computations, operating margin to total asset and gross revenue are used as the dependent variables, and a number of hospital operating characteristics are chosen as the independent variables such as ownership type, location, bed size, period of establishment, bed occupancy rate, admission ratio of outpatients, patients per medical specialist, personnel cost per patient, liabilities to total assets, current ratio, fixed ratio, total asset turnover, medical assistance rate and public indicator. First, the results indicate that the bed occupancy rate and liabilities to total assets are positively and significantly associated with operating margin to total asset. Second, number of beds, the bed occupancy rate and number of patients per medical specialist are positively and significantly associated with operating margin to gross revenue. Third, the bed occupancy rate, number of patients per medical specialist, liabilities to total assets, total asset turnover are positively and significantly associated with profitability index revealed from DEA.

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The Effects of Proprioceptive Neuromuscular Facilitation on Gait Speed and Genu Recurvatume in Stroke Patients -A Case Report- (뇌졸중 환자의 보행속도 향상과 젖힌무릎 개선을 위한 고유수용성신경근촉진법의 적용: 증례보고)

  • Shin, Seung-Sub
    • PNF and Movement
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    • v.12 no.4
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    • pp.259-266
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    • 2014
  • Purpose: The purpose of this study is to describe the effects of proprioceptive neuromuscular facilitation (PNF) on gait speed and genu recurvatum episodes in stroke patients. Methods: The patient is a 58-year-old woman with left hemiplegia who presented with genu recurvatum while walking. Each week the patient received two sessions of PNF that each lasted 45 minutes. During a six-week interval the patient underwent therapeutic exercises and occupational therapy five times a week between the two PNF treatments. During each treatment a preand post-test (a 4 m walk test) was conducted, the patient described their fear of falling down (10-point visual analogue scale), and the number of genu recurvatum episodes was recorded. Results: After the first PNF treatment, the fear of falling down was decreased from 8 points to 7 points, and the number of genu recurvatum episodes decreased from 11 to 6. After the second PNF treatment, the fear of falling down decreased from 6 points to 5 points, and the number of genu recurvatum episodes decreased from 5 to 1. The 4 m walking test time also decreased from 30 seconds to 24 seconds. Conclusion: The PNF treatment is beneficial for reducing the fear of falling down, reducing the number of genu recurvatum episodes, and improving the gait speed of stroke patients.