• The Korean Society of Law and Medicine
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• v.15 no.2
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• pp.367-397
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• 2014

Dans le contentieux m$\acute{e}$dical, il est difficile de prouver l'existence d'un lien de causalit$\acute{e}$ entre la faute m$\acute{e}$dicale et les pr$\acute{e}$judices subis par la victime. R$\acute{e}$partir bien de façon raisonnable la charge de la preuve du lien causal est alors une des questions pr$\acute{e}$occup$\acute{e}$es par la doctrine cor$\acute{e}$enne. La Cour supr$\hat{e}$me cor$\acute{e}$enne semble toutefois facilliter l'indemnisation des victimes dans les cas o$\grave{u}$ la responsabilit$\acute{e}$ du m$\acute{e}$decin a ${\acute{e}}t{\acute{e}}$ mise en cause, et cela en admettant des fois une solution op$\acute{e}$rant un renversement de la charge de la preuve du lien causal. Une telle attitude a ${\acute{e}}t{\acute{e}}$ m$\hat{e}$me affirm$\acute{e}$e dans un arr$\hat{e}$t rendu r$\acute{e}$cemment en cas de dommage caus$\acute{e}$ par le fait du produit de sant$\acute{e}$, notamment pour le cas de contamination virale par voie de transfusion. La Cour a $\acute{e}$galement reconnu que l'action se pr$\acute{e}$scrit $\grave{a}$ partir du moment de la consolidation du pr$\acute{e}$judice. Aux termes de cette $\acute{e}$tude, on pourra constater que le juge français reconna$\hat{i}$t aussi l'assouplissement de la charge de la preuve du lien de causalit$\acute{e}$ en mati$\acute{e}$re d'action m$\acute{e}$dicale. Il faudra toutefois souligner que le ph$\acute{e}$nom$\acute{e}$ne ne soit pas g$\acute{e}$n$\acute{e}$ralis$\acute{e}$ en droit français, d'autant plus que la pr$\acute{e}$somption de l'existence de la causalit$\acute{e}$ en la mati$\grave{e}$re a $\acute{e}$t$\acute{e}$ admise de mani$\grave{e}$re restrictive par la l$\acute{e}$gislation sp$\acute{e}$cifique. Tel $\acute{e}$tait notamment le cas pour les accidents de la contamination par le virus du sida ou de l'h$\acute{e}$patite C survenus apr$\grave{e}$s la transfusion. En d$\acute{e}$finitive, on peut dire qu'en droit français, le principe est maintenu en cas de manquement $\grave{a}$ une obligation de r$\acute{e}$sultat n$\acute{e}$e du contrat m$\acute{e}$dical, tandis que la Cour de cassation admet parfois en mati$\grave{e}$re de droit commun de la responsabilit$\acute{e}$ contractuelle la pr$\acute{e}$somption de causalit$\acute{e}$ en cas d'inex$\acute{e}$cution des obligations de r$\acute{e}$sultat. En fait, la pr$\acute{e}$somption de causalit$\acute{e}$ dans le contentieux m$\acute{e}$dical pourra mener les m$\acute{e}$decins $\grave{a}$ se diriger vers les traitements d$\acute{e}$fensifs. Cette situation peut m$\hat{e}$me conduire $\grave{a}$ emp$\hat{e}$cher le d$\acute{e}$veloppement de la science m$\acute{e}$dicale, enfin $\grave{a}$ une situation d$\acute{e}$savantageuse aux patients. Il y a alors lieu de se m$\acute{e}$fier des int$\acute{e}$r$\hat{e}$ts d$\acute{e}$s$\acute{e}$quilibr$\acute{e}$s entre le m$\acute{e}$decin et le patient. De ce point de vue, on peut estimer que le droit français donne des suggestions aux juristes cor$\acute{e}$ens dans la recherche des solutions plus ad$\acute{e}$quates en ce qui concerne la charge de la preuve du lien causal en mati$\acute{e}$re de responsabilit$\acute{e}$ m$\acute{e}$dicale.

• The Journal of Korean Society for Radiation Therapy
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• v.30 no.1_2
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• pp.201-208
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• 2018

Purpose : The purpose of this study is to compare and analyze the set-up errors using the Combine IGRT with ExacTrac and CBCT phased in the treatment of Stereotatic Body Radiotherapy. Methods and materials : Patient who were treated Stereotatic Body Radiotherapy in the ulsan university hospital from May 2014 to november 2017 were classified as treatment area three brain, nine spine, three pelvis. First using ExacTrac Set-up error calibrated direction of Lateral(Lat), Longitudinal(Lng), Vertical(Vrt), Roll, Pitch, Yaw, after applied ExacTrac moving data in addition to use CBCT and set-up error calibrated direction of Lat, Lng, Vrt, Rotation(Rtn). Results : When using ExacTrac, the error in the brain region is Lat $0.18{\pm}0.25cm$, Lng $0.23{\pm}0.04cm$, Vrt $0.30{\pm}0.36cm$, Roll $0.36{\pm}0.21^{\circ}$, Pitch $1.72{\pm}0.62^{\circ}$, Yaw $1.80{\pm}1.21^{\circ}$, spine Lat $0.21{\pm}0.24cm$, Lng $0.27{\pm}0.36cm$, Vrt $0.26{\pm}0.42cm$, Roll $1.01{\pm}1.17^{\circ}$, Pitch $0.66{\pm}0.45^{\circ}$, Yaw $0.71{\pm}0.58^{\circ}$, pelvis Lat $0.20{\pm}0.16cm$, Lng $0.24{\pm}0.29cm$, Vrt $0.28{\pm}0.29cm$, Roll $0.83{\pm}0.21^{\circ}$, Pitch $0.57{\pm}0.45^{\circ}$, Yaw $0.52{\pm}0.27^{\circ}$ When CBCT is performed after the couch movement, the error in brain region is Lat $0.06{\pm}0.05cm$, Lng $0.07{\pm}0.06cm$, Vrt $0.00{\pm}0.00cm$, Rtn $0.0{\pm}0.0^{\circ}$, spine Lat $0.06{\pm}0.04cm$, Lng $0.16{\pm}0.30cm$, Vrt $0.08{\pm}0.08cm$, Rtn $0.00{\pm}0.00^{\circ}$, pelvis Lat $0.06{\pm}0.07cm$, Lng $0.04{\pm}0.05cm$, Vrt $0.06{\pm}0.04cm$, Rtn $0.0{\pm}0.0^{\circ}$. Conclusion : Combine IGRT with ExacTrac in addition to CBCT during Stereotatic Body Radiotherapy showed that it was possible to reduce the set-up error of patients compared to single ExacTrac. However, the application of Combine IGRT increases patient set-up verification time and absorption dose in the body for image acquisition. Therefore, depending on the patient's situation that using Combine IGRT to reduce the patient's set-up error can increase the radiation treatment effectiveness.

• Journal of Korean Academy of Nursing
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• v.3 no.2
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• pp.31-43
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• 1973

The trend in modern nursing is toward the performance of comprehensive nursing care. Psychiatric nursing emphasizes education which enables the nurse to understand the underlying difficulties being expressed through a wide range of emotions and through practice to be more adept in her selection of a manner of approach which best meets the needs of a given situation. Presently, in Korea, there is nothing in the literature regarding evaluation of the effect of psychiatric nursing education on the attitudes of nurses towards mental illness and mentally ill patients. This stud!1 was attempted in order to understand 1) some of the problems in psychiatric nursing education 2) some of tile factors which affect the attitudes of nurses towards mental illness and mental patients. A questionnaire, a Korean translation of the "Opinions about Mental illness Scale" by Cohen and Stranding, 1962, was administered to 188 nonpsychiatric registered nurses employed in Yonsei University Hospital (Y. Hospital) and Seoul National University Hospital (S. Hospital) located in the city of Seoul. All of the nurses were directly involved with adult patient care. They graduated from various nursing schools. The data was collected during the period of October 2 to October 16,1972. The age, educational background , marital status, type of previous psychiatric experience, experience as a graduate nurse and close personal relationship with someone who was a psychiatric patient were compared with the O.M.I. scores. The mean and standard errors for each of the comparison groups were computed and tile relationships calculated by a t-test. The results of the study are summarized as follow: 1. There is no significant difference between the age of the nurses and their attitudes toward mental illness and mental patients. 2. There is no significant difference between the. educational backgrounds of the nurses and their attitudes toward mental illness and mental patients. 3. There is a significant difference in the nurses ′student psychiatric nursing experience and their attitudes towards mental illness and mental patients for the nurses in 5. Hospital only. The nurses who had 3-4 week of student psychiatric nursing experience had a significantly higher mean score for Benevolence (factor B) than nurses whose student psychiatric experience had been less than 1 Ivcek (P<0.05). The nurses who had 1-2 weeks, 3-4 weeks and more than 4 weeks of student psychiatric nursing experience had significantly higher mean scores for Interpersonal Ethology (factor E) than nurses whose student psychiatric had been less than 1 week (p<0.05), 4. There is a significant difference in the nurses′student psychiatric nursing experience by types of institution and their attitudes towards mental illness and mental patients for S. Hospital nurses only. The nurses who had their student psychiatric nursing experience in the government psychiatric hospitals recorded significantly higher mean score for Authoritarianism (factor A) than nurses who had their. experience in private psychiatric hospitals (p<0.05). 5. There is no significant difference in the nurses′psychiatric nursing experience as a graduate nurse and their attitudes toward mental illness and mental patients. 6. There is no significant difference in the nature and variety of the nurses′experience as a graduate nurse and their attitude toward mental illness and mental patients. 7. There is no significant difference in the presence or absence of a close personal relationship with a mentally ill person and the nurses′attitude toward mental illness and mental patients. 8. There is no significant difference in the nurses′ marital status and their attitude toward mental illness and mental patients. 9. There is no significant difference between the nurses who were employed ill S. and Y. hospitals and their attitudes towards mental illness and mental patients. Major suggestion for further study was to have more larger and wider scale research for establishing of the reliability and validity of the Korean translation of the O.H.I. Scale.

• Advances in pediatric surgery
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• v.9 no.1
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• pp.45-51
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• 2003

A nationwide survey on choledochal cyst was undertaken among 39 members of the Korean Association of Pediatric Surgeons. The members were required to complete a questionnaire and the case registration form for each patient during the five year period of 1997 to 2001. Three hundred and forty eight patients were registered from 32 institutions. The average number of patients per surgeon was one to two every year. The male to female ratio was 1:3.4. The age of patients on diagnosis was $49.0{\pm}44.4$ months. The geographic distribution was 34.8% in Seoul and Kyoungki-do, 33.3% in Kyoungsang-do, 17.9% in Cholla-do, and 8.5% in Choongchung-do, in order of frequency. The three common clinical presentations were abdominal pain (63.8%), vomiting (35.3%), and jaundice (29.1%). Only seven patients (2%) presented with classic triad, and 25 patients were diagnosed by antenatal ultrasonographic examination. According to the Todani Classification, 238 patients (7l.3%) were type 1, 3 (0.9%) type 11, and 93 (27.8%) type IV. At the time of the operation, three important associated conditions were choledocholithiasis in 45 patients (15.1%), liver fibrosis (Grade 1-4) in 35, and previous operative procedure for biliary diseases in 10. Associated anomalies were observed in 13 patients (3.8%). Three hundred thirty nine (98.8%) of 343 lesions were treated by Cyst excision and Roux-Y hepaticoiejunostomy. One hundred seventy-six patients had an anomalous arrangement of the pancreatobiliary ductal system (APBD): APBD was not in 92 patients, biliary duct joined to the pancreatic duct in 51, and pancreatic duct joined to the biliary duct in 26. There were 8.5% early, and 7.7% late phase operative complications. The major complications were bleeding, anastomotic leakage, and acute pancreatitis. The combination of acute abdomen and choledochal cyst may suggest spontaneous rupture. Because of the development of late intrahepatic bile duct stones, long term follow up after cyst excision and hepaticojejunostomy is required. The optimal time of surgical intervention should also be considered in the situation of routine use of antenatal ultrasonographic examination. This is the first review of the choledochal cyst in Korea and provides baseline data for future comparisons.

• Journal of Korean Academy of Nursing Administration
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• v.3 no.1
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• pp.51-64
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• 1997

The purpose of the study was to introduce an integrated approach of new Casuistry and specified principlism in resolving ethical problems and studying nursing ethics. In studying clinical ethics and nursing ethics, there is no systematic research method. While nurses often experience ethical dilemmas in practice, much of previous research on nursing ethics has focused merely on describing the existing problems. In addition, ethists presented theoretical analysis and critics rather than providing the specific problems solving strategies. There is a need in clinical situations for an integrated method which can provide the objective description for existing problem situations as well as specific problem solving methods. We inherit two distinct ways of discussing ethical issues. One of these frames these issues in terms of principles, rules, and other general ideas; the other focuses on the specific features of particular kinds of moral cases. In the first way general ethical rules relate to specific moral cases in a theoretical manner, with universal rules serving as "axioms" from which particular moral judgments are deduced as theorems. In the seconds, this relation is frankly practical. with general moral rules serving as "maxims", which can be fully understood only in terms of the paradigmatic cases that define their meaning and force. Theoretical arguments are structured in ways that free them from any dependence on the circumstances of their presentation and ensure them a validity of a kind that is not affected by the practical context of use. In formal arguments particular conclusions are deduced from("entailed by") the initial axioms or universal principles that are the apex of the argument. So the truth or certainty that attaches to those axioms flows downward to the specific instances to be "proved". In the language of formal logic, the axioms are major premises, the facts that specify the present instance are minor premises, and the conclusion to be "proved" is deduced (follows necessarily) from the initial presises. Practical arguments, by contrast, involve a wider range of factors than formal deductions and are read with an eye to their occasion of use. Instead of aiming at strict entailments, they draw on the outcomes of previous experience, carrying over the procedures used to resolve earlier problems and reapply them in new problmatic situations. Practical arguments depend for their power on how closely the present circumstances resemble those of the earlier precedent cases for which this particular type of argument was originally devised. So. in practical arguments, the truths and certitudes established in the precedent cases pass sideways, so as to provide "resolutions" of later problems. In the language of rational analysis, the facts of the present case define the gounds on which any resolution must be based; the general considerations that carried wight in similar situations provide warrants that help settle future cases. So the resolution of any problem holds good presumptively; its strengh depends on the similarities between the present case and the prededents; and its soundness can be challenged (or rebutted) in situations that are recognized ans exceptional. Jonsen & Toulmin (1988), and Jonsen (1991) introduce New Casuistry as a practical method. The oxford English Dictionary defines casuistry quite accurately as "that part of ethics which resolves cases of conscience, applying the general rules of religion and morality to particular instances in which circumstances alter cases or in which there appears to be a conflict of duties." They modified the casuistry of the medieval ages to use in clinical situations which is characterized by "the typology of cases and the analogy as an inference method". A case is the unit of analysis. The structure of case was made with interaction of situation and moral rules. The situation is what surrounds or stands around. The moral rule is the essence of case. The analogy can be objective because "the grounds, the warrants, the theoretical backing, the modal qualifiers" are identified in the cases. The specified principlism was the method that Degrazia (1992) integrated the principlism and the specification introduced by Richardson (1990). In this method, the principle is specified by adding information about limitations of the scope and restricting the range of the principle. This should be substantive qualifications. The integrated method is an combination of the New Casuistry and the specified principlism. For example, the study was "Ethical problems experienced by nurses in the care of terminally ill patients"(Um, 1994). A semi-structured in-depth interview was conducted for fifteen nurses who mainly took care of terminally ill patients. The first stage, twenty one cases were identified as relevant to the topic, and then were classified to four types of problems. For instance, one of these types was the patient's refusal of care. The second stage, the ethical problems in the case were defined, and then the case was analyzed. This was to analyze the reasons, the ethical values, and the related ethical principles in the cases. Then the interpretation was synthetically done by integration of the result of analysis and the situation. The third stage was the ordering phase of the cases, which was done according to the result of the interpretation and the common principles in the cases. The first two stages describe the methodology of new casuistry, and the final stage was for the methodology of the specified principlism. The common principles were the principle of autonomy and the principle of caring. The principle of autonomy was specified; when competent patients refused care, nurse should discontinue the care to respect for the patients' decision. The principle of caring was also specified; when the competent patients refused care, nurses should continue to provide the care in spite of the patients' refusal to preserve their life. These specification may lead the opposite behavior, which emphasizes the importance of nurse's will and intentions to make their decision in the clinical situations.

• The Journal of Korean Society for Radiation Therapy
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• v.35
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• pp.7-13
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• 2023

Purpose: In this study, we evaluated the effect of using a customized bolus on dose delivery in the treatment plan when cervical cancer protruded out of the body along with the uterus and evaluated reproducibility in patient set-up. Materials & Methods: The treatment plan used the Eclipse Treatment Planning System (Version 15.5.0, Varian, USA) and the treatment machine was VitalBeam (Varian Medical Systems, USA). The radiotherapy technique used 6 MV energy in the AP/PA direction with 3D-CRT. The prescribed dose is 1.8 Gy/fx and the total dose is 50.4 Gy/28 fx. Semiflex TM31010 (PTW, Germany) was used as the ion chamber, and the dose distribution was analyzed and evaluated by comparing the planned and measured dose according to each position movement and the tumor center dose. The first measurement was performed at the center by applying a customized bolus to the phantom, and the measurement was performed while moving in the range of -2 cm to +2 cm in the X, Y, and Z directions from the center assuming a positional error. It was measured at intervals of 0.5 cm, the Y-axis direction was measured up to ±3 cm, and the situation in which Bolus was set-up incorrectly was also measured. The measured doses were compared based on doses corrected to CT Hounsfield Unit (HU) 240 of silicon instead of the phantom's air cavity. Result: The treatment dose distribution was uniform when the customized bolus was used, and there was no significant difference between the prescribed dose and the actual measured value even when positional errors occurred. It was confirmed that the existing sheet-type bolus is difficult to compensate for irregularly shaped tumors protruding outside the body, but customized Bolus is found to be useful in delivering treatment doses uniformly.

• Journal of Korean Academy of Nursing
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• v.28 no.2
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• pp.441-456
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• 1998

The purpose of this study was to develop a reliable and valid instrument to measure hope for cancer patients in Korea. This Hope Scale(Kim & Lee Hope Scale ; KLHS ) was developed based on not only critical universal attributes explaining both basic hope (generalized hope) and specific hope but also particular characteristics varing from culture and situation, which were revealed in a comprehensive review of the literature. Initially 60 items were generated from three sources : 36 items from the Q-sample used in the Kim's study, 1992, 21 representative items(statements) from the rest Q-population of the above study, 3 items related to the newly discovered category in the new qualitative study using 10 open ended question(death and dying) from the new qualitative study on the 20 cancer patients. At first 3 items were eliminated by the critique of the content validity experts, who were high experienced nurse, nursing professors. And then 4 items were eliminated in consideration of corrected item total correlation coefficiency, theoretical framework of this study. After that, 14 items were eliminated in comparing two or three items identified with the same meaning in each factor by this research team with factor loading and communality. This Hope Scale was finally constructed with 39 items. Psychometric evaluation was done on 492 adults(104 cancer patients, 388 adults who imagined who were cancer patients ranging from 18 to 76 years old. The results revealed high internal consistency Alpha coefficiency of .9351. Princial Component Factor Analysis with Varimax Rotation resulted in 8 factors with more than 1.0 of Eigenvalue. Referring to Eigenvalues, percent of variances(>60%), reproduced correlation matrix, and our theoretical framework, we decided the eight factors were the best1 solution to represent hope dimensions sufficiently. The eight factors were "confidence in possibility of cure", "sense of internal satisfaction", "being in communion", "meaning of life", "Korean hope perspectives", "belief in god", "self confidence", "self-worth". Among these factors, "confidence in possibility of cure", "sense of internal satisfaction", "Korean hope perspectives" were identified as different hope dimensions from those of Nowotny Hope Scale and Herth Hope Scale. There was significant negative correlation of r=-.4736 between this hope scale and Beck Hopelessness Scale (BHS), and significant positive correlation of r=.3685 between this hope scale and Life Orientation Test (LOT) which indicate convergent and discriminant validity. The range of hope scores was from 71 to 244, with a mean of 171.97(SD=28.16).

• Journal of Acupuncture Research
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• v.19 no.3
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• pp.180-191
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• 2002

Objective : This study was performed to evaluate the effect of oriental medical treatment in whiplash injury patients which caused by traffic accident. Methods : The clinical study was carried out 37 cases of whiplash injury patients which had been admitted in Daejon university Cheon-an oriental hospital from June, 2001 to December, 2001. Results : l. In the distribution of sex distinction was female much more than male in the ratio of 3:2 and thirties was most in age distribution. 2. In situation of traffic accident, The most case was rear-ending(70.27%). 3. Except cervical pain or it's reffered pain, there were whole body symptoms as fallow, insomnia in 11cases(29.73%), night pain in 10 cases(27.03%), general body pain in 8cases(21.62), dizziness in 6cases(16.22%). 4. According to Meridian Muscle theory, a injured parts of patient were devided as follows. There were 22cases(59.46%) which have injury in Bladder, Small Intestine Meridian Muscle, 10cases(27.03%) in Gallblader, Triple Energizer Meridian Muscle, 5cases(13.51%) in Stomach, Large Intestine Meridian Muscle. 5. There were 6cases(16.22%) of the grade of complete recovery, 10cases(27.03%) of the grade of excellent, 12cases(32.43%) of the grade of improvement, 6cases(16.22%) of the grade of disimprovement and 3cases(8.11%) of the grade of poor. So 28cases(75.68%) were efficacious. 6. Generally Herb-meds that have efficacy of Geo-Eohyeol were most used(27cases, 72.97%) in early stage. Secondly Herb-med that have efficacy of Yiqi-sunqi were used(20case, 54,05%) in middle stage and Herb-med of Bo-Qiheol were used(l0cases, 27.03%) in latter term. The most used Herb-med was Hoisu-san, Oyaksungi-san(22cases, 54.96%). 7. In l5cases which have Aqua-Acupuncture treatment, There were 3cases of Complete recovery, 5cases of Excellent, 4cases of Improvement, 2cases of Disimprovement, 1cases of Poor. 8cases(53.33%) were above Excellent grade, so it is more efficatious Than simple treatment without Aqua-Acupuncture(36.37%). 8. The improvement of Bladder, Small Intestine Meridian Muscle was 77.27%, Gallblader, Triple Energizer Meridian Muscle was 70% and Stomach, Large Intestine Meridian Muscle was 80%. Additional Aqua-Acupuncture treatment improved to be effective in Bladder, Small Intestine Meridian Muscle(77.78%), in Gallblader, Triple Energizer Meridian Muscle(75%), in Stomach, Large Intestine Meridian Muscle(100%). Conclusions : In this study, Oriental treatment especially Aqua-Acupuncture was effective in whiplash injury patients which caused by traffic accident.

• Journal of Korea Association of Health Promotion
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• v.2 no.1
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• pp.1-8
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• 2004

Background : Since 2001 the Korean Association of Health Promotion has attempted to establish her own reference valves that can be used in her all fifteen branch laboratories instead of using those adapted from the published data or there commended data by the reagent companies supplied as inserts. However, the previous two reference values derived from the statistics(year 2001 and 2002) were need to adjust to apply to actual practice. Besides there was an unavoidable situation that the reagent has to be changed to other companies in 2002 that creates another statistical problem. Subsequently, the third attempt to derive the reference ranges of tests in KAHP to solve those problems and define common)v acceptable reference ranges was done and and reported here. Methods : Al1 the results performed during January 2, 2003 through September 30, 2003 were collected in Excel tile format. All the data include dthe necessary information such as age and sex. The age was grouped in six; baby(0-3y), children(4-l2y), adolescent(13-l8y), adult(19-S4y), younger elderly (65-79y),old elderly(oyer 80y), with references of statistics in medical informatics and WHO classification. The data were statistically analyzed with SAS 6.04 for-Gaussian distribution as the previous two occasions. None of the tests showed Gaussian distribution. These procedures had been repeated twice or three times after trimming out the results lying outside three standard deviations. Though, all the tests showed non-Gaussian distribution. Subsequently, the reference ranges were defined in the range from the point of lower 2.5% to the point of higher 97.5 %. And in case the lower range could be "0", the reference ranges were defined in the range of 0 to 95%.Results : The reference ranges of most of 56 test items were newly assigned. Also with adaptation of the recommendation of WHO etc. on fasting blood sugar, hemoglobin, cholesterol. Among these there were eight tests that needed reference ranges by the age groups and nine tests by the sex. Conclusions : The third attempt will credit more the reference range of all15 laboratories of Korean Association of Health Promotion, which will be essential part of the better service to the patient and clients to visit KAHP.

• Quality Improvement in Health Care
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• v.1 no.1
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• pp.96-108
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• 1994

Background: An appropriate use of hospital beds can improve productivity of hospital significantly. The authors' previous study revealed that approximately one third of Korean hospital bed days and one sixth of admissions were inappropriately used, when it was measured by Appropriateness Evaluation Protocol(AEP) and Delay Tool modified into Korean situation by the authors. This study aims to evaluate applicability of the instruments in a new hospital. More specifically the study aims to measure appropriateness of the instruments used by newly trained nurse reviewers at a new hospital setting. Methods: In order to evaluate applicability of these instruments, agreement rates of the scores recorded by newly trained nurse reviewers with by skilled nurse reviewer and also compared with the scores recorded by physician's implicit decision were assessed. Agreement rates were derived from concurrent application of AEP and Delay Tool to 52 admissions and 104 patient days from internal medicine, pediatrics, and general surgery of one university hospital. Overall agreement rate, specific nonacute agreement rate, and kappa statistics were used to indicate level of agreement. Results: Overall agreement rates on appropriateness between newly trained nurse reviewers and skilled nurse reviewer were 100% in admission and 98% in bed days. Overall agreement rates on reason for inappropriateness between newly trained nurse reviewers and skilled nurse reviewer were 96% in admission and 91% in bed days. Overall agreement rates between newly trained nurse reviewers and physician reviewer were 86% in admission and 87% in bed days. Conclusion: Results indicated that AEP and Delay Tool were applicable to a new hospital in detecting inappropriate utilization of beds and reasoning of the inappropriateness. These instruments could contribute to enhance efficiency of hospital use, through continuous monitoring of level of inappropriate hospital use at national or individual hospital level.