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A Preliminary Study for Expending of Hospital-Based Home Health Care Coverage - Focused on Car Accident Inpatients Who has the Compensation Insurance - (병원중심 가정간호관리대상 범위 확대를 위한 기초연구(II) - 자동차보험가입 입원환자를 대상으로 -)

  • Park, Eun-Sook;Lee, Sook-Ja;Park, Young-Ju;Ryu, Ho-Sihn
    • Journal of Home Health Care Nursing
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    • v.7 no.1
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    • pp.58-72
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    • 2000
  • This study was an attempt to encourage the development of a rehabilitation delivery system and programs as a substitute service for hospitalization on the case of car accident patients, such as hospital based home health care nursing services. Various substitute services for hospitalization are required to curtail the length of stay for inpatients who were hospitalized with car accident compensation insurance. It focused on developing an estimation an early discharge day for car accident inpatients based on detailed statements of treatment for 111 inpatients who were hospitalized at the General Hospital in 1997. This study had four specific purposes as follows. First. to find out the utilization of medical services. Second, to estimate the time of early discharge and income increasing effect based on early discharge for those patients. Third, to identify the factors affecting total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze the length of stay and medical expenditure for inpatients who were hospitalized due to car accidents, the authors conducted micro- and macro-analysis of medical and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria, such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the test consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, and stable conditions. In addition to identifying variables affecting medical expenditure, and the length of stay and income effect due to early discharge day, the data was analyzed with a multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study were as follows. First. the mean length of stay was 50.3 days. whereas the mean length of stay due to early discharge was 34.3 days at the hospital. The estimation of time of early discharge depended on the length of stay. The longer the length of stay, the longer the length of time of early discharge : for instance a length of stay under 10 days was estimated as correlating to a mean length of stay of 6.6 days and early discharge of 6.5. The mean length of stay was 217.4 days and the time of early discharge was 110.1 respectively. The mean medical expenditure per day was found to be 169.085 Won and the mean medical expenditure per day showed negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to being discharged 16 days early was around 2,244,000 won per bed. However. this sum does not represent the real benefits resulting from early discharge, but rather the income increasing amount without considering medical prime cost in the general hospital. Therefore, further analysis is required on the cost containments and benefits as turn over rate per bed as the medical prime costs. The length of stay was most significant and was positive to the total medical expenditure, as expected. Surgery and patient's residential area was also an important variable in explaining medical expenditure. The level of complications was the most significant variable in explaining the length of stay. There was a high level for need a home health care nursing service which further supports early discharge for accident patients. In addition, when the patient was discharged. they needed follow up care for complications suffered during the car accident. $86.8\%$ of discharged patients responded that they needed home health services after early discharge. From these research findings, the following suggestions have been drawn. Strategies on a health care delivery system must be developed in order to focus on the consumer's needs and being planned for 21 century health policy in Korea. Community based intermediate facilities or home health care should be developed for rehabilitation services as a substitute for hospitalization in order to shorten the length of stay would be. A hospital based home health care nursing service. it would be available immediately to utilize by patients who want rehabilitation services as a substitute for hospitalization with the cooperation of car insurance companies.

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Treatment Margin Assessment using Mega-Voltage Computed Tomography of a Tomotherapy Unit in the Radiotherapy of a Liver Tumor (간종양 방사선치료 시 토모테라피 메가볼트 CT를 이용한 치료 여백 평가)

  • You, Sei-Hwan;Seong, Jin-Sil;Lee, Ik-Jae;Koom, Woong-Sub;Jeon, Byeong-Chul
    • Radiation Oncology Journal
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    • v.26 no.4
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    • pp.280-288
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    • 2008
  • Purpose: To identify the inter-fractional shift pattern and to assess an adequate treatment margin in the radiotherapy of a liver tumor using mega-voltage computed tomography (MVCT) of a tomotherapy unit. Materials and Methods: Twenty-six patients were treated for liver tumors by tomotherapy from April 2006 to August 2007. The MVCT images of each patient were analyzed from the $1^{st}$ to the $10^{th}$ fraction for the assessment of the daily liver shift by four groups based on Couinard's proposal. Daily setup errors were corrected by bony landmarks as a prerequisite. Subsequently, the anterior-, posterior-, right-, and left shifts of the liver edges were measured by maximum linear discrepancies between the kilo-voltage computed tomography (KVCT) image and MVCT image. All data were set in the 2-dimensional right angle coordinate system of the transverse section of each patient's body. Results: The liver boundary shift had different patterns for each group. In group II (segment 2, 3, and 4), the anterior mean shift was $2.80{\pm}1.73\;mm$ outwards, while the left mean shift was $2.23{\pm}1.37\;mm$ inwards. In group IV (segment 7 and 8), the anterior-, posterior-, right-, and left mean shifts were $0.15{\pm}3.93\;mm$ inwards, $3.15{\pm}6.58\;mm$ inwards, $0.60{\pm}3.58\;mm$ inwards, and $4.50{\pm}5.35\;mm$ inwards, respectively. The reduced volume in group II after MVCT reassessment might be a consequence of stomach toxicity. Conclusion: Inter-fractional liver shifts of each group based on Couinard's proposal were somewhat systematic despite certain variations observed in each patient. The geometrical deformation of the liver by respiratory movement can cause shrinkage in the left margins of liver. We recommend a more sophisticated approach in free-breathing mode when irradiating the left lobe of liver in order to avoid stomach toxicity.

The Hope of the Stroke Patients (뇌졸중환자의 희망)

  • 김이순
    • Journal of Korean Academy of Nursing
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    • v.27 no.1
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    • pp.212-227
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    • 1997
  • Cerebrovascular diseases in Korea is an important health problem since mortality and mobidity have been increased rapidly. It marked the 2nd cause of specific death rates in 1993. The stroke causes physical function disorder due to hemiparalysis and emotional disorder, and stroke patients experience helplessness, powerlessness. sense of alienation and loss of hope. These feelings make the rehabilitation difficult because they lose the will of life. The subjects of the study were seven citizens who live in Pusan, are over 50 years old and belong to low income-level. The data were collected from Jan. to Sep. 1995. The researcher as a caregiver and volunteer made confidence of them and asked for their agreement on the purpose of the study. The subjects expressed their experience as openheartedly as possible. The analysis of the data was made through the phenomenological analytic method suggested by Giorgi, which is as follows ; as an unit of description which include the subject' expressions and the researcher's observation, it is examined the theme that express the hope experience with the subject's language(underlining), and the focal meanings are identified. The focal meaning is the crystalization of the theme, which is written in the language of the researcher. After intergrating the focal meaning and make the situated structural description as the meaning of the hope experience identified on each subject's point. After intergrating the situated structural description and make the general structural description as the meaning of the hope experience identified on total subject's point then the systemizing of the structure of the hope experienced phenomena and the flowing of the conciousness was researched. The conclusions of this study was as follows : The ten sources of hope which the subjects experienced were sorted as under 〈mutual relations to others : spouse, children, relatives, fellow believer. health professioner. associate patient group〉, 〈spiritual dependence〉. 〈recovery of physical function〉. 〈rumination of the past life〉, 〈expectation of the future〉. 〈economic power〉, 〈belief〉, 〈ability〉. 〈spontaneous participation〉 and 〈recovery of roles〉. Their hope was spoken out by the following two kinds of linguistics. First. the hope was expressed in the affirmative expression as follows : 〈 to be dependable〉, 〈to make efforts〉, 〈to keep under control〉, 〈to desire〉, 〈to be pleasant〉, 〈to be peaceful〉, 〈to be grateful〉, 〈to give help〉, 〈self-confidence. Courage〉, 〈to be happy〉, 〈to satisfy oneself〉, 〈to share with others〉, 〈to understand〉 and 〈to be affected, be impressed〉 Second, the hope was expressed in the negative on pression as under : 〈to be distressed〉, 〈to be uneasy〉, 〈to be sorry, be unsatisfied〉 〈despair〉, 〈to abandon〉, 〈to be fearful〉, 〈to suffer〉, 〈to bear a burden〉 〈to be confused〉, 〈to be solitary〉, 〈chest trouble〉, 〈to feel heavy〉 〈grief〉, 〈to be daunted〉, 〈to get angry〉, 〈to be uncomfortable〉, 〈to have something regretable〉 and 〈to feel guilty〉. And their hope was expressed by the following four behavioral expressions : 〈physical sphere〉, 〈psychological sphere〉, 〈social support sphere〉 and 〈spiritual sphere〉. The reaction patterns of their hope experience appeared in the following 4 coping method : 〈conquest type〉, 〈dependence type〉, 〈adaptation type〉 and 〈fate type〉. Finally, in the hope structure the sense of certainty don't always coexict with the sense of uncertainty, When the stroke patients try to search for the best quality of life, the senses of certainty and uncertainty make a continual cyclic system in the hope structure.

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A Study on Nursing Students의 Attitudes toward the Elderly (노인에 대한 간호대학생의 태도조사 연구)

  • 김은일
    • Journal of Korean Academy of Nursing
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    • v.12 no.1
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    • pp.1-12
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    • 1982
  • Presently, there is increasing demand for geriatric nursing care due to increasing proportion of elderly population and extended age. And, of particular importance in deforming the effectiveness of nursing care given to the elderly is the attitude of nursing personnel toward the elderly patient. This study was intendent to investigate the attitudes of baccalaureate nursing students toward the elderly, and to investigate any possible correlation between these attitudes and the following variables: the students' levels (freshman, sophomore, junior, senior), their preferences for var-ious fields of specialization in nursing after graduation, their clinical experiences with geriatric-patients, their personal experience with elderly family members, their educational experience of the elderly's health problems and geriatric nursing, and their experience with relatives and acquaintances over 60 years of age. Therefore, the purpose of this study was to compile basic data about the attitudes of nursing students toward the elderly in order to contribute to the improvement of geriatric nursing. The subjects for this study were 259 nursing students: 163 in the College of Nursing at E-womans University., and 96 in the Department of Nursing in K. College. Data was collected from the 11th of Sep., to the 8th of Oct., 1981, using the Tuckman-Lorge Attitude Questionnaire which contained 131 items excepting 6 items. The attitudes toward the elderly was scored by the use of mean and standard deviation. The relations between attitudes toward the elderly and six independent vairables were analysed by T-test. The results which were obtained are as follows : 1. The attitude score of nursing students was M=71.67 S.D= 16.18. Nursing students agreed with 54.8% of the stereotypic statements, and they had stereotypic attitudes toward the elderly relatively. (P<0.01). 2. There was a significant difference between the attitudes of nursing students toward the elderly, and sophomores had a less stereotypic attitudes than juniors and seniors (P<0.01). 3. There was significant difference between the attitudes toward the elderly and the preferences for various fields of specialization in nursing after graduation, and nursing students those who wanted maternity fields had a more stereotypic attitudes than others (P<0.05, p<0.01). 4. There was no significant difference between the attitudes toward the elderly and the clinical experience with the geriatric patients (P>0.05). 5. There was no significant difference between the attitude3 toward the elderly and the personal experience with elderly family members (F>0.05). 6. There was no significant difference between the attitudes toward the elderly and the educational experience of the elderly's health problems and geriatric nursing (P>0.05). 7. There was no significant difference between the attitudes toward the elderly and the experience with relatives and acquaintances over 60 years of age (P>0.05).

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Descriptive Study on the Development of Educational Program for Mothers with Children who have had Open Heart Surgery in Congenital Heart Disease (개심술을 받은 심기형 환아모의 교육프로그램 개발을 위한 조사연구)

  • Lee, Kun-Ja;Jo, Hyun-Sook
    • The Korean Journal of Rehabilitation Nursing
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    • v.4 no.1
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    • pp.73-83
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    • 2001
  • The aims of this study were to identify the mothers educational needs when they have children who have had open heart surgery in congenital heart disease, to identify the children's characteristics with this problem, and also to provide the basic information on the development of the educational program for the mothers. The subjects of the study were 101 mothers of children and their children hospitalized with congenital heart disease in pediatric wards of G. University Hospital in Inchon and S. Hospital in Puch on from June to November 2000. The study used a Likert-type questionnaire with 39 questions which was based on a previous questionnaire developed by Lee Mi-ryun(1989) for adult open heart surgery patients. The reliability of the questionnaire was Cronbach' ${\alpha}$=.9375. The data were collected directly from mothers of the patients in wards. The t-test, ANOVA was adopted for the data analysis. The key results of the study are as follows : 1) The average age of the children was 32.90 months. The majority of the children are male and weighted 3.0-3.5Kg at birth. Most of the children had VSD(29.7%), and 10.9% of children had a family history of heart disease. 2) An average score of 4.62 out of a maximum of 5.00 was recorded for the educational needs of the children's mother. The highest score of 4.69 was for home care after discharge followed by a score of 4.67 for diagnosis and prognosis on congenital heart disease. And pre-post operation care scored 4.51. The mean scores of single-question items of educational need were, in order, 4.81 for immunization after operation, 4.80 for recovery process, and 4.77 for prognosis of the disease. The score of 4.18 for measurement of intake and output was the lowest. 3) The analysis on the children's mothers educational needs by social-demographic characteristics such as sex, age of patient and mother, economical status, educational status, number of child, hospitalization times, and hospitalization cause showed no significant difference statistically, but there was a significant difference between mothers with jobs and with out jobs.

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The degree of burden and depression in family caregivers of patients with stroke (뇌졸중 환자의 자가간호 수행수준에 따른 환자가족의 부담감과 우울정도에 관한 연구)

  • Lee, Kang Yi;Song, Young Shin
    • Journal of Haehwa Medicine
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    • v.6 no.1
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    • pp.555-566
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    • 1997
  • This study was undertaken to identify the degree of burden and depression according to level of self-care activity and variables to which affect that in family caregivers of patients with stroke. The data were collected from October 23th to November 20th, 1995 The subjects in this study were 80 caregivers, that is, one family member and 80 patients with stroke who were hospitalized in one oriental medicine hospital in D city. The questionnaires consisted of questions regarding burden(13 items, 6 point scale), depression(20 items, 4 point scale), and self-care activity(15 items, 5 point sacle) Data were analyzed using percentages, means, t-test and ANOVA with the SAS program. The results of this study are as follows: 1) The mean score for client's self-care activity was 2.58. The highest score of the self-care activity item was 'returning'(M=3.604), and the lowest score of the self-care activity item was 'shower or tubbathing'(M=1.925). 2) the degrees of self-care activity according to the general characteristics of patients were tested. It was significantly different by sex(P<0.01), occupation(P<0.05), and relationships with patients(P<0.05). That is, the degree of self-care activity was higher in men than that of women, and caregiver with job than caregiver without that. In the case that caregiver was a patient's spouse, the degree of self-care activity was higher than other case. 3) The score for family caregiver's burden was higher than the mid level for the 13 items and caregiver's depression was relatively low. 4) According to the degree of self-care activity, the group was divided to 3, that is, A( 15-33), B(34-56), and C(57-75). The score of total burden was the highest in group A(M=55.257) and the lowest in group C(M=51.928), but there were no statistically significant differences between groups. The score of objective burden was the highest in group A(M=30.400), and the lowest in group C(M=25.214), and there were statistically significant differences between groups. The score of subjective burden was the highest in group B(M=26.000) and the lowest in group A(M=24.783), but there were no statistically significant differences between groups. The degree of depression was the highest in group A(M=44.750) and the lowest in group C(M=40.751), but there were no statistically significant differences between groups.

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Research on the Evaluation and Utilization of Constitutional Diagnosis by Korean Doctors using AI-based Evaluation Tool (인공지능 기반 평가 도구를 이용한 한의사의 체질 진단 평가 및 활용 방안에 대한 연구)

  • Park, Musun;Hwang, Minwoo;Lee, Jeongyun;Kim, Chang-Eop;Kwon, Young-Kyu
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.36 no.2
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    • pp.73-78
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    • 2022
  • Since Traditional Korean medicine (TKM) doctors use various knowledge systems during treatment, diagnosis results may differ for each TKM doctor. However, it is difficult to explain all the reasons for the diagnosis because TKM doctors use both explicit and implicit knowledge. In this study, an upgraded random forest (RF)-based evaluation tool was proposed to extract clinical knowledge of TKM doctors. Also, it was confirmed to what extent the professor's clinical knowledge was delivered to the trainees by using the evaluation tool. The data used to construct the evaluation tool were targeted at 106 people who visited the Sasang Constitutional Department at Kyung Hee University Korean Medicine Hospital at Gangdong. For explicit knowledge extraction, four TKM doctors were asked to express the importance of symptoms as scores. In addition, for implicit knowledge extraction, importance score was confirmed in the RF model that learned the patient's symptoms and the TKM doctor's constitutional determination results. In order to confirm the delivery of clinical knowledge, the similarity of symptoms that professors and trainees consider important when discriminating constitution was calculated using the Jaccard coefficient. As a result of the study, our proposed tool was able to successfully evaluate the clinical knowledge of TKM doctors. Also, it was confirmed that the professor's clinical knowledge was delivered to the trainee. Our tool can be used in various fields such as providing feedback on treatment, education of training TKM doctors, and development of AI in TKM.

A Study on the Prediction of Mortality Rate after Lung Cancer Diagnosis for Men and Women in 80s, 90s, and 100s Based on Deep Learning (딥러닝 기반 80대·90대·100대 남녀 대상 폐암 진단 후 사망률 예측에 관한 연구)

  • Kyung-Keun Byun;Doeg-Gyu Lee;Se-Young Lee
    • The Journal of Korea Institute of Information, Electronics, and Communication Technology
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    • v.16 no.2
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    • pp.87-96
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    • 2023
  • Recently, research on predicting the treatment results of diseases using deep learning technology is also active in the medical community. However, small patient data and specific deep learning algorithms were selected and utilized, and research was conducted to show meaningful results under specific conditions. In this study, in order to generalize the research results, patients were further expanded and subdivided to derive the results of a study predicting mortality after lung cancer diagnosis for men and women in their 80s, 90s, and 100s. Using AutoML, which provides large-scale medical information and various deep learning algorithms from the Health Insurance Review and Assessment Service, five algorithms such as Decision Tree, Random Forest, Gradient Boosting, XGBoost, and Logistic Registration were created to predict mortality rates for 84 months after lung cancer diagnosis. As a result of the study, men in their 80s and 90s had a higher mortality prediction rate than women, and women in their 100s had a higher mortality prediction rate than men. And the factor that has the greatest influence on the mortality rate was analyzed as the treatment period.

Young Women with Breast Cancer in the United States and South Korea: Comparison of Demographics, Pathology and Management

  • Son, Byung Ho;Dominici, Laura S;Aydogan, Fatih;Shulman, Lawrence N;Ahn, Sei Hyn;Cho, Ja Young;Coopey, Suzanne B;Kim, Sung Bae;Min, H Elise;Valero, Monica;Wang, Jiping;Caragacianu, Diana;Gong, Gyung-yub;Hevelone, Nathanael D;Baek, Seunghee;Golshan, Mehra
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.6
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    • pp.2531-2535
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    • 2015
  • Background: Breast cancer diagnosed in young women may be more aggressive, with higher rates of local and distant recurrence compared to the disease in older women. Epidemiologic evidence suggests that Korean women have a lower incidence of breast cancer than women in the United States, but that they present at a younger age than their American counterparts. We sought to compare risk factors and management of young women with breast cancer in Boston, Massachusetts (US) with those in Seoul, South Korea (KR). Materials and Methods: A retrospective review was performed of consecutive patients less than 35 years old with a diagnosis of breast cancer at academic cancer centers in the US and KR from 2000-2005. Patient data were obtained by chart review. Demographic, tumor and treatment characteristics were compared utilizing Pearson's chisquare or Wilcoxon rank-sum tests where appropriate. All differences were assessed as significant at the 0.05 level. Results: 205 patients from the US and 309 from KR were analyzed. Patients in US were more likely to have hormone receptor positive breast cancer, while patients in KR had a higher rate of triple negative lesions. Patients in US had a higher mean body mass index and more often reported use of birth control pills, while those in the KR were less likely to have a sentinel node procedure performed or to receive post mastectomy radiation. Conclusions: Patients under 35 diagnosed with breast cancer in the US and KR differ with respect to demographics, tumor characteristics and management. Although rates of breast conservation and mastectomy were similar, US patients were more likely to receive post mastectomy radiation. The lower use of sentinel node biopsy is explained by the later adoption of the technique in KR. Further evaluation is necessary to evaluate recurrence rates and survival in the setting of differing disease subtypes in these patients.

Phenotypic and Molecular Characteristics of Children with Progressive Familial Intrahepatic Cholestasis in South China

  • Zhang, Wen;Lin, Ruizhu;Lu, Zhikun;Sheng, Huiying;Xu, Yi;Li, Xiuzhen;Cheng, Jing;Cai, Yanna;Mao, Xiaojian;Liu, Li
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.23 no.6
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    • pp.558-566
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    • 2020
  • Purpose: Progressive familial intrahepatic cholestasis (PFIC) is a rare genetic autosomal recessive disease caused by mutations in ATP8B1, ABCB11 or ABCB4. Mutational analysis of these genes is a reliable approach to identify the disorder. Methods: We collected and analyzed relevant data related to clinical diagnosis, biological investigation, and molecular determination in nine children carrying these gene mutations, who were from unrelated families in South China. Results: Of the nine patients (five males, four females) with PFIC, one case of PFIC1, four cases of PFIC2, and four cases of PFIC3 were diagnosed. Except in patient no. 8, jaundice and severe pruritus were the major clinical signs in all forms. γ-glutamyl transpeptidase was low in patients with PFIC1/PFIC2, and remained mildly elevated in patients with PFIC3. We identified 15 different mutations, including nine novel mutations (p.R470HfsX8, p.Q794X and p.I1170T of ABCB11 gene mutations, p.G319R, p.A1047P, p.G1074R, p.T830NfsX11, p.A1047PfsX8 and p.N1048TfsX of ABCB4 gene mutations) and six known mutations (p.G446R and p.F529del of ATP8B1 gene mutations, p.A588V, p.G1004D and p.R1057X of ABCB11 gene mutations, p.P479L of ABCB4 gene mutations). The results showed that compared with other regions, these three types of PFIC genes had different mutational spectrum in China. Conclusion: The study expands the genotypic spectrum of PFIC. We identified nine novel mutations of PFIC and our findings could help in the diagnosis and treatment of this disease.