• Korean Journal of Clinical Pharmacy
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• v.21 no.2
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• pp.170-181
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• 2011

Purpose: There is considerable variability in rates of hospitalization for patients with community-acquired pneumonia (CAP) in part because of physicians' uncertainty in assessing the severity of illness at presentation. The purpose of the study was to examine the current treatment patterns and factors influencing the Pneumonia Severity Index (PSI) and clinical outcomes in the patient with CAP. Method: The retrospective data collection of the patients with CAP was conducted and the data were reviewed. The collected data included demographic, clinical, laboratory and microbiological medical information. All patients were stratified into three risk groups according to PSI: low risk (PSI score I-II), moderate risk (III) and high risk (IV-V) groups. The examined treatment patterns were the appropriateness of admissions, category of antibiotics used. The prognostic factors associated with PSI and clinical outcomes were examined. Results: One hundred and six patients' medical data were reviewed. The overall appropriateness of admissions was low presenting many of patients were admitted or intensely treated in the hospital despite of lower risk of prognosis and treated with intravenous antibiotics instead of oral fluoroquinolones. Primary pneumonia pathogens were Klebsiella pneumoniae (27%) and Streptococcus pneumoniae (21.6%). Mean LOS was 8.5 days and was significantly longer (10.0days) (p<0.001) in high risk group. The patients with age >65 (p<0.001), diabetes mellitus (p<0.001), mental alteration (p<0.001), and/or $PaO_2$ <60 mmHg (p<0.001) had a tendency to have higher PSI. The prognostic factors associated with longer LOS were age >65 years (p=0.008), mental status alteration (p<0.001), dyspnea (p=0.002) and PSI score (p=0.001). The prognostic factors associated with mortality were congestive heart failure (p=0.038), systolic blood pressure <90 mmHg (p=0.002) and arterial pH <7.35 (p=0.013). Conclusion: Most of patients were found to over-utilize medical service according to appropriateness of admissions. The elderly, mentally altered patients with low $PaO_2$ had higher PSI score with increased risk of LOS. The mortality could be increased in the patient with disease state of congestive heart failure, high blood pressure, and/or acidosis.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.16 no.1
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• pp.52-56
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• 2016

Propionic acidemia (PA) is a rare autosomal recessive metabolic disease caused by the deficiency of propionyl-CoA carboxylase (PCC). PA affects the catabolism of branched chain amino acid and oddchain fatty acid then results in accumulation of propionic acid and other metabolites in plasma and urine. Catabolic stress such as infection, illness or any stress can precipitate cause acute metabolic decompensation, especially in the first years of life. Acute metabolic decompensation commonly calls for emergency treatment or admission and if the patient is in a serious condition, it can lead to coma or death. But frequent admissions or visiting the emergency room are much burden to the patients and their kins. And we experienced the propionic academia with a confirmed novel mutation and the patient suffered from frequent admission and visiting the emergency room. So, we tried the regular home carebased fluid therapy after securing a central venous line. Finally, we succeeded in preventing frequent admissions resulted from acute metabolic decompensation and could contribute to relieving the burden to the patient and their family.

• Korea Journal of Hospital Management
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• v.9 no.2
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• pp.102-127
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• 2004

The objective of this study is to analyze a current trend of and relating factors on profitability of the Korean Public Corporation Medical Centers(KPCMCs, hereinafter, hospitals) in Korea. There are 34 hospitals in Korea as of 2004. Among these hospitals some are red ink hospitals, others are black inks in terms of profitability. Data were collected by Korea Health Industry Development Institute(KHIDI) Statistics for Hospital Management 2000-2002 and Ministry of Health and Welfare(MOHW) financial data of public hospitals which was planned to coordinate public health care services roadmap in the long run. The samples are 32 hospitals. Profitability was measured in the aspect of profit rate with normal profit to total assets, and normal profit to gross revenues as dependent variables in respective. Independent variables were classified by general factors, i.e., location, intern/resident training, period of opening, number of beds, and managerial factors(current ratio, fixed ratio, liability to total assets, total assets turnover, personnel costs, materials cost, administrative cost), and finally factors related to patient treatment(average length of stay, bed occupancy rate, admission ratio of outpatients). The methods of analysis are correlation and multiple regression analysis. This study shows firstly, a lot of hospitals are optimal current ratio. Hospitals in upper 100% current ratio are 81.2%. And the personnel cost in total costs are high. Secondly, the trend of normal profit to gross revenues of hospitals are deteriorating gradually. And lastly, as a result of multiple regression analysis, the factors had on significant effect on normal profit to total assets are fixed ratio(+), liability to total assets(-), bed occupancy rate(+), admissions of outpatients(+), etc. And the factors had on significant effect on normal profit to gross revenues are current ration(+), fixed ratio(+), personnel cost(-), administrative expenses(-), admissions of outpatients(+), etc. In conclusion, to improve the profitability of hospitals, the efforts to reduce personnel cost and average length of stay might be needed. And also beds utilization rate need to be increased.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.224-230
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• 2023

Purpose: Patients with penetrating injuries are at a high risk of mortality, and many of them require emergency surgery. Proper triage and transfer of the patient to the emergency department (ED), where immediate definitive treatment is available, is key to improving survival. This study aimed to evaluate the epidemiology and outcomes of patients with penetrating torso injuries in Incheon Metropolitan City. Methods: Data from trauma patients between 2014 and 2018 (5 years) were extracted from the National Emergency Department Information System. In this study, patients with penetrating injuries to the torso (chest and abdomen) were selected, while those with superficial injuries were excluded. Results: Of 66,285 patients with penetrating trauma, 752 with injuries to the torso were enrolled in this study. In the study population, 345 patients (45.9%) were admitted to the ward or intensive care unit (ICU), 20 (2.7%) were transferred to other hospitals, and 10 (1.3%) died in the ED. Among the admitted patients, 173 (50.1%) underwent nonoperative management and 172 (49.9%) underwent operative management. There were no deaths in the nonoperative management group, but 10 patients (5.8%) died after operative management. The transferred patients showed a significantly longer time from injury to ED arrival, percentage of ICU admissions, and mortality. There were also significant differences in the percentage of operative management, ICU admissions, ED stay time, and mortality between hospitals. Conclusions: Proper triage guidelines need to be implemented so that patients with torso penetrating trauma in Incheon can be transferred directly to the regional trauma center for definitive treatment.

• Journal of Trauma and Injury
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• v.37 no.3
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• pp.214-219
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• 2024

Purpose: The aim of this study is to present the causes and numbers of hospital admissions and deaths at hospital of Korean soldiers including civilian worker during the Korean War. Methods: The War History of Rear Troops of the Korean War (confidential) published in 1955 by the Republic of Korea Army Headquarters was reviewed. Results: During the war, 397,519 patients were admitted to hospitals (wounded in action, 53.9%; wounded on duty, 5.2%; due to disease, 40.9%). Most of the admitted patients were service members (92.4%), while the remaining were non-soldiers (7.6%). Among the 397,519 patients admitted to hospitals, 11,537 patients (2.9%) died. Most of the patients who died were service members (87.9%), and the remaining were non-soldiers (12.1%). The yearly numbers of died on duty did not vary much. The yearly number of deaths from diseases was lower in 1950, but suddenly increased in the next year and continued thereafter. Injuries accounted for more than three-fifths of the causes of death (n=7,444, 60.1%). Respiratory diseases corresponded to almost a quarter (n=2,799, 22.6%; 1,611 pulmonary tuberculoses and 1,188 other respiratory diseases). The most common category of causes of death was wounds (gunshot or stab; n=3,199, 25.8%), followed by wounds from fragments (n=3,173, 25.6%), pulmonary tuberculosis (n=1,611, 13.0%), and other respiratory diseases (n=1,188, 9.6%). Among the common causes of death, percentages of wounds and wound by fragments decreased over time; however, the deaths from respiratory disease increased. Conclusions: These findings reflect several aspects of the public health and social situation during the Korean War.

• Journal of Oriental Neuropsychiatry
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• v.17 no.3
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• pp.87-96
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• 2006

Psychogenic neurological conditions account for 1% to 9% of admissions at neurological unit. They are considered manifestations of underlying psychiatry disorders such as somatoform disorders and factitious disorders or malingering. Diagnosis for psychogenic tremor is difficult because mimic tremor is occurred at the secondary of the organic disorders or coexist in a patient with tremors of organic origin. A patient in this case report was diagnosed as psychogenic tremor, and she also complained the severe anger. A patient did not improved with the chemical medication for a long time. The patient received relaxation training, herbal medication and acupuncture for 20 days and showed short-term alleviation on tremor and decreased anger problem and other somatic problems.

• Quality Improvement in Health Care
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• v.2 no.1
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• pp.58-67
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• 1995

Background: This paper describes an effort to provide baseline informations for appropriate utilization of emergency room in a tertiary hospital. Methods: Authors have evaluated that the admissions in the emergency room were medically necessary by objective criteria, Appropriateness Evaluation Protocol(AEP), for one month in a tertiary hospital. Data were analysed by chi-square test and multiple logistic regression to exmaine statistical significances at the level of 0.05. Results: The prevalence of inappropriate decisions for admission was found to be 47.8%(154/322). Whether the physician decided the patient to admit or not was affected by type of services, number of departments involved, patients' medical condition, route of visit, and a day of the week visited. Level of appropriateness of admission is significantly related to patients' age, type of services, and a day of the week visited. Conclusion: We found that substantial proportion of admissions through emergency room are medically unnecessary and that non-medical factors are related to physician's for admission decisions and level of appropriateness of admission. This suggests that policy measures be required to relieve the overcrowding problem and to reduce non-emergent utilization of emergency room in a tertiary hospital.

• Journal of Korean Academy of Nursing
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• v.33 no.6
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• pp.686-692
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• 2003

Purpose: To assess the effect of handwashing improving program and MRSA carrier detection program on MRSA(methicillin resistant Staphylococcus aureus) infection rate in a intensive care unit. Method: The intervention was Nosocomial Infection(NI) control program consisted of hand washing improving program and identification and treatment of MRSA carrier. Data on the NI and MRSA infections were collected by an infection control nurse based on the definition of CDC. MRSA infection rates were calculated by the number of MRSA infection per 100 admissions or 1,000 patients-days. The difference of MRSA infection rates between pre and post intervention was tested by Chi-square at =.05. Result: MRSA infection rates 3.0% or 3.2 per 1,000 patient-days at the pre, 4.6% or 3.7 per 1,000 patient-days at the post, and the differences were not statistically significant (p=.411, p=.769 respectively). Conclusion: The handwashing improving program and MRSA carrier detection program was not effective in reducing the Nosocomial Infection(NI) or MRSA infection rates. It is recommended further studies with a longer intervention and follow-up period.

• Journal of Yeungnam Medical Science
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• v.27 no.1
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• pp.18-26
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• 2010

The clinical picture in severe cases of pandemic (H1N1) 2009 influenza is markedly different from the disease pattern seen during the epidemics of seasonal influenza as many of those affected were previously healthy young people. Current predictions estimate that during a pandemic wave, 12~30% of the population will develop clinical influenza (compared with 5~15% for seasonal influenza) with 4% of those patients requiring hospital admissions and one in five requiring critical care. Until July 6, 94,512 people have been infected in 122 countries, of whom 429 have died with an overall case-fatality rate of <0.5%. Most of the confirmed cases of S-OIV (Swine-Origin Influenza A Virus) infection have been characterized by a self-limited, uncomplicated febrile respiratory illness and 38% of the cases have also included vomiting or diarrhea. Efforts to control these outbreaks are based on our understanding of novel S-OIV (Swine-Origin Influenza A Virus) and the previous influenza pandemics. So, this review covers the experience with S-OIV (Swine-Origin Influenza A Virus) for the admission and background data and the clinical presentation, diagnosis and treatment of H1N1 in pediatric patient with S-OIV (Swine-Origin Influenza A Virus) at YUMC, 2009.

• Journal of Preventive Medicine and Public Health
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• v.39 no.5
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• pp.397-403
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• 2006

Objectives: We estimated the asthma-related health care utilization and costs in Korea from the insurer's and societal perspective. Methods: We extracted the insurance claims records from the Korea National Health Insurance claims database for determining the health care services provided to patients with asthma in 2003. Patients were defined as having asthma if they had ${\geq}$2 medical claims with diagnosis of asthma and they had been prescribed anti-asthma medicines, Annual claims records were aggeregated for each patient to produce patient-specific information on the total utilization and costs. The total asthma-related cost was the sum of the direct healthcare costs, the transportation costs for visits to health care providers and the patient's or caregivers' costs for the time spent on hospital or outpatient visits. Results: A total of 699,603people were identified as asthma patients, yielding an asthma prevalence of 1.47%. Each asthma patient had 7.56 outpatient visits, 0.01 ED visits and 0.02 admissions per year to treat asthma. The per-capita insurance-covered costs increased with age, from 128,276 Won for children aged 1 to 14 years to 270,729 Won for those aged 75 or older. The total cost in the nation varied from 121,865 million to 174,949 million Won depending on the perspectives. From a societal perspective, direct health care costs accounted for 84.9%, transportation costs for 15.1 % and time costs for 9.2% of the total costs. Conclusions: Hospitalizations and ED visits represented only a small portion of the asthma-related costs. Most of the societal burden was attributed to direct medical expenditures, with outpatient visits and medications emerging as the single largest cost components.