• Korean Journal of Clinical Pharmacy
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• v.31 no.2
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• pp.153-159
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• 2021

Background: With increasing economic evaluation studies on the treatment of or screening tools for liver diseases that cause hepatocellular carcinoma (HCC), interest in the analysis of the medical utilization and costs of HCC treatment is increasing. Therefore, we aimed to estimate the medical utilization and costs of HCC patients, and calculate the cost of main procedures for HCC treatment, including liver transplant (LT), hepatic resection (HR), radiofrequency ablation (RFA), and transarterial chemoembolization (TACE). Methods: We analyzed claim data from January to December 2018 from the Health Insurance and Review and Assessment Service-National Patient Sample (HIRA-NPS-2018) dataset, including data of patients diagnosed with HCC (Korean Standard Classification of Diseases code C22.0) who had at least one inpatient claim for HCC. Results: A total of 715 HCC patients were identified. In 2018, the yearly average medical cost per HCC patient was ₩18,460K (thousand), of which ₩14,870K was attributed to HCC. Among the total medical costs of HCC patients, the inpatient cost accounted for the largest portion of both the total medical and HCC-related costs. The major procedures of HCC treatment occurred most frequently in the order of TACE, RFA, HR, and LT. The average medical cost per treatment episode was the highest for LT (₩87,280K), followed by HR (₩10,026K), TACE (₩4,047K), and RFA (₩2,927K). Conclusion: By identifying the medical costs of HCC patients and the costs of the main procedures of HCC treatment, our results provide basic information that could be utilized for cost estimation in liver disease-related economic evaluation studies.

• The Korean Journal of Pain
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• v.34 no.3
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• pp.271-287
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• 2021

Background: Postoperative pain management is crucial for patients undergoing total knee arthroplasty (TKA). There have been many recent clinical trials on post-TKA peripheral nerve block; however, they have reported inconsistent findings. In this meta-analysis, we aimed to comprehensively analyze studies on post-TKA analgesia to provide evidence-based clinical suggestions. Methods: We performed a computer-based query of PubMed, Embase, the Cochrane Library, and the Web of Science to retrieve related articles using neurothe following search terms: nerve block, nerve blockade, chemodenervation, chemical neurolysis, peridural block, epidural anesthesia, extradural anesthesia, total knee arthroplasty, total knee replacement, partial knee replacement, and others. After quality evaluation and data extraction, we analyzed the complications, visual analogue scale (VAS) score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: We included 16 randomized controlled trials involving 981 patients (511 receiving peripheral nerve block and 470 receiving epidural block) in the final analysis. Compared with an epidural block, a peripheral nerve block significantly reduced complications. There were no significant between-group differences in the postoperative VAS score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Conclusions: Our findings demonstrate that the peripheral nerve block is superior to the epidural block in reducing complications without compromising the analgesic effect and patient satisfaction. Therefore, a peripheral nerve block is a safe and effective postoperative analgesic method with encouraging clinical prospects.

• Research in Community and Public Health Nursing
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• v.10 no.1
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• pp.80-92
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• 1999

The purpose of this study was to survey appropriateness of admission and days of care for the cerebral ischemia patients as a basis to provide an effectiveness of hospitalization. The authors retrospectively reviewed the medical records of cerebral ischemia patients in two hospitals from November 1997 to February 1998. Of 194 medical records reviewed, there were 2108 medical days. I t is used a 'Appropriateness Evaluation Protocol' previously developed by Gertman and Restuccia (1981) and translated by Department of Health Management, Seoul National University and Korea Institute for Health Services Management (1993), It was found that the 'Appropriateness Evaluation Protocol' had a high inter-rater reliability(k=.92), Statistical significant was tested by using the percentage, mean, and logistic regression by SAS 6.12. The results were as follows; 1. The appropriate admissions were 87.6%, days of care 63.4%, and the average length of stay $10.9{\pm}6.7$ days. 2. The reasons of inappropriate admissions were for work-up(75.0%) and conservative care (25.0%). Major reasons of inappropriate days of care were 'cases in which the medical purpose of hospitalization has been accomplish or can be addressed in a less setting(45.0%)', and 'cases in which there is a delay in performing the work-up or treatment which required patients is hospitalized (44.4%)'. 3. Appropriate days of care were higher as ageing. Appropriate days of care were higher in patients with lower accademic back ground than those of upper college graduates, and in the patients who enter a hospital via emergency room than out-patients department. Appropriate days of care were higher in the patient with MCA infarction, and lower in the patient with cerebellar infarction than the patient with lacunar infarction. Appropriate days of care were higher in attack first than attack above second, in nomortension patients than hypertensive, and lower in groups who engaged in semi-private room and public room than private room in hospital. Appropriate days of care were higher in shorter length of stay than longer length of stay. 4. Diagnosis, admission path, and appropriate days of care explained appropriate admissions. Diagnosis, appropriate admissions, hypertension explained appropriate days of care. According to the above results, author confirms the substantial amount of inappropriate hospital bed utilization. To reduce inappropriateness, it is necessary to develop some alternative services such as home care services or nursing home with which can be replaced inpatient services and to introduce policy such as case management which includes Critical Pathway for consistent management. And, it should be followed the further study for the effectiveness.

• The Journal of Korean Academy of Prosthodontics
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• v.61 no.2
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• pp.160-178
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• 2023

Diagnosis and analysis of occlusal relationships are important factors in prosthetic treatment. A thorough occlusion analysis and evaluation should be performed before treatment to restore a stable interocclusal relationship. Analysis and evaluation are essential during the treatment process and at regular follow-ups. Recently, with the development of dental equipment and digital processing methods, new quantitative analysis methods that can record the patient's occlusal relationship have been introduced. Among them, the T-Scan Novus (Tekscan Inc., S. Boston, MA, USA) displays the strength of the initial contact point and the occlusal contact point of the teeth using a pressure sensor. With this, occlusal contact time of the teeth, anteroposterior and left-right balance of occlusal force can be compared. The Dental prescale II (GC Co., Tokyo, Japan) scans the occlusal contact point using a pressure-sensing film and analyzes the density of the contact point. It can measure the distribution and strength of the occlusal force of the teeth in the most natural occlusion state. Based on this, appropriate prosthetic treatment (four-unit fixed partial denture, removable partial denture, complete denture, and complete oral restoration cases) was performed according to the area and extent of the patient's tooth loss. The patient's occlusion at the first visit, treatment stage, right after treatment, and regular follow-up were compared and evaluated using a quantitative method for appropriate occlusion analysis using T-Scan Novus and Dental prescale II. This report enhances the understanding of occlusion analysis during prosthetic restoration. The results satisfied both the clinician and patients in terms of function and aesthetics.

• Journal of radiological science and technology
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• v.32 no.4
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• pp.401-410
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• 2009

Purpose : Pelvis and lumbar spine radiography, among various types of diagnostic radiography, include gonads of the human body and give patients high radiation dose. Nevertheless, diagnostic reference levels for patient radiation dose in pelvis and lumbar spine radiography has not yet been established in Korea. Therefore, the radiation dose that patients receive from pelvis and lumbar radiography is measured and the diagnostic reference level on patient radiation dose for the optimization of radiation protection of patients in pelvis and lumbar spine radiography was established. Methods : The conditions and diagnostic imaging information acquired during the time of the postero-anterior view of the pelvis and the postero-anterior and lateral view of the lumbar spine at 125 medical institutions throughout Korea are collected for analysis and the entrance surface dose received by patients is measured using a glass dosimeter. The diagnostic reference levels for patient radiation dose in pelvis and lumbar spine radiography to be recommended to the medical institutes is arranged by establishing the dose from the patient radiation dose that corresponds to the 3rd quartile values as the appropriate diagnostic reference level for patient radiation dose. Results : According to the results of the assessment of diagnostic imaging information acquired from pelvis and lumbar spine radiography and the measurement of patient entrance surface dose taken at the 125 medical institutes throughout Korea, the tube voltage ranged between 60~97 kVp, with the average use being 75 kVp, and the tube current ranged between 8~123 mAs, with the average use being 30 mAs. In the posteroanterior and lateral views of lumbar spine radiography, the tube voltage of each view ranged between 65~100 kVp (average use: 78 kVp) and 70~109 kVp (average use: 87 kVp), respectively, and the tube current of each view ranged between 10~100 mAs(average use: 35 mAs) and between 8.9~300 mAs(average use: 64 mAs), respectively. The measurements of entrance surface dose that patients receive during the pelvis and lumbar spine radiography show the following results: in the posteroanterior view of pelvis radiography, the minimum value is 0.59 mGy, the maximum value is 12.69 mGy and the average value is 2.88 mGy with the 1st quartile value being 1.91 mGy, the median being 0.59 mGy, and the 3rd quartile value being 3.43 mGy. Also, in the posteroanterior view of lumbar spine radiography, the minimum value is 0.64 mGy, the maximum value is 23.84 mGy, and the average value is 3.68 mGy with the 1st quartile value being 2.41 mGy, the median being 3.40 mGy, and the 3rd quartile value being 4.08 mGy. In the lateral view of lumbar spine radiography, the minimum value is 1.90 mGy, the maximum value is 45.42 mGy, and the average value is 10.08 mGy with the 1st quartile value being 6.03 mGy, the median being 9.09 mGy and the 3rd quartile value being 12.65 mGy. Conclusions : The diagnostic reference levels for patient radiation dose to be recommended to the medical institutes in Korea is 3.42 mGy for the posteroanterior view of pelvis radiography, 4.08 mGy for the posteroanterior view of lumbar spine radiography, and 12.65 mGy for the lateral view of lumbar spine radiography. Such values are all lower than the values recommended by 6 international organizations including World Health Organization, where the recommended values are 10 mGy for the posteroanterior view of pelvis radiography, 10 mGy for the posteroanterior view of lumbar spine radiography and 30 mGy for the lateral view of lumbar spine radiography.

• Journal of radiological science and technology
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• v.38 no.1
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• pp.1-6
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• 2015

Whole spine scanography (WSS) is a radiological examination that exposes the whole body of the individual being examined to x-ray radiation. WSS is often repeated during the treatment period, which results in a much greater radiation exposure than that in routine x-ray examinations. The aims of the current study were to evaluate the patient dose of WSS using computer simulation, image magnification and angulation of phantom image using different patient position. We evaluated the effective dose(ED) of 23 consecutive patients (M : F = 13:10) who underwent WSS, based on the automatic image pasting method for multiple exposure digital radiography. The Anterior-Posterior position(AP) and Posterior-Anterior position( PA) projection EDs were evaluated based on the PC based Monte Carlo simulation. We measured spine transverse process distance and angulation using DICOM measurement. For all patient, the average ED was 0.069 mSv for AP position and 0.0361 mSv for PA position. AP position calculated double exposure then PA position. For male patient, the average ED was 0.089 mSv(AP) and 0.050 mSv(PA). For female patient, the average ED was 0.0431 mSv(AP) and 0.026 mSv(PA). The transverse process of PA spine image measured 5% higher than AP but angulation of transverse process was no significant differences. In clinical practice, just by change the patient position was conformed to reduce the ED of patient. Therefor we need to redefine of protocol for digital radiography such as WSS. whole spine scanography, effective dose, patient exposure dose, exposure direction. protocol optimization.

• Quality Improvement in Health Care
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• v.28 no.1
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• pp.14-33
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• 2022

Purpose: To examine whether the Patient Experience Assessment (PEA) has led to perceptible changes at the ground level of health care, as a way of evaluating PEA as a policy intervention for quality improvement. Methods: Four focus group discussions (FGDs) were conducted, each comprising six to eight participants who were employees responsible for patient experience at their respective hospitals. The primary focus of the FGDs was on questions such as: 1) How do hospitals respond to PEA? 2) What significant changes were observed after the implementation of PEA? 3) What were the unintended consequences of implementing PEA, if any? 4) What areas of improvement have been identified for maximizing the potential of PEA? Results: Two broad themes emerged out of the FGDs: changes observed post implementation of PEA, and areas for improvement of PEA. Four significant changes were reported by participants: changes in perception and attitude regarding patient experience in hospital employees, increased active involvement by the hospital leadership, enhanced efforts to improve patient experience, and increased cooperation between such activities. Furthermore, eight areas of improvement were identified, which have been grouped in three categories: improving the process of data collection for PEA, introducing additional catalysts to facilitate further changes, and paying attention to structure- and patient-level constraints that must be addressed in parallel. Conclusion: The implementation of PEA led to perceptible changes within hospitals, which implies that it can serve as an effective catalyst for improving patient experience. A number of areas of improvement that would aid in maximizing the potential of PEA were also identified.

• Journal of Korean Society for Quality Management
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• v.22 no.3
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• pp.142-151
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• 1994

In a hospital, there are many clinical departments. In general, the hospital management often uses the index of cure rate (i.e. the rate of patients recovered by the cure of this hospital) to evaluate the medical quality of each clinical department. But, since the cure rate varies significantly with the rate of patient with severe disease, the evaluation by cure rate is unreasonable and incomplete. This paper proposes a new evaluation method called the cause-selecting evaluation method proposed by Prof. Gongxu Zhang (1990). Besides, this method can also be used to diagnose the abnormality of cure rate. The practical case studies check with the theory very well.

• Proceedings of the KIEE Conference
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• 2004.11c
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• pp.3-5
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• 2004

Cleft lip is one of the most common congenital deformities in craniofacial region. Despite the many reports on the outcome of various surgical techniques from individual medical centers, the evaluation of the outcome is based on the subjective observation because of lack of the objective evaluation system. Therefore, a new technique of objective and scientific evaluation for the nasal deformity of secondary cleft lip and nose deformity is critical to improve the management of the cleft patients including the decision of optimal age of operation and surgical technique as veil as evaluation of the outcome. In this study, a new method was proposed to evaluate the nasal deformity using nostril angle, distance, and area of patient images. The images were also evaluated by three expert plastic surgeons, and put into scale of 5 percentile. Measurement results were compared between the each category and the surgeon's evaluation, and coefficients of each category were statistically tested. As a result, The normalized overlap area of right and left nostrils and distance ratio between two centers of nostrils showed high coefficient with evaluations of plastic surgeons.

• Proceedings of the KIEE Conference
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• 2005.05a
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• pp.45-47
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• 2005

Cleft lip is a congenital deformity condition with separation of the two sides of the lip and results in nose deformity. Evaluation of surgical corrections and outcome assessments in nose deformity resulting from the cleft lip depend mainly on doctor's objective judgment. Development of an objective assessment tool in evaluation of the condition and surgical outcome of cleft lip nose deformity patients will help in advancement and evaluation of surgical techniques of cleft lip. Hence, our study aimed on quantitative assessment of a cleft lip nose deformity condition by comparing following parameters gathered from a photographic image of a cleft lip patient: (1) angle difference between two nostril axis, (2) center of the nostril and distance between two centers, (3) overlapped area of two nostrils and (4) the overlapped area ratio of two nostrils. Assessment results of the nose deformity were determined by statistical analysis of evaluation results from three greatly experienced plastic surgeons. In addition, regression model was developed using correlation relationship and factor analysis of parameters from results of the image analysis.