• Radiation Oncology Journal
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• 제37권1호
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• pp.60-65
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• 2019

Purpose: The quality assurance (QA) chart rounds are multidisciplinary meetings to review radiation therapy (RT) treatment plans. This study focus on describing the changes in RT management based on QA round reviews in a single institution. Materials and Methods: After 9 full years of implementation, a retrospective review of all patients whose charts passed through departmental QA chart rounds from 2007 to 2015. The reviewed cases were presented for RT plan review; subcategorized based on decision in QA rounds into: approved, minor modifications or major modifications. Major modification defined as any substantial change which required patient re-simulation or re-planning prior to commencement of RT. Minor modification included treatment plan changes which didn't necessarily require RT re-planning. Results: Overall 7,149 RT treatment plans for different anatomical sites were reviewed at QA rounds. From these treatment plans, 6,654 (93%) were approved, 144 (2%) required minor modifications, while 351 (5%) required major modifications. Major modification included changes in: selected RT dose (96/351, 27%), target volume definition (127/351, 36%), organs-at-risk contouring (10/351, 3%), dose volume objectives/constraints criteria (90/351, 26%), and intent of treatment (28/351, 8%). The RT plans which required major modification according to the tumor subtype were as follows: head and neck (104/904, 12%), thoracic (12/199, 6%), gastrointestinal (33/687,5%), skin (5/106, 5%), genitourinary (16/359, 4%), breast (104/2387, 4%), central nervous system (36/846, 4%), sarcoma (11/277, 4%), pediatric (7/251, 3%), lymphoma (10/423, 2%), gynecological tumors (2/359, 1%), and others (11/351, 3%). Conclusion: Multi-disciplinary standardized QA chart rounds provide a comprehensive and an influential method on RT plans and/or treatment decisions.

• 보건행정학회지
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• 제31권2호
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• pp.173-179
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• 2021

Background: In Korea, the length of stay and medical expenses incurred by medical aid patients are increasing at a rate faster than the national health insurance. Therefore, there is a need to create a management strategy for each type of hospitalization to manage the length of stay of medical aid patients. Methods: The study used data from the 2019 National Health Insurance Claims. We analyzed the factors that affect the length of stay for 186,576 medical aid patients who were hospitalized for more than 31 days, with a focus on the type of hospitalization in long-term care hospitals. Results: The study found a significant correlation between gender, age, medical aid type, chronic disease ratio, long-term care hospital patient classification, and hospitalization type variables as factors that affect the length of hospital stay. The analysis of the differences in the length of stay for each type of hospitalization showed that the average length of stay is 291.4 days for type 1, 192.9 days for type 2, and 157.0 days for type 3, and that the difference is significant (p<0.0001). When type 3 was 0, type 1 significantly increased by 99.4 days, and type 2 by 36.6 days (p<0.0001). Conclusion: A model that can comprehensively view factors, such as provider factors and institutional factors, needs to be designed. In addition, to reduce long stays for medical aid patients, a mechanism to establish an early discharge plan should be prepared and concerns about underutilization should be simultaneously addressed.

• 한국학교ㆍ지역보건교육학회지
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• 제23권4호
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• pp.29-39
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• 2022

Objectives: The purpose of this study was to assess the incidence of delivery and puerperium complications in South Korea and analyze the correlations between the patient's characteristics and delivery and complications before and after 10 years. Methods: This study used the data from an Korean National Hospital Discharge In-depth Injury Survey. Cases of which the principal diagnosis and second diagnoses were disease classification ICD code O00-O99(Pregnancy, childbirth and the puerperium) were defined as the study subjects, and the first study group was divided as the year of discharge from 2005 to 2007, and the second study group from 2015 to 2017. Results: The number of patients discharged whose principal diagnosis or second diagnoses was O00-O99 was 21,598(Weighted 423,306) from 2005 to 2007 and 19,028(Weighted 364,384) from 2015 to 2017, which decreased by 13.9% compared to 10 years ago. The average age of discharged patients increased by about 2 years and was statistically significant (p<.0001). Factors associating spontaneous delivery, caesarean section and puerperium complication were hospitalization route, bed size, maternal age, length of hospital stay, and the year of discharge. Conclusion: Based on the results of this study, health and education policies and economic support for medical care for high-risk pregnancy and delivery management would be necessary continuously. In addition, policies to strengthen the medical system for high-risk pregnancy management in non-metropolitan areas with high fertility rates would also be needed.

• 디지털융복합연구
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• 제10권2호
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• pp.153-159
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• 2012

최근 u-헬스케어는 웰빙 시대와 IT 대중화가 맞물려 RFID 기술을 의료 서비스에 접목하는 새로운 비즈니스 모델이 각광을 받고 있다. u-헬스케어 서비스는 RFID 기술이 u-헬스케어에 접목되면서 의료 프로세스 상에 발생하는 수기입력, 중복 데이터 발생, 데이터 위 변조, 정보 버전 상이 등의 품질 저하 요인을 해결할 수 있는 방안이 필요하다. 이 논문에서는 u-헬스케어를 통해 의료 서비스를 제공받는 사용자의 프라이버시를 보호하기 위한 RFID 기반의 사용자 인증 프로토콜을 제안한다. 제안 프로토콜에서는 의료 서비스를 제공받는 사용자의 데이터 위 변조 및 프라이버시와 u-헬스케어 보안시스템의 안전성을 획기적으로 제고하기 위해서 환자에 관한 비밀 정보는 병원에서 생성된 비밀키와 연접하여 DB 테이블 내의 해당 환자의 비밀키 필드에 저장한다. 또한, 불법적인 사용자의 접근이 있을 경우 인증 서버에게 통보하여 u-헬스케어의 불법 유 무 판별한 후 u-헬스케어 서비스 접근을 승인받도록 한다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권10호
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• pp.4729-4733
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• 2016

Objectives: Lung cancer is a major public health problem and one of the most costly illnesses. The study aimed to estimate the economic burden of lung cancer in Iran in 2014. Methods: A cross-sectional study was conducted to estimate the direct and indirect costs for patients with lung cancer using a prevalence-based approach. A human capital approach was employed to estimate the indirect costs. Data were obtained from several sources such as through patient interview using structured questionnaire, medical records, the GLOBOCAN databases, the Iranian Statistical Center, the Iranian Ministry of Cooperation, Labor and Social Welfare, and the Institute for Health Metrics and Evaluation (IHME). Results: The economic burden of lung cancer in Iran in the year 2014 was 3,225,998,555,090 IR. The main components of the cost were associated with mortality (81.9 %) and hospitalization (7.6 %). The costs of direct medical care, non-medical aspects, patient time, and mortality accounted for 10.8%, 2.7%, 4.5%, and 81.5% of the total cost, respectively. Conclusion: Findings from this study indicated that the economic burden of lung cancer is substantial both to Iran's health system and to society as a whole. Early diagnosis, strengthening cancer prevention, implementing new cancer therapy and medical technology, and effective smoking-cessation interventions could offset some of the costs associated with lung cancer in Iran.

• 한국안전학회지
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• 제29권6호
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• pp.125-131
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• 2014

The purpose of this study is to investigate the effect of high quality CPR using the 4 types of rescue device equipment and chest compressions energy measurement in pre-hospital settings. So, we used the mode to insert load cell in ALS Skill master Manikin to develop CFMM(Compression Force Measurement Manikin) on main stretcher, CPR board, long spine board, scoop stretcher and floor. And, our research team could know that the main stretcher needed average force of 32.55 (${\pm}1.01$) kg, CPR board of 27.23 (${\pm}1.08$) kg, long spine board of 27.13 (${\pm}1.18$) kg, Scoop Stretcher of 27.38 (${\pm}1.05$) kg and Floor of 27.24 (${\pm}0.93$) kg. CPR board must be necessary in the case of CPR on main stretcher in a moving ambulance. But if the condition of patient's back surface is the removable stretcher and the long spine plate, the patient doesn't have to be spent time to use a CPR board. Furthermore, this research suggests to consider that how to take advantage of the education to students for the equipment to check in real time the energy(kg) requirement of chest compressions.

• Asian Pacific Journal of Cancer Prevention
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• 제15권6호
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• pp.2647-2650
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• 2014

Background: Colorectal cancers(CRC) are the third most common cancer in the western world, with surgery preferred for management of non-metastatic disease and post surgical treatment usually arranged according to the TNM staging system. However, there is still prognostic variation between patients who have the same stage. It is increasingly recognized that variations within disease course and clinical outcome in colorectal cancer patients are influenced by not only oncological characteristics of the tumor itself but also host response factors. Recent studies have shown correlation between the inflammatory response and clinical outcomes in various cancers. The neutrophil/lymphocyte ratio (NLR) has been described as a marker for immune response to various stimuli including cancer. Material-Methods: Two hundred eighty-one CRC patients were included in our retrospective analysis, separated into two groups according to a cut-off value for the NLR. Patient data including age, gender, vertical penetration, anatomic location, and differentiation of the tumor, TNM stage, survival rate, and disease-free survival were analyzed for correlations with the NLR. Results: Using ROC curve analysis, we determined a cut-off value of 2.2 for NLR to be best to discriminate between patient survival in the whole group. In univariate analysis, high pretreatment NLR (p=0.001, 95%CI 1.483-4.846), pathologic nodal stage (p<0.001, 95%CI 1.082-3.289) and advanced pathologic TNM stage (p<0.001, 95%CI 1.462-4.213) were predictive of shorter survival. In multivariate analysis, advanced pathologic TNM stage (p=0.001, 95%CI 1.303-26.542) and high pretreatment NLR (p=0.005, 95%CI 1.713-6.378) remained independently associated with poor survival. Conclusions: High pre-treatment NLR is a significant independent predictor of shorter survival in patients with colorectal cancer. This parameter is a simple, easily accessible laboratory value for identifying patients with poorer prognosis.

• 한국의료질향상학회지
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• 제7권2호
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• pp.204-216
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• 2000

Background : There has been a concern that the quality of care provided to end-stage renal disease (ESRD) patients in the United States may not be as good as recommended. This paper illustrates a composite measure to assess, the quality of care received by ESRD patients undergoing in-center hemodialysis by incorporating outcomes for 4 major treatment areas. The 4 treatment areas are: dialysis treatments, anemia control, nutritional management, and blood pressure control. Methods : The major data source for the study was the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study Wave 1 (DMMS-1) d Sixteen categories of a composite quality indicator were constructed by combining 4 dichotomous variables (16=2*2*2*2). representing the optimal vs. less than optimal level of outcome for each of the 4 treatment outcome measure respectively. Optimal outcome level for each treatment area was defined based on the recommendation from the National Kidney Foundation: (a) delivered dialysis doses (Kt/V) ${\geq}$ 1.2; (b) hematocrit level ${\geq}$ 30%; (c) serum albumin concentration ${\geq}$ 3.8g/dl ; and (d) blood pressure of <140 / <90mmHg. The 16 quality indicator were ranked according to their relative quality weights, which were estimated from its association with the relative risk of survival, adjusting for patient's baseline severity and dialysis facility characteristics. Results : Out of the entire sample of 2,179 patients, only 229 (10%) meet th recommended outcome levels for all 4 treatment areas. Overall, the study patients were distributed evenly over the 16 quality indicators, indicating a great variation in the quality of ESRD care. It appears that the rank of the 16 quality-indicators is driven by serum albumin concentration, suggesting that serum albumin concentration may be the most powerful predictor of ESRD patient survival among the 4 outcome measures. Conclusion : The developed quality indicator has the advantage of describin a range of care for dialysis patients and thus providing a more complete picture of care as compared to previous studies that have focused on only single or few components of the ESRD care.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.772-777
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• 2000

Objectives : After lumbar microdiscectomy there are relatively higher incidence of readmission because of various postoperative discomfort. Analyzing these readmitted patients in our private hospital where the patients can be readmitted more easily, we expect to find out which factors are associated with improvement of the surgical outcome. Patients and Methoes : After discharge all significant patient's clinical data were registered to our computerized data bank system and periodic follow-up were performed. The authors analysed 651(97.7%) cases followed up over 2 years(average 3 years) out of 666 patients who underwent a initial lumbar microdiscectomy from May, 1994 to April, 1997. Among them, 63 patients(9.7%) were readmitted. Results : Among the patients readmitted, 29 patients(4.5%) were reoperated because of recurred disc herniation, 17 patients were myofascial pain syndrome, 4 patients were discitis, 3 patients were adhesion and one patient was epidural abscess. Treatment results of these readmitted patients showed that success rate of all readmitted patients was 68.3%, reoperation was 58.6% and myofascial pain syndrome was 82.4%. Conclusion : Treatment results of the patients readmitted because of a continuous lumbago or leg pain after microdiscectomy were acceptable through the careful analysis of the causes of the recurrent symptom. Therefore, the incidence of the chronic failed back syndrome can be reduced by efforting a more active management through readmission.

• 한국융합학회논문지
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• 제7권5호
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• pp.117-125
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• 2016

의료서비스를 이용하는 고객의견 대한 구현은 효과적이고 효율적인 관리가 중요하다. 이에 본 연구는 고객의 불만족 사항에 대한 내용의 의료융합적 분석을 확인하여 전략을 수립하고자하는 후향적 조사연구이다. 2014년 3월부터 2015년 2월까지 일 상급종합병원의 민원 319건을 대상으로 분석하였다. 본 연구에서는 초진보다 재진이, 입원환자보다는 외래환자의 불만족이 높았으며 불만족 분류 시 행정서비스의 업무절차, 진료 및 간호영역의 의사소통 및 설명부분에서 불만족이 높았다. 질병 분류에서는 소화기계와 암 진단관련 대상자들의 불만족이 높았다(p<0.05). 본 연구를 바탕으로 의료서비스의 질을 향상시키고 불만족의 재발을 막는 고객 지향적 의료융합 경영전략을 수립하기 위해 각 환자의 질환별 불만족 요인의 내용을 융합분석하고 지속적인 융합연구를 통해 질환별 구체적인 의료서비스 전략에 대해 유형을 구조화 할 필요가 있다.