Objectives: Regional disparities in cardiovascular care in Korea have led to uneven patient outcomes. Despite the growing need for and access to procedures, few studies have linked regional service availability to mortality rates. This study analyzed regional variation in the utilization of major cardiovascular procedures and their associations with short-term mortality to provide better evidence regarding the relationship between healthcare resource distribution and patient survival. Methods: A cross-sectional study was conducted using nationwide claims data for patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by the relevance index (RI). The associations between the regional RI and 30-day mortality were analyzed. Results: The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p=0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). Conclusions: Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex procedures. Disparities should be addressed through collaboration among hospitals and policy efforts to improve outcomes.
Park, Hyoung-Wook;Sohn, Myong-Sei;Kim, Han-Joong;Park, Eun-Cheol;Yu, Seung-Hum
Journal of Preventive Medicine and Public Health
/
v.29
no.4
s.55
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pp.877-897
/
1996
In recent years, the Korean Medical Association has undertaken the feat of establishing the Korean Standard Terminology of Medical Procedures with the dedicated help of 32 medical academic societies. However, because the project is being conducted by several different circles, it has yet to see a clear system of classification. This thesis, therefore, proposes the three principles of scientific properties, usefulness and ideology as the basis for classification system and has developed the Classification System of Medical Procedures in Korea upon their foundation. The methodology and organization of this thesis as follows. First, by adopting scientific classification system of Feinstein(1988), an analysis of the classification systems of the medical procedures in the United States, Japan, Taiwan, WHO was carried out to reveal the framework and the basic principles in each system. Second, the direction of classification system has been constructed by applying the normative principle of medical field in order to show the future direction of the medical field and realize its ideology. Third, a finalized framework for the classification system will be presented as based on the direction of classification system. Of the three basis principles mentioned above, the analysis on the principles of usefulness was left out of this thesis due to the difficulty of establishing specific standards of analysis. The results of the study are as follows. The overall structure of the thesis is aimed at showing the 'Prevention-Therapy-Rehabilitation' quality of comprehensive health care and consists of six chapters; I. Prevention and Health Promotion II. Evaluation and Management III. Diagnostic Procedures IV. Endoscopy V. Therapeutic Procedures VI. Rehabilitation Chapter three Diagnostic Procedures is divided into four parts : Functional Diagnosis, Visual Diagnosis, Pathological Diagnosis, Biopsy and Sampling. Chapter five Therapeutic Procedures is divided into Psychiatry, Non-Invasive Therapy, Invasive Therapy, Anaesthesia and Radiation Oncology. Of these sub-divisions, Functional Diagnosis, Biopsy and Sampling, Endoscopy and Invasive Therapy employs the anatomical system of classification. On the other hand, Visual Diagnosis, Pathological Diagnosis, Anesthesia and Diagnostic Radiology, namely those divisions in which there is little or no overlapping in services with other divisions, used the classification system of its own division. The classification system introduced in this thesis can be further supplemented through the use of the cluster analysis by incorporating the advice and assistance of other specialists.
The purpose of this study was to evaluate clinical changes in graft size after treatment with connective tissue autograft in human. 40 premolar teeth in 23 patients having the following mucogingival problemswere selected. The width of extension, attached gingiva including free marginal gingiva, width of transplant and clinical sulcus depth were measured at the initial examination, 2, 12 and 24 weeks following the connective tissue autograft and free gingival autograft. The change of width of extension, attached gingiva including free marginal gingiva, width of transplant and clinical sulcus depth according to healing process in both graft procedures was statistically analyzed by ANOVA test and independent ttest using SPSS program. The results were as follows : 1. The change of keratinized gingiva in both grafting procedures was increased significantly at 24 weeks post-op. 2. The clinical sulcus depth exhibited no marked changes throughoutthe entire investigation in both grafting procedures. 3 . After 12 weeks, no dimensional variation was seen in graft size in both grafting procedures. 4. Shrinkage differs significantly in both grafting procedures. From the day of graft to 24 weeks after surgery the percentages of shrinkage were connective tissue autograft 55% and free gingival autograft 29%.
Fox, Matthew J.;Sullivan, Timothy J.;Beyer, Katrin
Earthquakes and Structures
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v.9
no.4
/
pp.911-936
/
2015
This work evaluates the performance of a number of seismic assessment procedures when applied to a case study reinforced concrete (RC) wall building. The performance of each procedure is evaluated through its ability to accurately predict deformation demands, specifically, roof displacement, inter-storey drift ratio and wall curvatures are considered as the key engineering demand parameters. The different procedures include Direct Displacement-Based Assessment, nonlinear static analysis and nonlinear dynamic analysis. For the latter two approaches both lumped and distributed plasticity modelling are examined. To thoroughly test the different approaches the case study building is considered in different configurations to include the effects of unequal length walls and plan asymmetry. Recommendations are made as to which methods are suited to different scenarios, in particular focusing on the balance that needs to be made between accurate prediction of engineering demand parameters and the time and expertise required to undertake the different procedures. All methods are shown to have certain merits, but at the same time a number of the procedures are shown to have areas requiring further development. This work also highlights a number of key aspects related to the seismic response of RC wall buildings that may significantly impact the results of an assessment. These include the influence of higher-mode effects and variations in spectral shape with ductility demands.
Objective : This study aimed to investigate the rates, types, and risk factors of surgical site infection (SSI) following intracranial neurosurgical procedures evaluated by a Korean SSI surveillance system. Methods : This was a prospective observational study of patients who underwent neurosurgical procedures at 29 hospitals in South Korea from January 2017 to June 2017. The procedures included craniectomy, craniotomy, cranioplasty, burr hole, and ventriculoperitoneal shunt. Univariate and multivariate logistic regression analyses were performed. Results : Of the 1576 cases included, 30 showed infection, for an overall SSI rate of 1.9%. Organ/space infection was the most common, found in 21 out of the 30 cases (70%). Staphylococcus aureus was the most common (41%) of all bacteria, and Serratia marcescens (12%) was the most common among gram-negative bacteria. In univariate analyses, the p-values for age, preoperative hospital stay duration, and over T-hour were <0.2. In a multivariate analysis of these variables, only preoperative hospital stay was significantly associated with the incidence of SSI (p<0.001), whereas age and over T-hour showed a tendency to increase the risk of SSI (p=0.09 and 0.06). Conclusion : Surveillance systems play important roles in the accurate analysis of SSI. The incidence of SSI after neurosurgical procedures assessed by a national surveillance system was 1.9%. Future studies will provide clinically useful results for SSI when data are accumulated.
There are few studies on the characteristics of debtors in individual rehabilitation procedures, though research in this field is needed. The scarcity of research means that public policy and perception are being made with inadequate information and, to a certain extent, based on personal prejudices and misconceptions. The purpose of this study was to find out demographic, economic and psychological characteristics of debtors in individual rehabilitation procedures. For this study, an in-depth interview was used. The major findings were as follows : The focus of this study is debtors in individual rehabilitation procedures. They were all under 40 and received relatively high educations. Interestingly, they showed a high tendency to use debt and an inability to manage their money. They had short time horizons and imperfect self-control in consumption and borrowing decisions. Monthly income, expenditures, asset and debt of the debtors, and monthly payment to creditors were reported. There were a lot of reasons for their bankruptcy : business failure, job loss, the cost of raising children, and expenditures for entertainment causing them to file for individual rehabilitation procedures. One of the major conclusions of this study was the discovery that their psychological characteristics were nearly the same. The implications of the study suggest that financial education and counseling must consider psychological characteristics.
Purpose: This study was done to suggest the standard ICU nursing procedure and standard ICU nursing practice time carried out according to the standard ICU nursing procedure. Methods: Through the literature review, 35 standard ICU nursing activities were selected and classified under 6 categories. Standard nursing procedures were described by research team and 4 clinical practice experts. Content validity of descripted nursing procedure was performed by 6 clinical practice experts. After that standard ICU nursing procedures were identified, standard nursing practice times were checked through 1:1 observation. Results: 35 ICU nursing activities were identified and categorized into 6 domains of activities. Also, their standard nursing procedures were identified, and finally 33 standard nursing practice times were measured and analyzed. The result of the measurement, 1 ICU nursing activity was spent above 30 minutes, 3 activities done within 10-20 minutes, 4 activities done within 5-10 minutes, and 25 activities were spent below 5 minutes. Conclusion: Through this study, 35 standard ICU nursing procedures were described and 33 standard ICU nursing practice times which carried out according to standard ICU nursing procedures were checked. The result can be as fundamental data for the study of nursing activity time in the ICU.
Background Most women consider an oval-shaped face to be youthful and beautiful. In recent years, demand has grown for surgical procedures with a shorter downtime and fewer complications. These minimally invasive procedures include botulinum toxin type A (BoNTA) injection, filler injection, suction-assisted liposuction (SAL), laser-assisted lipolysis (LAL), thread lifting, and fat grafting. This study aims to introduce an effective method for creating an aesthetically pleasing lower face using a combination of minimally invasive procedures. Methods From March 2017 to March 2019, 94 patients simultaneously underwent LAL, SAL, and thread lifting. Ancillary procedures such as BoNTA injections, hyaluronic acid filler injections, and removal of the buccal fat pad (BFP) were selectively performed according to the patient's condition. Results Patients rated their postoperative satisfaction as very satisfied, satisfied, dissatisfied, or very dissatisfied. Approximately 83% of all respondents were satisfied with the results, whereas the remaining respondents had complaints regarding the outcomes. The most common reasons for dissatisfaction were a longer-than-expected recovery time and undercorrection, and the most severe complaint was skin depression as a result of overcorrection. Conclusions Our method of simultaneously performing LAL, SAL, and thread lifting, while adding BoNTA, filler injections, and BFP removal as needed, was capable of producing consistent and reliable aesthetic outcomes for the lower face.
Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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v.20
no.1
/
pp.11-16
/
2009
OPD based laryngeal procedures offers a new avenue to the modern laryngologist, incorporating new technology in the office setting. With the development of flexible fiberoptic endoscopes, compact video system, and short acting anesthetics and sedatives allow these procedures. The success or failure of procedures are depend on excellent topical anesthesia. An inadequately anesthetized patient is apt to be uncomfortable, anxious and hyperresponsive and therefore unlikely to tolerate the procedure. On the other hand, a patient who is well informed, reassured, and thoroughly anesthetized can complete procedures. Therefore, optimal anesthesia is obligatory for excellent surgical results. The phonosurgeon should choose the anesthetic and sedative agents based on duration of action, time of onset of action, and any medical contraindications that the patient may have. And should be familiar with the properties and interaction of the agents used, as well as the signs of toxicity.
According to related studies, it was revealed that the procedural deviation plays a significant role in initiating accidents or incidents. This means that, to maximize safety, it is indispensable to be able to answer the question of “why the operators deviate from procedures\ulcorner” In this study, the SC (step complexity) measure is introduced to investigate its applicability for studying the procedural deviation, since it was shown that the change of the operators' performance is strongly correlated with the change of SC scores. This means that the SC measure could play an important role for researches related to the procedural deviation, since it is strongly believed that complicated procedures would affect both the operator' performance and the possibility of the procedural deviation. Thus, to ensure this expectation, the meaning of the SC measure is investigated through brief explanations including the necessity, theoretical basis and verification activities of the SC measure. As a result, it is confirmed that the SC measure can be used to explain the change of the operators' performance due to the task complexity implied by procedures. In addition, it seems that the SC measure nay be useful for various purposes, particularly for scrutinizing the relationship between the procedural deviation and complicated procedures.
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