• Korea Journal of Hospital Management
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• v.25 no.4
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• pp.13-28
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• 2020

Purposes: The purpose of this study is to analyze the institutional and personal factors that affect the medical utilization of patients transferred to tertiary medical institutions. Methodology: We retrospectively analyzed the 2 weeks electronic medical records of 1,556 patients, who were referred to the tertiary hospital, from June 15 to 26, 2015. The patient's personal characteristics, referral hospital, referral path, medical experiences and expenses were analyzed for 6 months after the patient's first visit. Findings: The largest proportion (848; 54.5%) of referrals was referred from primary clinic but the referrals of the same tertiary hospital level were one in seven (228; 14.7%) of the patients. Most patients (1,401; 90%) were referred from the clinics and hospitals directly and only one in ten (155; 10%) of the patients utilized the medical referral center. Patients who had been referred from tertiary care institutions had significantly higher medical costs than those referred to primary care (7,560,000 vs 2,333,000 won). The institutional factors including the numbers of visits to outpatient clinic, previous history of hospitalization and operation, consultation to other medical departments and hospitalization fee significantly influenced on medical utility pattern. Personal factors including patient's medical diagnosis and department of disease have a highly correlation with patient's referrals. Practical implications: The medical utilization of medical expenses and experiences is influenced by institutional and individual factors, and it is important to establish a referral system considering the institutional factors of the type of referral hospital.

• Health Policy and Management
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• v.12 no.2
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• pp.115-135
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• 2002

Many tertiary hospitals have started to establish cooperative relationships with small and medium sized hospitals in Korea. But the performance of the relationship is not satisfactory to both of partners. The relationship and performance of cooperation for small and medium sized hospitals are analyzed according to the framework of inter-organizational cooperation. Data are collected by 4 focal hospital and 34 small and medium sized hospitals through interview and questionnaire. The findings are : a) The cooperation is focused on management area, such as healthcare technology transfer and information sharing, rather than patient referral. b) Patient referral is not yet active in cooperative relationship. But some partner hospitals which is located close and managing internal organization for cooperation show a significant number of referrals. c) The characteristics of high performers are positive attitude about cooperation, and recognition of the relationship as flexible, experiences of cooperation, internal and external management activities.

• International Journal of Quality Innovation
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• v.7 no.1
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• pp.161-176
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• 2006

The objective of the study was to empirically assess the practice of quality management among employees of Malaysian public hospitals at the district, state and national level hospitals. Comparative analysis on the practice of quality management was made among the three groups of hospitals. Self-administered questionnaire was the main method of data collection. Twenty-three public hospitals throughout Peninsular Malaysia participated in the survey. Practice of quality management was found to be significantly higher in district hospitals than in the national referral centre, which is based in the capital city of Kuala Lumpur. However, there was no significant difference in perception of implementation outcome between the three levels of hospitals. Among the factors of quality management, teamwork was found to be significantly higher in district hospitals than in state hospitals and the national referral centre. Leadership and management commitment was found to be significantly higher in district and state hospitals than in the national referral centre. The effect of organizational structure could have an effect on practice of quality management.

• Journal of Hospice and Palliative Care
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• v.23 no.4
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• pp.252-255
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• 2020

This article aims to discuss the barriers hindering cancer patients from receiving early palliative care, which has been demonstrated to be more effective in improving quality of life and controlling symptoms. Specifically, there are barriers in four aspects of delivering early palliative care. First, the difficulty of starting discussions about early palliative care and the lack of adequate appointment time can impede communication between oncologists and patients and their family members. Second, determining the timing of referral and deciding upon and applying a standard for referral can be barriers in the process of referral from oncology to palliative care. Third, palliative care patients and their family members can face difficulties regarding in what format and by whom the services will be delivered. Fourth, biases, misinformation, and inaccurate beliefs can be barriers in the process of patients and their family members accepting care. In order to facilitate early palliative care, research and policy regarding these barriers are necessary, along with efforts made by medical staff.

• Korean Journal of Psychosomatic Medicine
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• v.21 no.2
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• pp.106-113
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• 2013

Objectives: The purpose of this study was to examine the characteristics and the psychosocial factors associated to the referral to psychiatric care in the suicide attempters visiting emergency center. Methods: We conducted a systematic chart review of 377 suicidal attempters visiting emergency center of the Korea University Ansan Hospital between January 2008 and December 2011. We gathered a data contain 20 items including psychosocial characteristics and factors related to suicide and factors related to psychiatric treatment. Multivariate logistic regression models were fitted to data to estimate the unique effects of sex, drunken status, companion, suicidal methods, place of suicide and current use of psychiatric medication on the referral to psychiatric care. Results: The female gender(OR=1.63, 95% CI=0.99-2.69), suicidal attempts at home(OR=3.40, 95% I= 1.21-9.56) and drunken state at visit(OR=2.34, 95% CI=1.10-5.01) are the factors that predict the risk of the non-referral of the patients to psychiatric intervention. Place of suicidal attempt was the most important factor do play a role in determining whether referral to psychiatric care will take place or not. Current use of psychiatric medication showed a trend toward significance(p=0.08, OR=1.67, 95% CI=0.95-2.95). Conclusions: These results suggest that when deciding whether to adapt or to refuse the referral to psychiatric care, the factors such as suicidal intent, lethality of suicide methods, familiar factors and alcohol may contribute onto the referral to psychiatric care. Additional research is required to investigate an association of these factors with referral to psychiatric care.

• Journal of Veterinary Clinics
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• v.31 no.3
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• pp.237-240
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• 2014

A 12-year-old, intact, female Alaskan malamute presented with severe spinal pain and hind limb lameness. On radiographs, a round, demarcated lytic lesion was identified in the central fifth lumbar vertebra. On magnetic resonance imaging (MRI), the lesion involving the spinal cord appeared hypointense on T1 weighted, hyperintense on T2 weighted, heterogeneously enhanced on post-contrast T1 weighted, and hypointense on GE images. A focal, small, ill-defined, lytic lesion was also observed radiographically in the sixth lumbar vertebra, it appeared as a focal hyperintense lesion on T1 weighted, T2 weighted, and GE images and showed focal enhancement on post-contrast T1 weighted images. She was euthanized owing to extreme pain and severe and progressive clinical signs; a plasmacytoma was histopthologically diagnosed. This report presents an unusual type of spinal tumor, plasmacytoma. MRI is a useful modality to evaluate the anatomic location and extension of spinal lesions.

• Quality Improvement in Health Care
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• v.9 no.2
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• pp.198-208
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• 2002

Background : This research, as a part of improving management process of college hospital in this rapidly changing circumstances, is searching for the actual state of private clinics referring patients to referral center including college hospitals. Methods : This research examined the sense of satisfaction and requesting degree in using referral center and by analyzing the correlation and differences among factors such as primary factors regarded as selecting ones in referring patients to a referral center in college hospital and expecting factors expected to be supported to patients and cooperative hospitals. Results : The main researched results are as follows. First, as for the primary factors, the differences between cooperative and uncooperative hospitals revealed the fact that choosing target hospital in accordance with cooperative relation and convenient process in referring patients are important. Second, satisfaction rates, analyzed from the paired t-test revealed kindness and convenience as the top priorities, while sending patients back again and benefit of supporting such as the use of facilities were revealed as the least satisfactory aspects, despite the fact that they should be fulfilled through actual service. Conclusion : The recognition of the practitioner is examined and analyzed in this research by examining primary factors in selecting college hospitals, expecting factors expected to be supported to patients and satisfaction degree, which are expected to be used as basic materials for the development of referral center of college hospitals.

• Journal of the korean veterinary medical association
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• v.33 no.1
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• pp.44-48
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• 1997

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.31 no.4
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• pp.185-192
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• 2020

Objectives: Our study aimed to analyze the demographic and clinical characteristics of children and adolescents during their first visit to psychiatric outpatient departments for the management of suicidal ideation and behavior, and to compare the changes before and in 2012 or later. Methods: This multicenter study was conducted at five university hospitals in a metropolitan area in South Korea. Medical records of patients aged 6-18 years were retrospectively reviewed from January 2009 to December 2016. Patients were analyzed by classifying them into suicidal and non-suicidal groups based on their visit to the hospital for management of suicidal ideation or suicide attempt and other mental problems, respectively. Results: There were differences in the year of visit, diagnosis, education level, and referral sources between patients in the suicidal and non-suicidal groups. Multiple regression analysis was conducted based on the sex, education level, referral by school, and diagnosis of depression in patients in the suicidal group, which revealed significant association. Conclusion: Suicide-related problems were significantly associated with the sex, education level, referral by school, and a diagnosis of depression in the patients. A well-connected referral system would be necessary for professional mental health management of high-risk children and adolescents.

• Korean Journal of Veterinary Research
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• v.48 no.1
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• pp.111-117
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• 2008

Gastrointestinal stromal tumor (GIST) is one of the mesenchymal tumors originated from gastrointestinal submucosa. A 10 year-old, male, mixed breed dog with persistent diarrhea, anorexia and lethargy was referred to Haemaru Animal Referral Hospital. Large mass originated from the transverse colon was observed and large amount of ascites and free gas were found on abdominal radiography and ultrasonography. The ascites was septic exudate mixed with bacteria that consisted with intestinal perforation. There was no metastatic lesion. This mass was tentatively diagnosed as adenocarcinoma, leiomyosarcoma (LMS) and lymphosarcoma and surgical resection and histilogical examination were planned. However, according to owner's request, the patient was euthanized and then the necropsy was performed. About 10 cm sized mass originated from the cecum, ascending colon and transverse colon was adhered to surrounding mesentery and the perforation and large amount of ascites were observed. GIST was suspected on histopathologic examination and confirmed according to CD 117 expression in immunohistochemistry. GIST, derived from interstitial cells of Cajal, can be distinguished from LMS and leiomyoma (LM) on the basis of expression of CD117 (KIT) immunohistochemically. GIST has a different biological behavior and clinical course compared with LMS and LM, therefore definite diagnosis for GIST using immunohistochemistry is clinically important to predict the precise prognosis of the patient.