• Journal of Korean Neurosurgical Society
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• 제57권1호
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• pp.68-71
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• 2015

We report a case of non communicating hydrocephalus due to membranous obstruction of Magendie's foramen. A 37-year-old woman presented with intracranial hypertension symptoms caused by the occlusion of Magendie's foramen by a membrane probably due to arachnoiditis. As far as the patient's past medical history is concerned, an Epstein-Barr virus infectious mononucleosis was described. Fundoscopic examination revealed bilateral papilledema. Brain magnetic resonance imaging demonstrated a significant ventricular dilatation of all ventricles and turbulent flow of cerebelospinal fluid (CSF) in the fourth ventricle as well as back flow of CSF through the Monro's foramen to the lateral ventricles. The patient underwent a suboccipital craniotomy with C1 laminectomy. An occlusion of Magendie's foramen by a thickened membrane was recognized and it was incised and removed. We confirm the existence of hydrocephalus caused by fourth ventricle outflow obstruction by a membrane. The nature of this rare entity is difficult to demonstrate because of the complex morphology of the fourth ventricle. Treatment with surgical exploration and incision of the thickened membrane proved to be a reliable method of treatment without the necessity of endoscopic third ventriculostomy or catheter placement.

• 대한물리치료과학회지
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• 제3권1호
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• pp.843-853
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• 1996

The purpose of this study was to determine whether extension exercise is effective in reducing low back pain. Nine patients with low back pain were randomly assigened to one of two groups-one was an experimental group in which the patient were treated with extension exercise(McKenzie method) and conservative therapy. The other was a control group in which the patients were treated with conservative therapy only. Treatment was performed for a period of ten days during Which we examed each patient three times: the first exam was done at the begining of treatment, the second after fives days, and the third after ten days. We used 'The Oswestry low back pain disability questionnaire'(r=.99) as the examination tool. The results were as follows: 1. Both experimental and control groups showed nonsignificant differences before and after treatment, and the between group difference was also non-significant(P>.05). 2. There was no effective reduction of low back pain by MecKenzie's extension exercise(p>.05). We admit that our study protocol had several shortcomings. If they had been accounted for, the result might have been different. Further study should be done with a better experimental design, a larger sample, and a longer experimental duration.

• Journal of Oral Medicine and Pain
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• 제42권4호
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• pp.89-101
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• 2017

Purpose: The purpose of this study is to investigate the prevalence of temporomandibular disorders (TMDs) in children and adolescents, their characteristic contributing factors, the characteristic features of symptoms and symptoms, and the response to treatment. Methods: We studied the researches, that were the results of the searches for words such as temporomandibular disorder, TMD, children, adolescents, and juvenile through PubMed and DBpia. Results: According to a study conducted in Busan, the ratio of adolescents increased from 18.3% to 21% in 2008 compared to 2000, and the proportion of boys increased from 38.58% to 45.38%. One of the characteristic contributing factors for adolescents is the macrotrauma such as jaw trauma, vehicle accidents, sports, physical abuse, forceful intubation, and third molar extraction. The second is a microtrauma from parafunctional habit such as bruxism, clenching, hyperextension, wind instrument, and fingernail biting that can cause joint overload, cartilage breakdown, synovial fluid alterations, and other changes within the joint. The diagnosis of TMDs in juvenile adolescents is not significantly different from that of adults. Medical history, clinical examination and radiological examinations are required. Conclusions: In the temporomandibular joint history and assessment, all comprehensive dental history examination is required, including head and neck pain, mandibular dysfunction, previous orofacial trauma, history of present illness with an account of current symptoms. For the treatment and management of temporomandibular arthritis in juvenile adolescents, understanding the characteristics of TMDs in juvenile adolescents and thoroughly analyzing appropriate diagnosis and possible contributing factors through comprehensive history taking & examination, conservative treatment, including fast and active cautions education, will be essential.

• 대한장애인치과학회지
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• 제10권1호
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• pp.38-42
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• 2014

본 증례에서는 특별한 주의가 필요한 장애인을 위한 효율적이고 전문적인 의료 전달을 위해 여러 과와의 협의를 통한 진료가 필요함을 알리고 있다. 특히 기관절개관을 가진 환자의 마취관리와 치과치료를 시행함에 있어서 전신상태 및 기관절개관에 대한 이해와 주의가 필요하다. 1. 충치치료를 주소로 내원한 22세 남환에서 기관내삽관의 활용을 통해 전신마취 하에서 치과치료를 성공적으로 전달하였다. 2. 환자는 발작의 위험성을 가지고 있었으며, 안전한 치과치료를 위해 전신마취를 행동조절의 방법으로 선택하였다. 3. 기관내삽관에는 여러 종류가 있으며, 그 중 전신마취 하에 호흡보조를 할 수 있는 종류는 커프를 가진, 이중내강의 형태로 된 관이다. 따라서, 기관내삽관을 가진 환자에서 전신마취 하 치과치료를 진행하기 위해서는 기관내삽관의 형태에 대한 적절한 평가 및 처치가 선행되어야 한다.

• 한국병원경영학회지
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• 제10권1호
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• pp.48-70
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• 2005

The purpose of this study was to make an analysis of the impact of the DRG payment system on medical care pattern and cost of cataract surgery in a general hospital. The subjects were 173 patients whose DRG severity grade was zero, selected from among the hospitalized who underwent cataract surgery before and after the joining to the demonstrational operation of the third year DRG payment system. Their medical records and the details of their medical bills were examined to find out the length of hospital stay, medical care pattern provided to them, the cost of medical care, and the quality of medical care. The length of stay and the amount of medical care supplied during being in hospital dropped significantly for both single-eye and double-eyes cataract surgery groups. The amount of antibiotic use went down during the hospitalization and upon discharge from the hospital, but decreased after discharge. The total medical bills and the rate of basic examination implementation increased in the OPD before hospitalization but after discharge dropped. For double-eyes cataract patients, the rate of double-eyes cataract surgery went down. The total medical bills of DRG payment system converted into the fee-for-service system was greater by 113.3% for the single-eye cataract surgery group and by 102.9% for the doble-eyes cataract surgery group, compared to that by the fee-for-service. The contribution shared by the insurance corporation increased for both single-eye and double-eyes cataract surgery groups, but the copayment by the insured went down. Regarding the treatment outcome, no difference was found in complication rate, resurgery rate and mortality rate before and after the joining to the DRG payment system was implemented. The use of special lens lessened significantly. The amount of medical care supplied during hospitalization decreased but the complication rate didn't increase. But the increased use of low-price artificial cataract and the avoidance of double-eyes cataract surgery was observed. The phenomenon decreased number of OPD visit and the decreased total medical bills of OPD care after discharge in this hospital required further evaluation.

• 한국병원경영학회지
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• 제19권3호
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• pp.11-28
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• 2014

This study, targeting Korean tertiary hospitals and general hospitals, aims to analyze how value chain model in health and medical institution suggested by Duncan and else influences on hospital management. A survey was conducted to verify the actual proof analysis of this study model. 880 questionnaires were distributed to entire 88 hospitals and 739 copies were returned from 76 hospitals. This study mainly consists of three steps to analyze the effect value chain activity has on management performance of general hospitals. For the first step, we analyzed the effects service delivery activity has on management performance. For the second step, we analyzed the effects service support activity has on management performance and for the third, we analyzed the effects interaction between service delivery activity and service support activity has on management performance. The main results of this study are as follows. First, in terms of the management performance of scale, the factors which influenced on daily charge of outpatient were service activity before treatment, at the moment of treatment and value chain activity, while more important factors in daily charge of inpatient were organizational culture, organizational structure and value chain activity. In terms of management performance of quality, the factors which influenced on the first medical examination rate of outpatient were service activity before, at the moment of and after treatment, while activity at the moment of treatment, organizational structure, and value chain activity which is interaction were more important factors in average length of stay. In terms of non-financial performance, the management performance factors which influenced on job satisfaction were service activity at the moment of, after the treatment and value chain activity, while organizational culture, strategy resources and value chain activity which is interaction were more important factors in job commitment. Secondly, all the service support activity, service delivery activity and value chain activity had statistically significant effect on management performance. Among the three factors, service support activity had relatively high effect than others.

• 한국병원경영학회지
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• 제3권1호
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• pp.100-120
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• 1998

Tertiary been increasing rapidly. There has been shortage of beds in hospitals and effective management of beds had to b considered. For the efficient utilization of the exsisting hospital beds, bed turnover rate ha to be high and their length of stay in hospital has to be shortened. The sample of this study was in-patients admitted in 13 clinical departments of a tertiar hospital in Wonju. Daily medical fees through length of stay in hospital were observed an we analyzed the increase of hospital revenues per bed for the shortening of length of stay. The results of the analysis were as follows: 1. The average length of stay by dept. was 11.0 in dept. of internal medicine. 12.4 in dept. of general surgery, 7.1 in dept. of gynecoloty, 6.8 in dept. of pediatrics, 26.1 in dept. of nervous surgery, 21.6 in dept. of orthopedic surgery, 25.5 in dept. of plastic sersury, 7.6 in dept. of ophthalmology, 7.1 in dept. of E.N.T, 8.1 in dept. dermatoloty, 9.0 in dept. urology. 2. The trend of daily medical fees of in-patients was the highest from the first day to the third day. Because most necessary examination and various treatment or operation took place in these period. 3. The estimative model for medical fees by the length of stay at each clinical department was inferred. 4. The increased revenue per bed by shortening the length of stay was calculated by the estimative model. Shortening one day would increase 305,999 thousand won in dept. of internal medicine 232,138 thousand won in dept. of general surgery., 177,795 thousand won in dept. of gynecology medicine, 69,031 thousand won in dept. of pediatrics 360,381 thousand won in dept. of nervous surgery 211.339 thousand won in dept. of orthopedic surgery, 100,249 thousand won in dept of plastic surgery, 10,569 thousand won in dept. of ophthalmology -814,122 thousand won in dept. of E.N.T, 1,582 thousand won in dept. of dermatology, -5,821 thousand won in dept. of urology. It is expected that they can improve their profitability by shortening the length of stay of the in-patients.

• 한국병원경영학회지
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• 제7권4호
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• pp.57-101
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• 2002

These days, the environment of hospital marketing is changing rapidly. The level of expectation and demand of patients have become greater and more diversified, and patients have more alternatives in selecting hospitals. The standard of hospital selection and the type of using hospital have been changed, and competition among hospitals has been accelerated due to the opening of the medical market through globalization. Accordingly, differentiation strategies are critical in hospital marketing. The quality of medical service oriented toward patient satisfaction becomes a strong strategic weapon to secure a hospital's competitive advantage. Therefore, marketing and communication strategies should be focused on patient-oriented, rather than hospital-oriented. Considering the changes in the hospital environment and the increase in the patients' expectation level, this study categorizes doctors' communication styles into four different ones: trust-type, professional-type, cooperation-type, and control-type. The effects of these communication styles on patient satisfaction were empirically examined. The moderating roles of the patient's characteristics and clinical characteristics between the doctors' communication styles and patient satisfaction were also investigated to find out managerial implications for hospital management. To achieve such goals, data were collected from patients of 12 general hospitals in Busan. The data were analyzed to test research hypotheses that examine 1) the relationships between doctors' communication styles and patient satisfaction, 2) the moderating roles of the patient characteristics and clinical characteristics in the research model, and 3) the impact of patient satisfaction on positive word-of-mouth and repurchase. The following summarizes the major results of this research. First, the data showed that patient satisfaction varied across doctors' communication styles. Trust-type style had the strongest impact on patient satisfaction while control-type style had the weakest influence on patient satisfaction. Professional-type style and cooperation-type style also had positive effects on patient satisfaction but the impact of the two are not statistically different. Second, significant differences in terms of patient satisfaction were found depending upon demographic variables such as gender, marital status, age, occupation, and education. Patient satisfaction, however, was consistent across varying income groups. Third, patients' medical insurance types were also related to patient satisfaction. It implies that a doctor may need to use different communication styles depending on a patient's medical insurance type. Fourth, out-patient and in-patient showed a different level of satisfaction with varying communication styles. Fifth, highly professional knowledge and strong control can influence patient satisfaction depending on the characteristics of the patient treatment field. Sixth, patient satisfaction were proved to have significantly positive effects on word-of-mouth and repurchase. The implications drawn from this study must be tempered by its limitations. First of all, the subjects used in this study were patients in Busan and small- and medium-size hospitals were excluded from the research. Therefore, future research should examine the research model by using a variety of hospitals and clinics throughout Korea. Another research agenda has to do with finding more determinant and moderating variables which will increase an explanatory power of the model. In short, this study may be the first empirical research that investigates the effects of doctors' communication styles on patient satisfaction. Interestingly enough, the results showed that each communication style had a unique impact on patient satisfaction. The findings from this research can be very useful in developing hospital marketing strategies.

• 한국병원경영학회지
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• 제8권1호
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• pp.112-134
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• 2003

The purpose of this study is to analyze the consumer's expectation before the health care service and the consumer's satisfaction after it. The participants of the study are inpatients in a general hospital located in Seoul. The resources were collected from the self-administration questionnaire survey run parallel with face to face interview. In order to measure the degree of the consumer's expectation, 349 samples were collected from the first questionnaire survey on the date of admission to the hospital. The second questionnaire survey was carried out on the date of discharge to the hospital with the participants responding to the first questionnaire survey. There are 154 samples collected from this survey. The results from the analysis of these resources are as follow. First, the survey shows that one of the highest consumers' expectations was about the generosity, kindliness and sincerity from the staff at the hospital, specially from doctors. Second, according to the analysis of the factors affecting the expectations of the consumers, with regard to path of admission to a hospital relating to patient's features, outpatient who gets into a hospital expected good medical care much more than the other patients. In regard of doctor's features, patients usually and highly expect good medical care from doctors who have good carrier and much experience. Third, according to the second questionnaire survey, what patients are satisfied most with is about the generosity and sincerity from staff at a hospital, especially from doctors and their gem attitudes. The results from survey show that the differences among the degree of consumers' satisfaction are very variable, depending on surrounding environments and facilities. The only fact that expectation didn't meet with satisfaction appeared to the case about technology and skill of medical care and the case about updated medical skills and equipments. Fourth, comparing the degree of expectation with the degree of satisfaction of consumers, correlative analysis was concerned significantly and specifically about the part of overall cleanliness relating to facilities and surrounding environments, the items about medical examination and test plan procedure relating to skill of medical care, professional specialties and convenience for procedure, and the items about satisfying explanations and concern about patients from doctors relating to staff's generosity and sincerity. Fifth, the analysis of the factors affecting the degree of how much patients are satisfied with shows that relating to sociodemographical features, patients are not satisfied with the case when the time and process of medical treatment are getting longer. It is surveyed that consumer were satisfied with the motivation to visit a hospital and the insurance type in patient's feature and so were the medical department and the factor of the degree of the expectation in disease's feature. Sixth, according to analysis based on the survey, patients would join again a hospital when they get satisfaction from the medical care and also they want to come again regarding to doctor's capability. For example, when doctors are old, have a good carrier and much experience, patients would come again. As seen from the above, consumers are usually satisfied with the medical treatment more than that they expected before. They would intend to use again when they get satisfaction from the medical care provided at a hospital. Patients and consumers highly expect good attitude as well as capacity from medical doctors and they are also generally satisfied with those things. Therefore, in order to increase the degree of consumer's satisfaction and their intention to come again, the hospital staff would have to commit themselves to achieve high quality service continuously and would have to make an effort to offer the finest quality service.

• 한국병원경영학회지
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• 제14권2호
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• pp.1-20
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• 2009

The purpose of this study is to find the determinant variables to make profitability in regional public hospitals. The data come from financial statements and annual reports of 34 regional public hospitals for five years (from year 2003 to year 2007). The T or F-test and hierarchical multiple regression analysis are used. The dependant variables are the profitability indicators, ordinary income to total asset and operating margin to gross revenue, and the independent variables are general characteristics, diagnosis and treatment patterns, financial and public benefits. The findings of this study are summarized as follows. First, Variables affecting the profitability indexes revealed from DEA results is the bed occupancy rate, number of hospitalized patients to outpatients, ratio of first medical examination for outpatients, number of daily patients per medical specialist, labor cost per patient and managerial expenses per patient. Second, the ordinary income to total asset representing the asset usage performance is affected by the average hospitalized days, bed occupancy rate, labor cost per patient and ratio of patients with medical insurance coverage. Third, the operating martin to gross revenue obtained from the actual operations of hospitals has its significance with the bed occupancy rate, number of hospitalized patients to outpatients, managerial expenses per patient and public benefit indicator. This study has some restriction not to use pannel data analysis, although it used data for five years. Accordingly, various additional studies should be done to supplement such problems.