• 보건행정학회지
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• 제24권4호
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• pp.380-388
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• 2014

Background: The volume of surgery has been examined as a major source of variation in outcome after surgery. This study investigated the direct effect of surgery volume to in hospitals mortality and the moderating effect of structural complexity-the level of diversity and sophistication of technology a hospital applied in patient care-to the volume outcome relationship. Methods: Discharge summary data of 11,827 cancer patients who underwent surgery and were discharged during a month period in 2010 and 2011 were analyzed. The analytic model included the independent variables such as surgery volume of a hospital, structural complexity measured by the number of diagnosis a hospital examined, and their interaction term. This study used a hierarchical logistic regression model to test for an association between hospital complexity and mortality rates and to test for the moderating effect in the volume outcome relationship. Results: As structural complexity increased the probability of in-hospital mortality after cancer surgery reduced. The interaction term between surgery volume and structural complexity was also statistically significant. The interaction effect was the strongest among the patients group who had surgery in low volume hospitals. Conclusion: The structural complexity and volume of surgery should be considered simultaneously in studying volume outcome relationship and in developing policies that aim to reduce mortality after cancer surgery.

• Journal of Preventive Medicine and Public Health
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• 제27권4호
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• pp.793-805
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• 1994

Investigating the existence of volume-outcome relationships for specific disease groups relates directly to the policy issue of whether, and how, specific inpatient services should be regionalized. This study examined whether medical costs and lengths of stay as outcomes were affected by changes in volume within hospitals. Based on the claims data obtained from National Federation of Medical Associations, each six disease categories from medical and surgical conditions were selected and 29,720 cases from 1,266 hospitals were analyzed. Main findings of the research can be summarized as follows: 1. Analyzing volume and cost per case relationship, tonsillectomy class 1, hernia procedure class 0, appendectomy and cesarean section class 0,1 in surgical conditions showed negative relationship significantly. In cases of medical conditions, costs per case in respiratory neoplasm class 2, COPD class 1, 2, digestive malignancy were also related to volume negtively. 2. Comparing volume with length of stay per case, lens procedure class 0, hernia procedure class 0, appendectomy class 0,1, cesarean section class 1 in surgical conditions showed negative relationships significantly. In medical conditions, volume of respiratory neoplasm class 2, COPD class 1,2, digestive malignancy class 0 were associated with negatively. 3. Within same disease categories, changes in cost and length of stay per case to volume were more remarkable in severe cases. These results suggested a significant inverse relationship between disease cases and cost, length of stay per case as outcome variables.

• Journal of Preventive Medicine and Public Health
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• 제34권1호
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• pp.9-20
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• 2001

Objectives : To explore the relationship between Percutaneous Transluminal Coronary Angioplasty(PTCA) volume and the associated immediate outcome. Methods : A total of 1,379 PTCAs were peformed in 25 hospitals in Korea between October 8 and December 31 in 1997. Data from 1,317 PTCAs (95.5%) were collected through medical record abstraction. Inter-observer reliability of the data was examined using the Kappa statistic on a subsample of 110 PTCA procedures from five hospitals. Intra-observer reliability of the data was also examined. PTCA success and immediate adverse outcomes were selected as the outcome variables. A successful PTCA was defined as a case that shows less than 50% diameter stenosis and more than 20% reduction of diameter stenosis. Immediate adverse outcomes included deaths during the same hospitalization, emergency coronary artery bypass graft (CABG) within 24 hours after PTCA, and acute myocardial infarction within 24 hours after PTCA. The numbers of PTCAs performed in 1997 per hospital were used as the volume variables. Results : Without adjusting for patient risk factors that may affect outcomes, procedures at high volume hospitals ($\geq200$ cases per year) had a greater success rate (P=0.001) than low volume hospitals. There was a marginally significant difference (P=0.070) in major adverse outcome rates between high and low volume hospitals. After adjusting for risk factors, there were significant differences in procedural failure and major adverse outcome rates between high and low volume hospitals. Conclusions : After adjusting for patient clinical risk factors, the hospital volume of PTCA was associated with immediate outcomes. It is recommended that a PTCA volume per year be established in order to improve the immediate outcome of this procedure in Korea.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 2004년도 제56차 추계 학술대회 연제집
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• pp.79.1-79.1
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• 2004

• Journal of Preventive Medicine and Public Health
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• 제37권1호
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• pp.26-36
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• 2004

Objective : To examine the association between hospital procedure volume and treatment outcomes following allogeneic bone marrow transplantation (allo-BMT). Methods : Out of 1,050 patients who received allo-BMTs between 1998 and 2000 in 21 Korean hospitals, 752 with first allo-BMT and complete data were included in this study. Study subjects were divided into the following three groups according to cumulative hospital experience of all-BMTs during the study period: low (<30 cases), medium (30-49) and high ($\geq$50 cases) volume. Patient outcome was defined as early survival at day 100 and one-year survival. Multiple logistic regression analyses were performed to examine the association between hospital experience and survival at day 100 and one year. Results : When the low volume group was defined as the reference group, the adjusted relative risks (RR) of survival at day 100 for the high volume group were 2.46(95% CI, 1.13-5.36) for all patients, 2.61(1.04-6.57) for those with leukemia, and 2.20(0.47-10.32) for those with aplastic anemia. For one-year survival, adjusted RR for the high volume group were 2.52(1.40-4.51) for all patients, 1.99 (1.01-3.93) for leukemia, and 6.50(1.57-26.80) for aplastic anemia. None of the RR for the medium volume group was statistically significant. Patient factors showing significant relationship with survival were donor-recipient relation, human leukocyte antigen matching status, time from diagnosis to transplant, and disease stage. Conclusions : The study results suggest that the cumulative experience of hospitals in providing allo-BMT is positively associated with patient survival.

• Imaging Science in Dentistry
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• 제53권2호
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• pp.91-99
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• 2023

Purpose: This systematic review aimed to investigate the correlation between chronological age and dental pulp volume in cone-beam computed tomography (CBCT). Materials and Methods: The literature was searched in 4 databases(PubMed, Scopus, Web of Science, and Google Scholar). Within each study, the outcome of interest was the correlation (r) between chronological age and pulp volume. A random-effect meta-analysis was conducted. Subgroup analysis was carried out according to sex and tooth type. Results: Of 5,693 identified studies, 27 fulfilled the inclusion criteria and were selected for meta-analysis. These articles focused on single-rooted teeth (n=21), multi-rooted teeth (n=6), maxillary teeth (n=14), mandibular teeth (n=6), and maxillary and mandibular teeth (n=12). The relationship between chronological age and dental pulp volume was examined in the entire population (r= -0.67), men (r= -0.75), and women (r= -0.77) in single- and multi-rooted teeth. The results of the total population analysis showed a relatively strong negative relationship between age and pulp volume. Conclusion: This study suggested that CBCT is a reliable and repeatable tool for dental age estimation. A strong inverse relationship was observed between pulp chamber volume and age. Further studies on the correlation between chronological age and pulp volume of multi-rooted teeth may be beneficial.

• Journal of Korean Neurosurgical Society
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• 제54권4호
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• pp.296-301
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• 2013

Objective : We conducted a retrospective study examining the outcomes of intracerebral hemorrhage (ICH) in patients with chronic kidney disease (CKD) to identify parameters associated with prognosis. Methods : From January 2001 to June 2008, we treated 32 ICH patients (21 men, 11 women; mean age, 62 years) with CKD. We surveyed patients age, sex, underlying disease, neurological status using Glasgow Coma Scale (GCS), ICH volume, hematoma location, accompanying intraventricular hemorrhage, anti-platelet agents, initial and 3rd day systolic blood pressure (SBP), clinical outcome using the modified Rankin Scale (mRS) and complications. The severity of renal functions was categorized using a modified glomerular filtration rate (mGFR). Multifactorial effects were identified by regression analysis. Results : The mean GCS score on admission was $9.4{\pm}4.4$ and the mean mRS was $4.3{\pm}1.8$. The overall clinical outcomes showed a significant relationship on initial neurological status, hematoma volume, and mGFR. Also, the outcomes of patients with a severe renal dysfunction were significantly different from those with mild/moderate renal dysfunction (p<0.05). Particularly, initial hematoma volume and sBP on the 3rd day after ICH onset were related with mortality (p<0.05). However, the other factors showed no correlation with clinical outcome. Conclusion : Neurological outcome was based on initial neurological status, renal function and the volume of the hematoma. In addition, hematoma volume and uncontrolled blood pressure were significantly related to mortality. Hence, the severity of renal function, initial neurological status, hematoma volume, and uncontrolled blood pressure emerged as significant prognostic factors in ICH patients with CKD.

• Journal of Chest Surgery
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• 제49권sup1호
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• pp.20-27
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• 2016

Background: This study analyzed the association between the volume of heart surgeries and treatment outcomes for hospitals in the last five years. Methods: Hospitals that perform heart surgeries were chosen throughout Korea as subjects using from the Health Insurance Review and Assessment Service. The treatment outcome of the heart surgeries was defined as the mortality within 30 postoperative days, while the annual volume of the surgeries was categorized. Logistic regression was used as the statistical analysis method, and the impacts of the variables on the heart surgery treatment outcomes were then analyzed. Results: The chance of death of patients who received surgery in a hospital that performed 50 or more surgeries annually was noticeably lower than patients receiving operations from hospitals that performed fewer than 50 surgeries annually, indicating that the chance of death decreases as the annual volume of heart surgeries in the hospital increases. In particular, the mortality rate in hospitals that performed more than 200 surgeries annually was less than half of that in hospitals that performed 49 or fewer surgeries annually. Conclusion: These results indicate that accumulation of a certain level of heart surgery experience is critical in improving or maintaining the quality of heart surgeries. In order to improve the treatment outcomes of small hospitals, a support policy must be implemented that allows for cooperation with experienced professionals.

• Journal of Korean Neurosurgical Society
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• 제50권2호
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• pp.89-94
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• 2011

Objective : D-dimer is a breakdown product of fibrin mesh after factor XIII stabilization. Previously, many authors have demonstrated a relationship between D-dimer level and stroke progression or type. This study aimed to investigate the relationship between D-dimer level and stroke volume. Methods : Between January 2008 and December 2009, we analyzed the D-dimer levels of 59 acute ischemic stroke patients in our neurosurgical department both upon admission and after seven days of initial treatment. Each patient's National Institute of Health Stroke Scale score, modified Rankin Scales score, Glasgow outcome score, and infarction volume were also evaluated. Results : Mean D-dimer level at admission was 626.6 ${\mu}g/L$ (range, 77-4,752 ${\mu}g/L$) and the mean level measured after seven days of treatment was 238.3 ${\mu}g/L$ (range, 50-924 ${\mu}g/L$). Mean D-dimer level at admission was 215.3 ${\mu}g/L$ in patients with focal infarctions, 385.7 ${\mu}g/L$ in patients with multiple embolic infarctions, 566.2 ${\mu}g/L$ in those with 1-19 cc infarctions, 668.8 ${\mu}g/L$ in 20-49 cc infarctions, 702.5 ${\mu}g/L$ in 50-199 cc infarctions, and 844.0 ${\mu}g/L$ in >200 cc infarctions (p=0.044). On the 7th day of treatment, the D-dimer levels had fallen to 201.0 ${\mu}g/L$, 293.2 ${\mu}g/L$, 272.0 ${\mu}g/L$, 232.8 ${\mu}g/L$, 336.6 ${\mu}g/L$, and 180.0 ${\mu}g/L$, respectively (p=0.530). Conclusion : Our study shows that D-dimer level has the positive correlation with infarction volume and can be use to predict infarction-volume.

• 한국환경복원기술학회지
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• 제12권2호
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• pp.73-82
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• 2009

The traffic volume of Seoul is extremely high in comparison to other major cities in Korea, and the result has been harmful physical and mental exposure to pollution by Seoulites on a regular basis. The street air pollution is more important than the others, because the air pollution generated by street traffic directly impacts the health of nearby pedestrians. This problem requires urgent attention and resolution. Among the factors creating the air pollution originating from the street, is the configuration of streets, which have emerged as the most significant because it is related to air and pollutant dispersion. Therefore, this study was conducted under the assumption that street form affects the air quality. Study sites were classified by street characteristics, and air quality was analyzed in each class. Then the OSPM (Operational Street Pollution Model) was employed to simulate the relationship between street configuration and air quality of streets within the old city center and new city center in Seoul. After that this study analyzed the correlation between air pollution and the spatial configuration of urban streets (ex. street width, building height, building density, etc.) to determine their contributions to air pollution. The outcome of this study is as follows : First, the result that was derived from the correlation analysis between street configuration and air quality hewed that the air pollution of the street is influenced by the average height of building, width of the roads as well as traffic volume. On the roadside, the concentration level of $NO_2$ is mainly affected by the average height of building and the deviation of building height along the street and CO is affected by street width. The outcome of this study can be used as a basis for more sound urban design policies, and the promotion of desirable street environments for pedestrians.