This paper describes a GPSS-based, multi-server queueing model that was developed to simulate the patient flow, and to analyze the effectiveness of the patient scheduling system under various conditions. Unpredictable and unacceptably long waits to receive the service at the outpatient department of a general hospital necessitated the study. Arrival and service time distribution needed for the simulation model were generated from actual arrival and service patterns observed during the peak hours. The simulation results show that a change in patient scheduling system (i.e. time interval between appointments, starting time, and the number of physicians) from a current system would significantly reduce the patient wait time. This study provides the hospital administrator with an analysis of patient scheduling system under several conditions, and will be used to plan future scheduling system and staffing. Studies such as this can demonstrate the value of simulation in providing information for use in future planning.
Appointments and Schedules ; Hospital Administrators ; Hospitals, General ; Humans ; Outpatients*

BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness* ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders* ; Retrospective Studies ; Shock, Septic

Volvulus of the colon is a twisting of a redundant segment of the colon about it's narrow mesentery and sigmoid volvulus is the most common type. In many developing counteries this disorder is a common cause of obstruction of the intestine and in the western hemisphere it occurs in elderly patients who often have significant coexisting disease. This disorder may spontaneously reduce and recur as a chronic problem, but more frequently it becomes acute by obstruction, which may lead to strangulation and gangrene with high mortality if not treated promptly. Recently We have experienced 5 cases of signmoid volvulus, which were all in their twenties and had surgical operation. They had the triad of abdominal pain, distention, and absolute constipation. Plain abdominal roentgenogram was diagnostic in all cases The first line of treatment was nonoperative decompression with rigid sigmoidoscopy and successful in four of five. One Patient had emergency Hartman operation and other four had elective sigmoid resection with primary anastomosis.
Abdominal Pain ; Aged ; Colon ; Colon, Sigmoid* ; Constipation ; Decompression ; Emergencies ; Gangrene ; Humans ; Intestinal Volvulus* ; Intestines ; Male* ; Mesentery ; Mortality ; Sigmoidoscopy

This study was carried out to analyse the economic feasibility of EPR. A hospital with 500 beds under the construction was selected for this study. The economic effect was performed with cost-benefit analysis for 5 years from the year 1998 to 2002. The results of this study were as follows; The economic effect of EPR was classified into direct benefit, value acceleration, and value linking. Each factor was applied and analyzed step by step. In the analysis including only direct benefit, the net present value and the ratio of benefit to cost were minus 82,920,000 won and 0.8. With this traditional cost-benefit analysis alone, the EPR in hospital can be regarded as very unprofitable. However, when value acceleration was added, the net present value and the ratio of benefit to cost rose to 748,637,000 won and 2.7 respectively. Moreover, when value linking was added, the net present value and the ratio of benefit to cost were 1,473,162,000 won and 4.3, respectively. In the results of this study, as EPR has only direct benefit, EPR can be regarded as unprofitable project. However, when value acceleration and value linking were added, EPR can be profitable project.
Acceleration ; Cost-Benefit Analysis ; Humans

No abstract available.
Leukemia, Hairy Cell*

Ibuprofen is currently widely prescribed in the pediatric population and has potentially very severe adverse events, even in the absence of an overdose. We treated a four year-old male who presented with severe jaundice, skin rash, xanthoma, eosinophilia and decreased hepatic function after overuse of ibuprofen for fever control. The liver biopsy revealed the vanishing bile duct syndrome. We report a case of vanishing bile duct syndrome associated with Ibuprofen overuse for the first case in Korea.
Bile Ducts* ; Bile* ; Biopsy ; Eosinophilia ; Exanthema ; Fever ; Humans ; Ibuprofen* ; Jaundice ; Korea ; Liver ; Male ; Xanthomatosis

The objective of this study is to present a new approach to the development of national health insurance rate-setting system using data mining technique. In particular, this paper examines the feasibility of applying the rate-setting system for the regional insurance program to the insureds of the workman' s insurance program, so that the unified rate-setting system can be developed. The subjects of the study were the beneficiaries(sample size = 234,224) of the workman' s insurance program(excluding government officials and teachers) residing in Goyang City. 1998 data from Korean Medical Insurance Corporation were analyzed through various data mining techniques such as Decision Tree, Regression, Assessment and SCORE. Major results and conclusions are as follows: 1) On average, the insured' s property element of insurance fee, automobile element of insurance fee, property score of income assessment, and automobile score of income assessment together accounted for only 16% of the actual income, which implies that we need more precise data in order to develop an equitable rate-setting system. 2) To do so, it is necessary to gather all the income-related data(property income, financial income, earnings, ...) in a timely manner. Since current computer and information system would not allow efficient maintenance and utilization of such data, it would also be necessary to establish data warehouse for this purpose. 3) In developing the rate-setting system on the basis of data warehouse, various data mining techniques should be employed to ensure the equity of insurance rates among different classes of insureds.
Automobiles ; Data Mining* ; Decision Trees ; Fees and Charges ; Humans ; Information Systems ; Insurance ; Insurance, Health* ; National Health Programs ; Occupational Groups

Ectopic pregnancy is a common medical problem that is difficult to diagnose and potentially may lead to significant mortality or morbidity. The incidence of ectopic pregnancy is definitely increasing due to the rise in pelvic inflammatory disease (PID), pelvic surgery, intrauterine device (IUD), and assisted reproductive technologies, such as in vitro fertilization and embryo transfer (IVF-ET). Combined ectopic gestations are much rare and their true incidence is unknown. Multiple ectopic gestations may occur in a variety of locations. The majority involve one or both fallopian tubes. We report a case of combined tubal and cervical pregnancies, and discuss their management.
Embryo Transfer ; Fallopian Tubes ; Female ; Fertilization in Vitro ; Incidence ; Intrauterine Devices ; Mortality ; Pelvic Inflammatory Disease ; Pregnancy* ; Pregnancy, Ectopic ; Reproductive Techniques, Assisted

Telomerase is an enzyme that maintains telomeres and prevents telomere shortening, and may be linked with cellular proliferation or the aging process. The purpose was to examine telomerase activity in human chorionic villi from early and term normal pregnancies, and to analyze the correlation of telomerase activity (TA) with MIB-1 & bcl-2. A total of 37 placentae were obtained from 16 early and 21 term pregnancies. TA was assayed by telomeric repeat amplification protocol, and immunohistochemical staining was performed for MIB-1 & bcl-2 expression. TA & MIB-1 expression were strong in early placenta, but bcl-2 was highly expressed in term placentae. Thirteen (81.25%) of 16 early placentae showed TA, but only 2 (9.52%) of 21 term placentae expressed TA (p<0.01). MIB-1 was observed in nuclei of cytotrophoblast, and the expression rate was 16.09% in early placentae and 2.87% in term placentae (p<0.01). bcl-2 was observed only in the cytoplasm of syncytiotrophoblast. Term placenta demonstrated stronger expression of bcl-2 compared to early placentae (p<0.05). These findings suggest that TA, MIB-1 & bcl-2 expression are critically regulated over the course of gestation: cytotrophoblast, main cells of early chorionic villi, may be a common source of telomerase and proliferative activity. The TA showed good correlation with cellular proliferative activity. Syncytiotrophoblast, may be a main source of bcl-2 expression which is stronger in the term placentae.
Aging ; Cell Proliferation ; Chorion* ; Chorionic Villi* ; Cytoplasm ; Humans* ; Placenta ; Pregnancy* ; Telomerase* ; Telomere ; Telomere Shortening ; Trophoblasts

The purpose of this study was to identify important items from the medical records to be used in the standardized discharge abstract. Common items were identified by analyzing medical records from the 11 largest hospitals in Seoul. Non-common items were identified by a questionnaire survey from the directors of medical record departments of 152 teaching hospitals. The results of research was follows; 1. Thirty eight common items were included in the analyzed sheet of 11 hospitals. 2. Eighty two non-common items were identified from the analyzed. Of these,10 items were found to be important items for the discharge abstract. 3. Another 26(half) or 18(first quarter) important non-common items were identified from the survey. 4. It was notified in the non-common standardized items group that the importance of some items like the patient's occupation, underlying cause of death, nosocomial infection, complications, house staff code in charge of completing records, and items concerning quality improvement showed difference by the number of beds. The importance of house staff code who is responsible for completion of the record also showed statistically significant difference by the number of beds per medical record professional and by regions. The item of the types of nosocomial infection also showed statistically significant difference between the regions. Most hospitals obtain a lot of medical information from the computerized discharge abstract. One of the results of the study showed that the concerned sheet can housed as both the data for the medical insurance claims and the basic data for medical quality improvement. Therefore, the discharge abstract should be regarded as the most necessary sheet to be standardized. It was found that 92.8% of the directors of medical record departments of nationwide teaching hospitals acknowledged the necessity of standardization of medical record data set.
Cause of Death ; Cross Infection ; Dataset ; Hospitals, Teaching ; Insurance ; Internship and Residency ; Medical Records ; Occupations ; Quality Improvement ; Surveys and Questionnaires ; Seoul