1.What is the proper way to apply the multiple comparison test?.
Korean Journal of Anesthesiology 2018;71(5):353-360
Multiple comparisons tests (MCTs) are performed several times on the mean of experimental conditions. When the null hypothesis is rejected in a validation, MCTs are performed when certain experimental conditions have a statistically significant mean difference or there is a specific aspect between the group means. A problem occurs if the error rate increases while multiple hypothesis tests are performed simultaneously. Consequently, in an MCT, it is necessary to control the error rate to an appropriate level. In this paper, we discuss how to test multiple hypotheses simultaneously while limiting type I error rate, which is caused by α inflation. To choose the appropriate test, we must maintain the balance between statistical power and type I error rate. If the test is too conservative, a type I error is not likely to occur. However, concurrently, the test may have insufficient power resulted in increased probability of type II error occurrence. Most researchers may hope to find the best way of adjusting the type I error rate to discriminate the real differences between observed data without wasting too much statistical power. It is expected that this paper will help researchers understand the differences between MCTs and apply them appropriately.
Analysis of Variance
;
Hope
;
Inflation, Economic
2.Understanding one-way ANOVA using conceptual figures.
Korean Journal of Anesthesiology 2017;70(1):22-26
Analysis of variance (ANOVA) is one of the most frequently used statistical methods in medical research. The need for ANOVA arises from the error of alpha level inflation, which increases Type 1 error probability (false positive) and is caused by multiple comparisons. ANOVA uses the statistic F, which is the ratio of between and within group variances. The main interest of analysis is focused on the differences of group means; however, ANOVA focuses on the difference of variances. The illustrated figures would serve as a suitable guide to understand how ANOVA determines the mean difference problems by using between and within group variance differences.
Analysis of Variance*
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False Positive Reactions
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Inflation, Economic
3.Effect of Adjuvant Balloon Inflation on Infarct Artery Flow after Primary Stenting.
Bon Kwon KOO ; Dong Hoon CHOI ; Dae Keun SHIM ; Ki Hwan KWON ; Young Won YOON ; Se Jung YOON ; Yang Soo JANG ; Won Heum SHIM ; Sung Il BAIK
Korean Circulation Journal 2002;32(5):427-432
BACKGROUND AND OBJECTIVES: Slow flow or no-reflow during the primary angioplasty is associated with a poor prognosis. The impact of adjuvant balloon inflation on infarct artery flow after successful primary stenting has not yet been studied. Therefore, we investigated the effect of adjuvant balloon inflation on infarct related artery flow after successful stenting in patients with acute myocardial infarction. SUBJECTS AND METHODS: The changes in infarct artery flow before and after adjuvant balloon inflation were assessed in 46 patients with a first episode of acute myocardial infarction (pain duration > 12 hr) who underwent adjuvant balloon inflation after successful primary stenting. Infarct artery flow was evaluated by corrected TIMI frame count (CTFC). RESULTS: After adjuvant balloon inflation, 20 patients (43%) showed a slower flow. The minimal lumen diameter became greater (3.0 > 0.5 mm vs. 3.2 > 0.5 mm, p=0.002) and the residual stenosis lessened (12.2 > 9.6% vs. 6.4 > 8.1%, p<0.001). There was no change in reference vessel diameter. CTFC was significantly increased after adjuvant balloon inflation (21.6 > 11.5 frames vs. 26.9 > 20.5 frames, p=0.005). On multivariate analysis, only pre-adjuvant balloon CTFC was a predictor of a slower flow after adjuvant balloon inflation (odds ratio 1.148, 95% CI:1.014-1.301). CONCLUSION: Adjuvant balloon inflation after successful primary stenting reduced residual stenosis but deteriorated the infarct artery flow. Further studies are required to define the clinical impact of the positive and negative effects of adjuvant balloon inflation.
Angioplasty
;
Arteries*
;
Constriction, Pathologic
;
Coronary Circulation
;
Humans
;
Inflation, Economic*
;
Multivariate Analysis
;
Myocardial Infarction
;
Prognosis
;
Stents*
4.A Study on the Regional Function of Health Care by the Disease Pattern of the Inpatients.
Huyn Rim CHOI ; Sang Il LEE ; Young Soo SHIN ; Yong Ik KIM
Korean Journal of Preventive Medicine 1988;21(2):390-403
The objectives of the study were to provide the basic informations needed in the development of balanced medical services throughout the nation. As the national health care system was expanding rapidly along with the economic growth, quantitative re-evaluation of the system is of great need. For that reason, characteristics of the admitted patients were analyzed for the case-mix and patients' flow within and through regions. Materials were 421,530 cases of inpatients, who were reported through Medical Insurance Corporation(KMIC) for insurance claim, during the period of March 1, 1985 through February 28, 1987. Korean Diagnosis Related Groups(K-DRGs) classification system was adopted for the study of case-mix and 189 cities and countries were classified into 5 district groups by factor analysis results of K-DRGs. The major findings of this study were as follows ; 1) Factor analysis of case-mix, employing K-DRG system, revealed 5 distinct functional district groups. Group A(18 district) was prominent for tertiary medical care. In group B(36 districts), rather simple procedures were prevalent. Group C(26 districts) was distinctive for the medical care of well organized internal medicine practices with qualified clinical laboratories. Group D(17 districts) was characterized by relatively high balanced medical care. Group E (92 districts) was with very low level of medical care. 2) Analysis of the case-flow through the districts showed 3 types of flow patterns ; inflow, outflow, and balanced types. Inflow type of case-flow was found in Group A, C and D while Group B and E showed outflow type. Inflow was most prominent in Group A and Group E was of typical outflow type. Group B was consistently the outflow type except for Major Diagnostic Category XX regardless of the disease treaders, but Group C and D were inflow or outflow types according to the disease tracers.
Classification
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Delivery of Health Care*
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Diagnosis
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Economic Development
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Factor Analysis, Statistical
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Humans
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Inpatients*
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Insurance
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Internal Medicine
;
Rationalization
5.An economic analysis of selective laser trabeculoplasty versus topical prostaglandin analogues as initial therapy for primary open-angle glaucoma in a tertiary government hospital in the Philippines
James Michael D. Jacomina, MD ; ohn Mark S. de Leon, MD ; Jose Maria D. Martinez, MD-MBA
Philippine Journal of Ophthalmology 2023;48(1):4-9
Objective:
This study compared the economic viability of initial medical therapy with topical prostaglandin analogues (PGAs) versus selective laser trabeculoplasty (SLT) in the treatment of primary open-angle glaucoma (POAG).
Method:
This was an economic analysis using actual, current treatment costs of PGA therapy versus SLT applied to theoretical, literature-derived clinical efficacy data projected for a period of 19 years. A socioeconomic and demographic survey conducted among POAG patients at the Department of Health Eye Center of the East Avenue Medical Center from March-April 2022 provided the economic context and setting for the analysis. The treatment regimens were compared in terms of total cost, clinical efficacy, cost-effectiveness and cost-utility in the setting of a tertiary government hospital.
Results:
Thirty-one (31) patients were included in the study. The total annual cost of topical PGAs was Philippine Pesos (Php) 13,532 versus Php 6,195 for SLT. Cost-effectiveness was Php 1,933 for PGAs/mmHg reduction in intraocular pressure (IOP) versus Php 983 for SLT. Cost-utility was Php 59,793/Quality Adjusted Life Years (QALY) gained for PGAs versus Php 27,373/QALY gained for SLT projected for 19 years. With government insurance coverage, cost-utility ratio was Php 47,831/QALY gained for topical PGAs versus 16,327/QALY gained for SLT.
Conclusion
In POAG patients, SLT was more cost-effective versus PGAs with a lower cost per mmHg IOP reduction, and lower cost-utility ratio for every QALY gained. SLT can be recommended as initial therapy for POAG especially for patients being treated at tertiary government hospitals.
Economic analysis
;
cost-utility
;
glaucoma
;
prostaglandin analogues
;
quality adjusted life years
;
Philippines
6.Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis.
Hamed ZANDIAN ; Amirhossein TAKIAN ; Arash RASHIDIAN ; Mohsen BAYATI ; Telma ZAHIRIAN MOGHADAM ; Satar REZAEI ; Alireza OLYAEEMANESH
Journal of Preventive Medicine and Public Health 2018;51(2):83-91
OBJECTIVES: One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. METHODS: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. RESULTS: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p < 0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p < 0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. CONCLUSIONS: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.
Delivery of Health Care*
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Economic Development
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Family Characteristics
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Gross Domestic Product
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Healthcare Financing*
;
Inflation, Economic
;
Iran
;
Jurisprudence
;
Regression Analysis*
;
Social Justice
;
Socioeconomic Factors
7.Historical background and development of applied nutrition and community nutrition in Korea.
Nutrition Research and Practice 2007;1(1):3-7
This paper overviews the historical background and development of applied nutrition and community nutrition in Korea. The nutrition studies in the early years focused on animal experiments, human metabolism, and food analysis and therefore were limited to classrooms and research laboratories in universities without spreading into the lives of people. Korean specialists trained through the UN International Course of Applied Nutrition initiated the Applied Nutrition Program (ANP) in Korea in the 1960s. The ANP in Korea was effectively implemented until 1986 with support from UNICEF, FAO, and WHO as a national project to improve the nutrition and health of rural residents. With economic development and urbanization in Korea, the rural-focusing ANP was re-born to a more extended version with the name of "Community Nutrition" targeting the nutrition and health of the entire Korean population. Scholarly associations including the Korean Society of Community Nutrition established in 1995 have significantly contributed to the development of Community Nutrition in Korea and are expected to continue to work for a better connection between nutrition and health promotion.
Animal Experimentation
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Atrial Natriuretic Factor
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Economic Development
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Food Analysis
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Health Promotion
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Humans
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Korea*
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Metabolism
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Specialization
;
United Nations
;
Urbanization
8.Socioeconomic Costs of Food-Borne Disease Using the Cost-of-Illness Model: Applying the QALY Method.
Hosung SHIN ; Suehyung LEE ; Jong Soo KIM ; Jinsuk KIM ; Kyu Hong HAN
Journal of Preventive Medicine and Public Health 2010;43(4):352-361
OBJECTIVES: This study estimated the annual socioeconomic costs of food-borne disease in 2008 from a societal perspective and using a cost-of-illness method. METHODS: Our model employed a comprehensive set of diagnostic disease codes to define food-borne diseases with using the Korea National Health Insurance (KNHI) reimbursement data. This study classified the food borne illness as three types of symptoms according to the severity of the illness: mild, moderate, severe. In addition to the traditional method of assessing the cost-of-illness, the study included measures to account for the lost quality of life. We estimated the cost of the lost quality of life using quality-adjusted life years and a visual analog scale. The direct cost included medical and medication costs, and the non-medical costs included transportation costs, caregiver's cost and administration costs. The lost productivity costs included lost workdays due to illness and lost earnings due to premature death. RESULTS: The study found the estimated annual socioeconomic costs of food-borne disease in 2008 were 954.9 billion won (735.3 billion won-996.9 billion won). The medical cost was 73.4 - 76.8% of the cost, the lost productivity cost was 22.6% and the cost of the lost quality of life was 26.0%. CONCLUSIONS: Most of the cost-of-illness studies are known to have underestimated the actual socioeconomic costs of the subjects, and these studies excluded many important social costs, such as the value of pain, suffering and functional disability. The study addressed the uncertainty related to estimating the socioeconomic costs of food-borne disease as well as the updated cost estimates. Our estimates could contribute to develop and evaluate policies for food-borne disease.
*Cost of Illness
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Costs and Cost Analysis
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Efficiency
;
Foodborne Diseases/*economics
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Health Services/economics/utilization
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Humans
;
*Models, Economic
;
*Quality-Adjusted Life Years
;
Republic of Korea
;
Severity of Illness Index
;
Socioeconomic Factors
9.Estimating the Socioeconomic Costs of Alcohol Drinking Among Adolescents in Korea.
Jaeyeun KIM ; Woojin CHUNG ; Sunmi LEE ; Chongyon PARK
Journal of Preventive Medicine and Public Health 2010;43(4):341-351
OBJECTIVES: The purpose of this study was to estimate the socioeconomic costs resulting from alcohol drinking among adolescents as of 2006 from a societal perspective. METHODS: The costs were classified into direct costs, indirect costs, and other costs. The direct costs consisted of direct medical costs and direct non-medical costs. The indirect costs were computed by future income losses from premature death, productivity losses from using medical services and reduction of productivity from drinking and hangover. The other costs consisted of property damage, public administrative expenses, and traffic accident compensation. RESULTS: The socioeconomic costs of alcohol drinking among adolescents as of 2006 were estimated to be 387.5 billion won (0.05% of GDP). In the case of the former, the amount included 48.25% for reduction of productivity from drinking and hangover, 39.38% for future income losses from premature death, and 6.71% for hangover costs. CONCLUSIONS: The results showed that the socioeconomic costs of alcohol drinking among adolescents in Korea were a serious as compared with that of the United States. Therefore, the active interventions such as a surveillance system and a prevention program to control adolescents drinking by government and preventive medicine specialist are needed.
Accidents, Traffic/economics
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Adolescent
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Alcohol Drinking/*economics
;
Costs and Cost Analysis
;
Efficiency
;
Health Services/economics/utilization
;
Humans
;
*Models, Economic
;
Republic of Korea
;
Socioeconomic Factors
10.Effect Oxygen in Inflation Gas for Warm Ischemia-reperfusion Injury in the Lung of a Mongrel Dog.
Sook Whan SUNG ; Hyun Jo KIM ; Young Tae KIM
The Korean Journal of Thoracic and Cardiovascular Surgery 2000;33(2):125-131
BACKGROUND: Hyperinflation during lung ischemia has been known to improve pulmonary functions after reperfusion which may be exerted through a pulmonary vasodilation and avoidance of atelectasis by an increased surfactant release and been known whether the improvement of pulmonary function was the effect of hyperinflation itself or the oxygen content in inflation gas. Therefore we attempted to clarify the effect of hyperinflation with oxygen in pulmonary inflation gas during warm ischemia on pulmonary function after reperfusion to solve the problem of ischemia-reperfusion injury after lung transplantation. MATERIAL AND METHOD: sixteen mongrel dogs were randomly divided into two groups: the left lung was inflated to 30-35 cm H2O with 100% oxygen in oxygen group and 100% nitrogen in nitrogen group. The inflated left lung was maintained with warm ischemia for 100 minutes. Arterial and mixed venous blood gas analysis and hemodynamics were measured before ischemia and 30, 60, 120, 180 and 240 minutes afer reperfusion. Lung biopsy was taken for the measurement of lung water content after the end of reperfusion. RESULT: In oxygen group arterial oxygen tension the difference of arterial and mixed venous oxygen tension and the difference of alveolar-arterial oxygen tension at 30-minute after reperfusion were not significantly different from those before ischemia and were stable during the 40hour reperfusion. However in nitrogen group these values were significantly deteriorated at 30-minute after reperfusion. there was no significant difference between two groups in hemodynamic data peak airway pressure and lung water content. CONCLUSION: The results indicated that the oxygenation one of the most important pulmonary functions was improved by pulmonary inflation with 100% oxygen during warm ischemia but the hemodynamics were not. Oxygen as a metabolic substrate during warm ischenia was believed to make the pulmonary tissues to maintain aerobic metabolism and to prevent ischemic damage of alveoli and pulmonary capillary.
Animals
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Biopsy
;
Blood Gas Analysis
;
Capillaries
;
Dogs*
;
Hemodynamics
;
Inflation, Economic*
;
Ischemia
;
Lung Transplantation
;
Lung*
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Metabolism
;
Nitrogen
;
Organ Preservation
;
Oxygen*
;
Pulmonary Atelectasis
;
Reperfusion
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Reperfusion Injury*
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Vasodilation
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Warm Ischemia