OBJECTIVES: Health information technology (IT) can assist healthcare providers in ordering medication and adhering to guidelines while improving communication among providers and the quality of care. However, the relationship between health IT and Case Mix Index (CMI) has not been thoroughly investigated; therefore, this study aimed to clarify this relationship. METHODS: To examine the effect of health IT on CMI, a generalized estimation equation (GEE) was applied to two years of California hospital data. RESULTS: We found that IT was positively associated with CMI, indicating that increased IT adoption could lead to a higher CMI or billing though DRG up-coding. This implies that hospitals' revenue could increase around $40,000 by increasing IT investment by 10%. CONCLUSIONS: The positive association between IT and CMI implies that IT adoption itself could lead to higher patient billings. Generally, a higher CMI in a hospital indicates that the hospital provides expensive services with higher coding and therefore receives more money from patients. Therefore, measures to prevent upcoding through IT systems should be implemented.
California ; Clinical Coding ; Diagnosis-Related Groups* ; Health Personnel ; Humans ; Investments ; Medical Informatics*

OBJECTIVES: The objective of this study was to create a new measure for clinical information technology (IT) adoption as a proxy variable of clinical IT use. METHODS: Healthcare Information and Management Systems Society (HIMSS) data for 2004 were used. The 18 clinical IT applications were analyzed across 3,637 acute care hospitals in the United States. After factor analysis was conducted, the clinical IT adoption score was created and evaluated. RESULTS: Basic clinical IT systems, such as laboratory, order communication/results, pharmacy, radiology, and surgery information systems had different adoption patterns from advanced IT systems, such as cardiology, radio picture archiving, and communication, as well as computerized practitioner order-entry. This clinical IT score varied across hospital characteristics. CONCLUSIONS: Different IT applications have different adoption patterns. In creating a measure of IT use among various IT components in hospitals, the characteristics of each type of system should be reflected. Aggregated IT adoption should be used to explain technology acquisition and utilization in hospitals.
Adoption ; Cardiology ; Delivery of Health Care ; Humans ; Information Systems ; Medical Informatics ; Pharmacy ; Proxy ; United States

PURPOSE: We wanted to evaluate the clinical efficacy, safety and satisfaction of patients with IRIS-transobturator tape (TOT) operation for the women suffering with stress urinary incontinence. MATERIALS AND METHODS: 53 women with stress urinary incontinence who underwent the TOT procedure between February 2004 and June 2005 were included in this study. Preoperatively, the patients were evaluated with history taking, a physical examination, a voiding diary, a one-hour pad test, uroflowmetry and the post voided residual urine. The procedure was carried out using a previously established method under local anesthesia for 37 patients and under spinal anesthesia for 16 patients. The post-operative symptoms and patient satisfaction were assessed by questionnaire. RESULTS: The patients' mean age was 49.6 years (average age: 35-73 years). The mean follow-up was 10.9 months (average follow-up: 3-20 months). The mean operation time was 30.2 minutes (average time: 20-50 minutes). The mean duration of the post operative indwelling catheter was 1 hour for local anesthesia and 18 hours (range: 14-20 hours) for spinal anesthesia. Of the 53 patients, 49 (92.4%) of the patients were cured and 4 (7.6%) were significantly improved. The postoperative complications were urinary retention in 4 patients, and tape exposure by vaginal erosion in 1 patient. De novo urgency occurred in 1 patient and de novo urge incontinence occurred in 1 patient. CONCLUSIONS: Despite the short term follow-up period, the IRIS-TOT procedure is simple, effective and less invasive for the treatment of stress urinary incontinence in terms of the high success rate and the low complication rates.
Anesthesia, Local ; Anesthesia, Spinal ; Catheters, Indwelling ; Female ; Follow-Up Studies ; Humans ; Iris ; Patient Satisfaction ; Physical Examination ; Postoperative Complications ; Surveys and Questionnaires ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urinary Retention

OBJECTIVES: The objective of this paper is to investigate the factors affecting adoption of an Electronic Medical Record (EMR) system in small Korean hospitals. METHODS: This study used survey data on adoption of EMR systems; data included that from various hospital organizational structures. The survey was conducted from April 10 to August 3, 2009. The response rate was 33.5% and the total number of small general hospitals was 144. Data were analyzed using the generalized estimating equation method to adjust for environmental clustering effects. RESULTS: The adoption rate of EMR systems was 40.2% for all responding small hospitals. The study results indicate that IT infrastructure (OR, 1.48; 95% CI, 1.23 to 1.80) and organic hospital structure (OR, 1.86; 95% CI, 1.07 to 3.23) rather than mechanistic hospital structure or the number of hospitals within a county (OR, 1.08; 95% CI, 1.01 to 1.17) were critical factors for EMR adoption after controlling for various hospital covariates. CONCLUSIONS: This study found that several managerial features of hospitals and one environmental factor were related to the adoption of EMR systems in small Korean hospitals. Considering that health information technology produces many positive health outcomes and that an 'adoption gap' regarding information technology exists in small clinical settings, healthcare policy makers should understand which organizational and environmental factors affect adoption of EMR systems and take action to financially support small hospitals during this transition.
Administrative Personnel ; Delivery of Health Care ; Electronic Health Records* ; Hospitals, General ; Humans ; Medical Informatics

PURPOSE: Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. The synergistic effect and low drug volume of each vasoactive drug in polypharmacotherapy for erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. We evaluated the treatment outcome of intracavernosal injection therapy with Trimix(the mixture of papaverine, phentolamine and prostaglandin E1). MATERIALS AND METHOD: From July 1993 to June 1997, 1000 patients with erectile dysfunction underwent a trial of intracavernous self injection therapy with Trimix(the mixture of papaverine 4.8mg, phentolamine 0.2mg and prostaglandin E1 1.8 microgram in 0.2ml). Underlying diseases were diabetes mellitus (33.1%), hypertension(7.5%) and others(12.3%). 471(47.1%) patients had no underlying disease. The volume of drug used ranged from 0.03 to 0.6ml(average: 0.18ml). RESULTS: After a mean follow-up of 10.9 months(3-44 months), 524 patients stayed on the home injection program. The drop-out rate was 47.6% with most of the cases during early home phase. The reasons for drop-out were inadequate response to medication, failure of injection, return of spontaneous erection, switch to other treatments, priapism, fear of needle or injection, loss of interest and economic reason. 88.3% of patients and 85.3% of the partners were satisfied wilts the result of home injection program. Priapism(3.9%), pain or discomfort(2.4%) and granuloma on injection site(1.5%) were noticeable complications, but corporal fibrosis and systemic side effect were not noticed. CONCLUSIONS: Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and most of all, very effective method for the treatment of the patients with erectile dysfunction.
Alprostadil ; Diabetes Mellitus ; Drug Therapy ; Erectile Dysfunction* ; Fibrosis ; Follow-Up Studies* ; Granuloma ; Humans ; Male ; Needles ; Papaverine ; Phentolamine ; Priapism ; Treatment Outcome

Medicine in the twenty-first century will be different from the medicine of today. Recent changes in medical environment, such as changes in disease and mortality pattern and rapid increase in medical knowledge, require change and adaptation of medical education. The task of medical education is to help people entering medicine to prepare to meet their professional obligations in this new context. So we tried to join Problem-base learning(PBL), which challenges students to be more actively involved in defining what they learn and how they learn, and Computer-assisted learning(CAL), which uses multimedia and medical informatics as learning tools. Finally we developed Problem-oriented medical education program using the Internet. First, using simulated patient cases, we built clinical database with patients' history, physical examinations, and various laboratory findings. To provide PBL program through the Internet, we constructed client-server system using IJS(Internet Information Server) on Windows-NT settings, and made user-friendly dynamic interface with HTML, JAVA, JAVA Script and so on. PBL on the Web will make students learn effectively and actively, and offer vivid multimedia environment for medical education. We expect this PBL program to be used as an effective learning tool for residents or doctors as well as for medical students in the near future. The Internet
Education, Medical* ; Humans ; Indonesia ; Internet* ; Learning ; Medical Informatics ; Mortality ; Multimedia ; Physical Examination ; Students, Medical

Objective: A suicide attempt by self-poisoning is a common cause of admissions to the emergency department (ED). Management of such intentiona poisoning often requires complicated medical procedures, resulting in a longer length of stay (LOS) as compared to other cases that require treatment in the ED. This study aimed to determine the factors affecting a longer LOS in self-poisoning patients. Methods: This was a retrospective study wherein all the medical charts of patients who visited the ED of one hospital, from August 2016 to July 2019, because of intentional self-poisoning, were reviewed. Results: Most of the patients visited the ED involuntarily and there were almost twice as many female patients as males. Almost half of the patients were referred to the psychiatry department. A comparison of various factors within the LOS groups revealed significant differences in mental status, guardian co-visitation, patient gender, psychiatric referral, and poisoning substance. Moreover, the LOS had a stronger association with the pre-consultation period than the consultation to decision-making period. Conclusion To reduce the LOS, it seems important to make a rapid decision on whether to observe the patient in the ED and wait until the workup is completed or to admit and then evaluate the patient in the ward. If the clinicians cannot obtain enough information to evaluate the patient for appropriate management, short-term admission may be an option to reduce the LOS and to provide a stable evaluation.

PURPOSE: We evaluated patterns of tumor recurrence after nephron sparing surgery for sporadic renal cell carcinoma MATERIALS AND METHODS: From December 1992 to October 1997, 20 patients(21 renal units) underwent nephron sparing surgery(partial nephrectomy, wedge resection, enucleation) for sporadic renal cell carcinoma at our department. Mean postoperative followup period was 25.4+/-0.3 months. All patients were evaluated with a medical history, physical examination, blood chemistry, chest x-ray, abdominal CT every 6 months. The clinical course and outcome for patients who had recurrence after nephron sparing surgery were reviewed retrospectively. We also reviewed 122 patients who underwent radical nephrectomy at the same period for patterns of tumor recurrence. RESULTS: Renal cell carcinoma were recurred after nephron sparing surgery in 3 patients (15%, 3/21 renal units:14.2%). Local tumor recurrence with(1) or without(1) metastatic disease developed in 2 patients(10%). Metastatic disease without local tumor recurrence developed in 1 patient(5%). One patient with only local recurrence had positive resection margin. Initial pathological tumor stage and period to tumor recurrence were T3a and 4 months for patient with local recurrence, T2 and 10 months for patient with local recurrence and brain metastasis, T2 and 12 months for patient with lung metastasis without local recurrence. Renal cell carcinoma recurred after radical nephrectomy in 8 patients(6.6%). Local recurrence was none and all recurrent tumors were distant metastasis. CONCLUSIONS: The incidence of metastatic disease after nephron sparing surgery for renal cell carcinoma was not different from that occurring after radical nephrectomy but the incidence of local tumor recurrence after nephron sparing surgery was greater than that occurring after radical nephrectomy. Nephron sparing surgery must be done with enough negative resection margin.
Brain ; Carcinoma, Renal Cell* ; Chemistry ; Follow-Up Studies ; Humans ; Incidence ; Lung ; Neoplasm Metastasis ; Nephrectomy ; Nephrons* ; Physical Examination ; Recurrence* ; Retrospective Studies ; Thorax ; Tomography, X-Ray Computed

PURPOSE: To assess the impact of physical characteristics on the incidence of varicoceles. Although previous reports have alluded to the fact that taller individuals may have a higher incidence of varicoceles, this has not been systematically studied. We hypothesized that physical characteristics such as height and weight could have a significant impact on the incidence of varicoceles. MATERIALS AND METHODS: We retrospectively reviewed charts of 145 patients who presented for evaluation of varicocele between 2000~2005. Each patients' age, symptoms, height, weight and body mass index (BMI) were recorded. Independent t-tests were performed to determine whether a correlation existed between presence of a varicocele and height, weight, or BMI. Moreover, we selected 90 patients whose varicocele was detected by pain and performed the same analysis in order to exclude selection bias. Additionally, we compared varicocele grade with height, weight and BMI by one-way ANOVA test. RESULTS: Our analysis showed that there was no association between height and the presence of a varicocele. However, the weight of the patient and the incidence of varicocele approached significance with greater weight associated with a lower incidence of varicoceles. There was also an association between BMI and the presence of varicoceles but the correlation did not depended on varicocele grade. CONCLUSIONS: Although previous reports have alluded to a higher incidence of varicoceles in taller patients, the current study found no correlation between height and the presence of a varicocele. Increased weight, however, was associated with a significantly lower incidence of varicoceles. Varicocele grade was not correlated with any factor. This study demonstrates that height is not a consideration when evaluating the infertile male, whereas weight may affect the ability to diagnose the varicocele.
Body Height ; Body Mass Index ; Humans ; Incidence ; Male ; Retrospective Studies ; Selection Bias ; Varicocele*

Objective: This study evaluated the usefulness, as a risk factor of 30-day mortality, in patients residing in nursing-homes (NHs) or long-term care facilities with the diagnosis of pneumonia. Methods: We conducted a retrospective study in a public hospital between January 2017 and December 2017. The subjects included elderly patients residing in NHs and diagnosed with pneumonia in the emergency room. Data on age, gender, comorbidities, laboratory findings, pneumonia severity index score (PSI), and CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and Age 65 or older) were entered into an electronic database. Results: A total of 439 patients were enrolled during the study period. The mean age was 82.1±8.0 years; 195 (44.4%) were men, and 30-day mortality was 21.8%. On multivariate Cox proportional hazard analysis, cerebrovascular accidents (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.33-0.87; P=0.012), chronic renal disease (HR, 2.28; 95% CI, 1.11-4.67; P=0.024), malignancy (HR, 1.69; 95% CI, 1.04-2.76; P=0.034), lactate (HR, 1.02; 95% CI, 1.01-1.03; P<0.001), albumin (HR, 0.52; 95% CI, 0.36-0.73; P<0.001), and red cell distribution width (RDW; HR, 1.11; 95% CI, 1.03- 1.19; P=0.007) were independently associated with 30-day mortality. Areas under the curve of PSI, RDW, albumin, lactate, and PSI+RDW+albumin+lactate were 0.690 (95% CI, 0.629-0.751), 0.721 (95% CI, 0.666-0.775), 0.668 (95% CI, 0.607-0.728), 0.661 (95% CI, 0.597-0.726), and 0.801 (95% CI, 0.750-0.852), respectively. Conclusion RDW, albumin, lactate and especially the combination of PSI and these factors appear to be major determinants of 30-day mortality in NH residents with pneumonia.