PURPOSE: To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing. METHODS: Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions. RESULTS: For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable. CONCLUSION: The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.
Hospitals ; Humans ; Logistic Models ; Nursing Staff, Hospital/economics/*supply & distribution ; Workplace

Objective:To explore the function of the bridging epithelium between maxillary process and nasal process in the devel-opment of lip and palate.Methods:The fertilized white leghorn chick eggs incubated to the appropriate Hamburger and Hamilton(H-H)stages were examined by tissue histologic studies,scanning electron microscopy observation,BrdU assay and TUNEL assay re-spectively.Results:At H-H stage 24,the epithelia between maxillary,lateral nasal and globular process were juxtaposed.At H-H stage 26-27,string-like filopodia appeared and the bridging epithelium formed,then in the bridging epithelium cell proliferation was decreased and the apoptotic cells appeared.At H-H stage 28,the apoptosis of the bridging epithelium cells increased,the full fusion of the processes was completed.Conclusion:The occurrence of bridging epithelium between maxillary process and nasal process plays an important role in the development of lip and palate.

PURPOSE: The purpose of this study is to evaluate the costs and benefits of individual home visiting health care using secondary data and literature review. METHODS: The total number of subjects was 1,008,837. A specific program was classified into disease management, care of infant, child and women, or elderly care. The costs and effects of a program were identified from a societal perspective, and the effects were converted into monetary terms or benefits. The total cost was calculated in the way that medical expenses, travel costs and productivity losses were offset by the decrease in benefits and thus only the program budget was included in the total cost. RESULTS: The total program cost was 47.6 billion won per year and the total annual benefit was estimated at 435.6 billion won. The benefits of arthritis management were the biggest among disease management programs. The net benefit was 388.0 billion won per year and the benefit/cost ratio was 9.16. CONCLUSION: Home visiting health care was validated to be economically effective. It made a positive contribution to improving the health status of vulnerable populations and reducing medical expenses. These results suggest that home visiting care should be extended more broadly to vulnerable populations.
Aged ; Arthritis ; Budgets ; Child ; Cost-Benefit Analysis* ; Delivery of Health Care* ; Disease Management ; Efficiency ; Female ; House Calls* ; Humans ; Infant ; Vulnerable Populations

Strengthening primary care has always been a major policy issue in most developed countries to achieve the health care system's goals, and policy makers continuously try to use payment system as an effective tool to improve overall performance of primary care. In this paper, we examined the various payment methods and growing trends in primary care payment system in some developed countries. Overall, a common form of payment for primary care doctors is a blend of fee-for-service (FFS), capitation, and pay-for-performance (P4P). In addition, many countries are still in the way of many new trials to find the right way to provide primary care service effectively, to meet the complex health care needs of populations. In Korea, primary care system is not well-established, and other institutional arrangements are not in good conditions for primary care, either. FFS, which is a dominant payment method in Korea, is not favorable for achieving good attributes of primary care. Mixing various payment components, like capitation, P4P to current FFS is essential to provide the optimal incentive structures for primary care physicians. Also, new models to encourage doctor-patient relationships with appropriate P4P mechanisms could be used as an early step in reforming primary care payment system gradually.
Administrative Personnel ; Delivery of Health Care ; Developed Countries ; Fee-for-Service Plans ; Humans ; Korea ; Motivation ; Physicians, Primary Care ; Primary Health Care ; Reimbursement, Incentive

We conducted in-depth interviews with 11 Korean Disaster Relief Team (KDRT) members about stress related to disaster relief work and analyzed the interview data using the Consensual Qualitative Research (CQR) method in order to evaluate difficulties in disaster relief work and to develop solutions to these problems in cooperation with related organizations. Results showed that members typically experienced stress related to untrained team members, ineffective cooperation, and the shock and aftermath of aftershock experiences. Stress tended to stem from several factors: difficulties related to cooperation with new team members, the frightening disaster experience, and the aftermath of the disaster. Other stressors included conflict with the control tower, diverse problems at the disaster relief work site, and environmental factors. The most common reason that members participated in KDRT work despite all the stressors and difficulties was pride about the kind of work it involved. Many subjects in this study suffered from various stresses after the relief work, but they had no other choice than to attempt to forget about their experiences over time. It is recommended that the mental health of disaster relief workers will improve through the further development of effective treatment and surveillance programs in the future.
Disasters* ; Earthquakes* ; Mental Health ; Methods ; Nepal* ; Qualitative Research* ; Relief Work ; Rescue Work ; Shock

Dopamine is a catecholamine used in the treatment of circulatory shock of various etiologies. The usual dose range used is from 1 to 25 ug/kg/min. When used at higher doses, the prominent effect of dopamine on the vasculature is vasoconstriction induced by stimulation of alpha-adrenergic receptors. We report a case of dopamine gangrene. The gangrene developed on the injection site in the right dorsum of foot in a 43-year-old man during infusion of dopamine for treatment of septic shock. The gangrenous lesion healded after change of injection site to subclavian vein. The dosage of dopamine was not higher, we think that the gangrene developed due to the local vasoconstriction caused by dopamine leakage from the vessels.
Adult ; Dopamine* ; Foot ; Gangrene* ; Humans ; Receptors, Adrenergic, alpha ; Shock ; Shock, Septic ; Subclavian Vein ; Vasoconstriction

PURPOSE: This study was performed to assess frequency, timings of occurrence, and predictors of radiologic lung damage (RLD) after forward-planned intensity-modulated radiotherapy (FIMRT) for whole breast irradiation. METHODS: We retrospectively reviewed medical records of 157 breast cancer patients and each of their serial chest computed tomography (CT) taken 4, 10, 16, and 22 months after completion of breast radiotherapy (RT). FIMRT was administered to whole breast only (n=152), or whole breast and supraclavicular regions (n=5). Dosimetric parameters, such as mean lung dose and lung volume receiving more than 10 to 50 Gy (V10-V50), and clinical parameters were analyzed in relation to radiologic lung damage. RESULTS: In total, 104 patients (66.2%) developed RLD after whole breast FIMRT. Among the cases of RLD, 84.7% were detected at 4 months, and 15.3% at 10 months after completion of RT. More patients of 47 or younger were found to have RLD at 10 months after RT than patients older than the age (11.7% vs. 2.9%, p=0.01). In univariate and multivariate analyses, age >47 and V40 >7.2% were significant predictors for higher risk of RLD. CONCLUSION: RLD were not infrequently detected in follow-up CT after whole breast FIMRT. More detected cases of RLD among younger patients are believed to have developed at later points after RT than those of older patients. Age and V40 were significant predictors for RLD after whole breast intensity-modulated radiotherapy.
Breast Neoplasms ; Breast* ; Follow-Up Studies ; Humans ; Lung Injury* ; Lung* ; Medical Records ; Multivariate Analysis ; Radiotherapy ; Radiotherapy, Intensity-Modulated* ; Retrospective Studies ; Thorax

OBJECTIVE: Endotracheal intubation is extremely difficult to perform in patients wearing a cervical collar for a head and neck injury. Therefore, we analyzed actual measurements using the look externally, evaluate 3-3-2, Mallampati score, obstruction, and neck mobility (LEMON) criteria before and after cervical collar application to investigate the causes of a difficult airway. METHODS: This simulation study was performed in 76 healthy volunteers. We measured the mouth opening, modified Mallampati classification, and neck extension before and after cervical collar application. RESULTS: The mean inter-incisor distance significantly decreased from 4.3 to 2.6 cm (P < 0.001). Fifty-seven participants classified as I and II were newly classified as III and IV according to the modified Mallampati classification after cervical collar application (16% to 91%). The angles of neck extension significantly decreased from 44° to 22° after cervical collar application (P < 0.001). Before cervical collar application, our simulations predicted that 14 of 76 participants (18%) would have a difficult airway, whereas after cervical collar application, 76 of 76 (100%) were predicted to have a difficult airway. CONCLUSION: All values for the LEMON criteria (mouth opening, modified Mallampati classification, and neck extension) worsened significantly after cervical collar application. Additionally, a difficult airway was predicted in all participants after cervical collar application.
Airway Management ; Classification ; Head ; Healthy Volunteers ; Humans ; Intubation, Intratracheal ; Mouth ; Neck ; Neck Injuries

Objective: There has been a consistent import of Plasmodium falciparum malaria into South Korea. As artesunate has been shown to reduce malaria related mortality in other countries, we sought to evaluate the treatment outcomes of P. falciparum malaria with artesunate. Methods: We retrospectively reviewed demographic (age, sex, travel history, and year of admission) and clinical data (sign and symptoms, laboratory findings, complications, treatment outcome) of patients with imported P. falciparum malaria diagnosed between 2014 and 2019. Results: A total of 55 patients with P. falciparum malaria were included, of which 36.4% had severe P. falciparum malaria. Their mean (±standard deviation) age was 42.6 (±12.8) years. Overall, the median length of hospital stay was 6 days (interquartile range, 4-9; range, 3-36) and 21.8% of the patients needed intensive care unit (ICU) care. The overall mortality rate was 3.6%. In patients with severe P. falciparum malaria, half of the patients (50.0%) needed ICU care and the mortality rate was 10.0%. Conclusion This is the first study to report the outcomes of imported P. falciparum malaria treated with artesunate. The mortality rate for severe P. falciparum malaria in this study was higher than that in other non-endemic countries. Further studies are needed to evaluate the effect of treatment of P. falciparum malaria with artesunate.

PURPOSE: Gallbladder cancer had poor prognosis because it is usually detected at a late stage. Some GB polyps are diagnosed as cancerous on the postoperative pathology. Because of the significance of the early detection of the cancer, the relationship between GB polyp and cancer is important. METHODS: From January 1994 to May, 2004, 94 cases of GB polypoid lesions were identified and diagnosed after cholecystectomy was performed at the Korea University Medical Center Anam hospital. The pateints' age, gender, the symptoms and signs, the diagnostic tools, the operative methods and the histopathologic findings were investigated. RESULTS: For the 94 patients, the mean age was 50.3+/-13.1 years and there were 42 males (44.7%). 92 patients were evaluated by abdominal ultrasonography, and it had a sensitivity of 72.8%. On the histopathologic results, there were 76 cases of benign polyps and 18 cases of malignant polyps. The diameter of the malignant polyps was 17.3+/-8.5 mm and the diameter of the benign polyps was 6.4+/-3.0 mm, so the malignant polyps were larger than the benign polyps. The mean age of the malignant polyp group was 62.6+/-14.2 years and the mean age of the benign polyp group was 47.1+/-11.1. The patients of the malignant polyp group were older than the patients of the benign polyp group. 19 GB polyps were greater than 10 mm in diameter and among them, there were 15 cases of malignant polyps (78.94%). CONCLUSION: The size of the polyps and the patient's age could be risk factors for malignant polyps, and the malignant potential was high for the polyps that exceeded 10 mm and for a patient age that exceeded 60 years. Surgical treatment is recommended for these patients.
Academic Medical Centers ; Cholecystectomy ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Korea ; Male ; Pathology ; Polyps* ; Prognosis ; Risk Factors ; Ultrasonography