OBJECTIVES: The Study of Small Area Variation(SAV) is most interesting issue in the health care researches. Most studies of SAV have been concluded the existences of variation on the basis of the magnitude of variation without statistical testing. But it is difficult to explain the existence of variation with this way because variation indicies are easily influenced by several parameters and also their distribution are skewed. So, it needs for the study to investigate the distribution of these indices and develop the statistical testing model. METHODS: This study was planned to analyze on the distribution of variation indices such as Extremal Quotient(EQ), Coefficient of Variation(CV), Systematic Component of Variation(SCV) and compare the statistical power among indicies. The simulations was performed on the basis of several assumptions and compared to the empirical data. RESULTS: Main findings can be summarized as follows. 1. If other conditions are constant, the more number of regions, the larger 95 percentile of EQ. But under same situation, 95 percentile of CV and SCV were slightly decreased. 2. If the size of regional population or utilization rate were increased, 95 percentile of all statistics were decreased. Also in the cases of small population size and low utilization rate, 95 percentiles of EQ showed various change contrast to the little change of CV. 3. If the difference at the size of regional population were increased, 95 percentiles of EQ and SCV were increased contrast to the little difference of CV 4. If the utilization rate were increased, 95 percentiles of all indicies were increased. But under the same difference of utilization rate, the power of CV and SCV were increased comparing to no change of the power of EQ. 5. Usually the power of EQ were lower than that of CV or SCV and it is similar between CV and SCV. CONCLUSIONS: Therefore, we suggest that in selecting the variation indicies at the SAV, CV or SCV are superior than EQ in terms of significance level and power.
Health Services Research ; Population Density ; Small-Area Analysis* ; Statistical Distributions*

OBJECTIVES: To investigate the information searching behavior of health care consumers according to sociodemographic characteristics. METHODS: A questionnaire survey was conducted of 1,507 persons who were selected through a multi-stage stratified area cluster sampling of the Republic of Korea, excluding the province of Jeju-do. Personal were conducted through a door-to-door survey between 27 July and 10 August 1999. RESULTS: 80.5% of respondents used more than one source of information and those 40~59 years of age, female, a housewife or student and those who claimed a religion demonstrated more active information searching behavior. A personal informer was used significantly more in those 20~39 years old, female, and those who claimed a religion. Clerical workers, those with post-secondary education and a monthly income greater than 2,000,000 won ($1500) were more actively used a public informer. Low socioeconomic status and older persons used an experimental informer when they chose a health care institution. CONCLUSION: Regardless of the sociodemographic characteristics, personal and experimental informers were the most useful source of information. Because appropriate information was not easy to obtain, the health care consumer was dependent upon word-of-mouth communication(personal informer) when using health care services.
Appetitive Behavior* ; Data Collection ; Delivery of Health Care* ; Education ; Female ; Humans ; Jeju-do ; Questionnaires ; Republic of Korea ; Social Class

Hyperamylasemia and hyperlipidemia occur when the amounts of amylase and lipase that enter the blood overweigh the kidney and liver reticuloendothelial system clearance of the enzymes. In normal homeostasis, most of these enzymes are excreted from the apical membrane of the acinar cells into the ductal system of the gland. However, in pathological conditions, this apical exocytosis is blocked, and the leakage of these enzymes at the basolateral membrane is increased. Therefore, these enzymes are released into the bloodstream. Many different pancreatic pathologies and Gullo syndrome can cause this type of leakage in the pancreas. This mechanism can also cause basolateral leakage in other organs that secrete amylase and lipase. In small bowel inflammatory conditions, amylase and lipase are absorbed through the inflamed mucosa and introduced into the bloodstream due to increased vascular permeability. Regardless of the enzymes that enter the blood circulation, several kidney and liver diseases prevent the excretion and metabolism of serum amylase and lipase. When the amylase and lipase are combined with immunoglobulins, they escape normal glomerular filtration due to the development of macroenzymes and accumulate in the blood. These situations related to the clearance of the enzymes are also crucial mechanisms of serum enzyme elevation that should not be overlooked.

OBJECTIVES: Organizational culture has been important in field of organizational behavior research for the past decade. Although there has been a growing interest in the organizational culture and organizational effectiveness, there is few research in health care field. This study was carried out to investigate the relationship of organizational culture and organizational effectiveness at general hospital. METHODS: Data was collected by self-administrated questionares. Organizational cultures were measured by using Likert scale. A general hospital in Kyunggi-Do was selected and survey was conducted to 675 workers. Data was analyzed with computer package, PC- SPSS. RESULTS: There were four types of organizational culture in this hospital : consensual culture, developmental culture, hierarchical culture, rational culture. Many workers recognized their culture as rational culture and developmental culture. This finding showed that the hospital had both human related and task related climate. There were some differences in recognition of sub-organizational culture by occupational group, but perceived organizational culture was in accordance with sub-organizational culture in general. Multiple regression analysis and multiple logistic regression analysis were conducted to find the relationship of organizational culture and organizational effectiveness. As a result, developmental culture showed a strong relationship with organizational commitment and job-satisfaction. CONCLUSIONS: These results showed that types of organizational culture were significantly related to organizational effectiveness and understanding the existing culture is essential to develope their organizational effectiveness.
Climate ; Delivery of Health Care ; Gyeonggi-do ; Hospitals, General* ; Humans ; Logistic Models ; Occupational Groups ; Organizational Culture*

Purpose: We report the therapeutic efficacy of using 18% SF6) injection into the anterior chamber or interrupted corneal sutures for Descemet membrane detachment related to cataract surgery. Case summary: Case 1) A 74-year-old female showed localized detachment of Descemet membrane of the cornea on the first day after cataract surgery on the left eye; her visual acuity was hand motion only. Non-expansible sulfur hexafluoride (18% SF6) gas was injected into the anterior chamber to treat the detachment and achieved improvement of vision due to relief of the corneal edema and adhesion of the Descemet membrane. Case 2) A 76-year-old male had poor visual acuity of the right eye after cataract surgery performed at a local eye clinic. Folding and detachment of the Descemet membrane was found before the postoperative 3-months follow-up. We injected 0.3 mL 18% SF6 gas into the anterior chamber twice. The corneal edema disappeared and visual acuity improved. Case 3) A 75-year-old female who had undergone cataract surgery was suspected of having Descemet membrane detachment. She was injected with 18% SF6 into the anterior chamber twice, but the detached membrane persisted in the lower right cornea, combined with pupillary block glaucoma. We performed interrupted corneal sutures of the detached Descemet membrane, and resolution of the detachment was confirmed by corneal optical coherence tomography. Conclusions Re-attachment of Descemet membrane of the cornea can be obtained by performing repeated injections of 0.3-0.4 mL of non-expansible 18% SF6 gas, or by direct corneal suture in cases of persistent detachment.

Purpose: To evaluate the 1-year clinical outcome of subsequent trabeculectomy following 25-gauge transconjunctival sutureless vitrectomy in refractory glaucoma with vitreous filling of the anterior chamber. Methods: This study was a retrospective and consecutive case series study. We reviewed the medical records of pseudophakic and aphakic glaucoma patients with vitreous filling of the anterior chamber who underwent subsequent trabeculectomy with mitomycin C (MMC), following 25-gauge transconjunctival sutureless vitrectomy. All patients had been followed up for more than 12 months. Complete surgical success was defined as an intraocular pressure (IOP) ≤18 mmHg and IOP reduction ≥20% without glaucoma medication. Qualified surgical success was defined as IOP ≤18 mmHg and an IOP reduction ≥20% with or without glaucoma medication. Results: Eight eyes of seven patients (four eyes of four patients with pseudophakic glaucoma and four eyes of three patients with aphakic glaucoma) were included in this study. The cumulative probability of qualified success was 87.5%, and the cumulative probability of complete success was 62.5% at 12 months after trabeculectomy. The mean IOP decreased from 28.1 ± 3.5 mmHg preoperatively to 15.0 ± 3.7 mmHg at the final visit (p = 0.012). The mean number of glaucoma medications decreased from 4 ± 0 to 1.5 ± 2.1 at the final visit (p = 0.010). Complications including retinal detachment, vitreous hemorrhage, cystoid macular edema, and vitreous incarceration into the fistula were not observed. Conclusions Transconjunctival sutureless vitrectomy and subsequent trabeculectomy with MMC is an effective method for controlling IOP in pseudophakic and aphakic glaucoma with vitreous filling of the anterior chamber.

Purpose: We report the therapeutic efficacy of using 18% SF6) injection into the anterior chamber or interrupted corneal sutures for Descemet membrane detachment related to cataract surgery. Case summary: Case 1) A 74-year-old female showed localized detachment of Descemet membrane of the cornea on the first day after cataract surgery on the left eye; her visual acuity was hand motion only. Non-expansible sulfur hexafluoride (18% SF6) gas was injected into the anterior chamber to treat the detachment and achieved improvement of vision due to relief of the corneal edema and adhesion of the Descemet membrane. Case 2) A 76-year-old male had poor visual acuity of the right eye after cataract surgery performed at a local eye clinic. Folding and detachment of the Descemet membrane was found before the postoperative 3-months follow-up. We injected 0.3 mL 18% SF6 gas into the anterior chamber twice. The corneal edema disappeared and visual acuity improved. Case 3) A 75-year-old female who had undergone cataract surgery was suspected of having Descemet membrane detachment. She was injected with 18% SF6 into the anterior chamber twice, but the detached membrane persisted in the lower right cornea, combined with pupillary block glaucoma. We performed interrupted corneal sutures of the detached Descemet membrane, and resolution of the detachment was confirmed by corneal optical coherence tomography. Conclusions Re-attachment of Descemet membrane of the cornea can be obtained by performing repeated injections of 0.3-0.4 mL of non-expansible 18% SF6 gas, or by direct corneal suture in cases of persistent detachment.

Purpose: To evaluate the 1-year clinical outcome of subsequent trabeculectomy following 25-gauge transconjunctival sutureless vitrectomy in refractory glaucoma with vitreous filling of the anterior chamber. Methods: This study was a retrospective and consecutive case series study. We reviewed the medical records of pseudophakic and aphakic glaucoma patients with vitreous filling of the anterior chamber who underwent subsequent trabeculectomy with mitomycin C (MMC), following 25-gauge transconjunctival sutureless vitrectomy. All patients had been followed up for more than 12 months. Complete surgical success was defined as an intraocular pressure (IOP) ≤18 mmHg and IOP reduction ≥20% without glaucoma medication. Qualified surgical success was defined as IOP ≤18 mmHg and an IOP reduction ≥20% with or without glaucoma medication. Results: Eight eyes of seven patients (four eyes of four patients with pseudophakic glaucoma and four eyes of three patients with aphakic glaucoma) were included in this study. The cumulative probability of qualified success was 87.5%, and the cumulative probability of complete success was 62.5% at 12 months after trabeculectomy. The mean IOP decreased from 28.1 ± 3.5 mmHg preoperatively to 15.0 ± 3.7 mmHg at the final visit (p = 0.012). The mean number of glaucoma medications decreased from 4 ± 0 to 1.5 ± 2.1 at the final visit (p = 0.010). Complications including retinal detachment, vitreous hemorrhage, cystoid macular edema, and vitreous incarceration into the fistula were not observed. Conclusions Transconjunctival sutureless vitrectomy and subsequent trabeculectomy with MMC is an effective method for controlling IOP in pseudophakic and aphakic glaucoma with vitreous filling of the anterior chamber.

PURPOSE: To evaluate the impact of LASIK on vision-related quality of life (QOL) in myopia patients METHODS: This study included 288 patients who received laser in situ keratomileusis (LASIK) between July and December 2001 from two eye clinics located in Seoul and Pusan. Myopia-specific Quality of Life Questionnaire (MQLQ) was developed. MQLQ contained 34 questions in 4 domains that assess the effect of LASIK on visual function, visual symptoms, social and role function, and psychological well-being. Baseline QOL for the condition that refractive error was corrected by glasses or contact lenses before undergoing LASIK were evaluated by means of self-administered questionnaire. The evaluation was repeated at 4 days, 1 month, 3 months, and 6 months after LASIK. All question items were rated on a scale ranging from 1 (maximal dysfuntion) to 5 (no dysfunction). RESULTS: Average score for the MQLQ changed from 3.20 preoperatively to 3.76, 3.99, 4.07, and 4.11 at 4 days, 1 month, 3 months, and 6 months after surgery, indicating a continuous improvement of overall QOL following LASIK. Among the 4 dimensions, social and role function showed the biggest improvement (changes in score: 1.48, p=0.001), followed by psychological well-being(0.98, p=0.001), visual function(0.67. p=0.001), and visual symptoms (0.49, p=0.001). CONCLUSIONS: LASIK has a significant contribution to improve QOL in myopia patients.
Busan ; Contact Lenses ; Eyeglasses ; Glass ; Humans ; Keratomileusis, Laser In Situ* ; Myopia* ; Quality of Life* ; Surveys and Questionnaires ; Refractive Errors ; Seoul

Background: Endoscopic forehead lift with cortical tunneling is an effective option for rejuvenation of the upper third of the face. Although it has been considered safe and reliable, with relatively consistent long-term results, relapse and weakening of adhesion have been common problems. Methods: We suggest the dual-tunneling method for overcoming these limitations. A total of 100 patients aged 17 to 65 years underwent forehead lifting with cortical tunneling by the senior author from August 2016 to December 2017. The single-tunnel method was applied in one half of the patients and the dual-tunnel method in the other half. Bilateral brow positions were measured immediately following surgery and 6 months later. Results: For all cases, cortical tunneling was done at the central incision and both paramedian incisions; therefore, three tunnels were used in the control group and six tunnels in the experimental group. In the single-tunnel group, relapse distances were 2.39±0.83 mm for the medial brow and 3.26±0.91 mm for the lateral brow (6 months postoperatively; n=100). The dual-tunnel group showed significantly smaller (P<0.001) relapse distances, with values of 1.69±0.46 mm and 2.17±0.59 mm for the medial and lateral brow, respectively (6 months postoperatively; n=100). The experimental group did not show an increase in complications. Conclusions The dual-tunneling method, designed to minimize the cheese-wiring effect, uses a triangular plane to avoid a focal fixation. The fixation also includes the periosteum to hold the forehead tissue in place, inducing stronger adhesion.