The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are established for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The "AUTOGRP System" was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The "Departmental Method" was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying pattern of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among this study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables(i.e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The weighted mean total case cost(TOTC) of the study hospitals for Medicare patients during the study years was $1127.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($745.45). The weighted mean per total cost (DTOC) of the study hospitals for Medicare patients during the study years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the lowest average DTOC($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variable to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of inter-hospital cost variation; 59.1 percent for TOTC and 44.3 percent for DTOC. These results demonstrate that the casemix index is the most important determinant of inter-hospital cost variation. Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix-related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.
Classification ; Connecticut ; Cost Control ; Data Collection ; Dataset ; Diagnosis ; Diagnosis-Related Groups ; Health Facility Size ; Hospital Costs* ; Hospitals, General ; Humans ; Information Systems ; Length of Stay ; Linear Models ; Medicare ; Mortality ; Population Characteristics* ; United States Social Security Administration

No abstract available.

The purposeof this project is offering fundamental and proper informations for the better health control and personnel management of the enlisted men of Marine corps. Korea. Survey has been done under 1,001 marine enlisted men for the purpose of understanding their condition of physique, vital capacity, and bodily strength. 1. Under the subject of physique, 7 items, body weight, chest-girth, relative body weight, relative chest-girth, Vervaeck index, and Roethrer index are listed, and under the subject of vital capacity, BTPS vital capacity and percent predicted vital capacity are listed, and under the subject of bodily strength, 7 items, grasping power, chining-up, throwing a hanp-grenade, forward jumping, sitting-up, 100 meter sprinting, are listed. The total items are 16 and mean score of each one is as follow. 1) physique. a. Height : 168+/-0.15cm. b. Body weight : 62.7+/-0.17kg. c. Chest-grith : 91.4+/-0.16cm. d. Relative body-girth : 37.2+/-0.09. e. Relative Chest-girth : 54.3+/-0.10. f. Vervaeck index : 91.6+/-0.15. g. Roehere index : 1.31+/-0.003. 2) Vital capacity. a. BTPS vital capacity : 4470+/-20cc. b. %Predicted vital capacity : 150+/-5.1% 3) Bodily strength. a. Grasping Power : 41.4+/-0.26kg. b. Chining-up : 5.7+/-0.10. c. Throwing a hand-grenade : 39.7+/-0.20m. d. Forward jumping : 214+/-0.58cm. e. Sitting-up : 19.1+/-0.25. . Pushing-up : 22.1+/-0.18. g. 100 meter sprinting : 16.1+/-0.04sec. 2. Comparative analysis has been done about the conditional classes of marine enlisted men with the results of above mentioned 16 items. 7 classes according to the branches, 3 according to the ranks, 9 according to the length of service are adopted respectively.
Body Weight ; Hand Strength ; Humans ; Korea* ; Male ; Personnel Management ; Vital Capacity

No abstract available.
Fracture Fixation, Intramedullary

One of the most important aspect of hemophilia is repeated bleeding into the joint. The frequency of such hemorrhages varies with the severity of the disease. In moderate or severe cases, repeated hemorrhages result in considerable impairment of joint structure and function: Contractures and gross deformity are frequent end result. This paper described a case of hemophilia A, 24-year-old male, who developed deformity of the shoulder, elbow, ankle and knee joint because of repeated hemoarthrosis. Author attempted to treat this patient by transfusion of fresh whole blood and traction, which resulted in some clinical improvement.
Ankle ; Congenital Abnormalities ; Contracture ; Elbow ; Hemophilia A ; Hemorrhage ; Humans ; Joints ; Knee Joint ; Male ; Shoulder ; Traction ; Young Adult

Vertebral pedicle screws have been widely used for secure posterior spinal fixation. When postoperative CT scan films were made, the blurring of pedicle screws were observed and we could not figure nut the exact diameter of screw and canal encroachment. There is no information in the difference hetween actual diameter and measured diameter of pedcile screws in CT yet. In this study, we try to find out partial voiume averaging artifact of pedicle screws made of stainless steel and titanium. Partial volume averaging artifact occurs when the shape of an object changes within the thickness of the CT slice or when a relatively small object is only partially included within the slice. Four pig cadaveric spinal column including 6 vertebrae each were prepared and CT scans were performed after insertion of C-D screws(stainless steel) to the left and TSRH screws(titanium) to the right pedicle. Another CT scans were performed after insertion of C-D screws to the right and TSRH screws to the left pedicle. The third CT scans were made after removal of all the pedicle screws. Actual C-D screw diameter was 6mm and CT scanned diameter was 8. I 6+/-0.66mm. Actual TSRH diameter was 6.5 mm and CT scanned diameter was 6.59+/-0.34mm. In conclusion, stainless steel has more partial volume averaging artifact than titanium. Safety margin of pedicle screw made of stainless steel is about 2mm and that of titanium is about 1 mm.
Artifacts ; Cadaver ; Nuts ; Spine ; Stainless Steel* ; Titanium* ; Tomography, X-Ray Computed*

Immunosuppressive therapy based on the use of antilymphocyte globulin (ALG) has become standard therapy for patients with splastic anemia who are not eligible for bone marrow transplantation. In this study, T cell subsets before and after ALG therapy, hematologic responses, complications and prognostic factors were analysed. Eleven (42%) out of twenty-six patients treated with ALG showed response, but two patients showed relapse. Most of the response (9 cases) was noticed within 6 months after the initiation of ALG therapy (median: 3 months). The main complications of ALG therapy were fever (91%), thrombocytopenia (86%), neutropenia (63%), and serum sickness (56%). Four patients were died just ALG therapy because of serum sickness (2 cases), intracranial hemorrhage (1 case), and shock (1 case). Short interval from diagnosis to treatment suggested to show good response (P=0.0575), but it was not significant statistically. Lymphocyte subsets were measured in the blood of 23 patients. Helper T/suppressor T cell ratio (T4/T8 ratio) at the initiation of ALG therapy (day 0) was higher significantly in patients who were responded (P=0.0299). The patients who showed above 1.0 of T4/T8 ratio on day 0 might be speculated good response (P=0.032). More difference of T4/T8 ratio between day 14 after ALG therapy and day 0 might show good response (P=0.0673). Then the actuarial probability of survival at 3 years in patients treated with ALG was 77%. Our data suggest that ALG therapy may be used as an alternative treatment to bone marrow transplantation, and T4/T8 ration of peripheral blood at the initiation of therapy may be used as one of the prognostic factors.
Anemia ; Anemia, Aplastic* ; Antilymphocyte Serum* ; Bone Marrow Transplantation ; Child* ; Diagnosis ; Fever ; Humans ; Intracranial Hemorrhages ; Lymphocyte Subsets ; Neutropenia ; Recurrence ; Serum Sickness ; Shock ; T-Lymphocyte Subsets ; Thrombocytopenia

An accurate and relatively simple method for estimating the amount of acute blood loss is essential in the hemorrhagic shock patients. Conventional physiologic parameters, blood pressure, pulse rate and CVP, could not serve for evaluation of the adequate oxygen transport in the tissue. Pulmonary artery catheter is a best tool for evaluating the cardiopulmonary function and the oxygen transport system, and mixed venous oxygen saturation(SvO2) monitoring have made a great advances for early detection of cardiovascular dysfunction and the changes in peripheral tissue oxygenation. But pulmonary artery catheterization is complicated procedure in emergency setting. Although the central venous oxygen saturation(ScvO2) cannot completely replace the SvO2 value, it has a close relation with SvO2 change in variable clinical situations. We testify the usefulness of ScvO2 monitoring in 24 patients of the hemorrhagic shock. Initial resuscitation was performed with ATLS standard and continuous ScvO2 was monitored. Systolic blood pressure and pulse rate were recorded for one hour from initial resuscitation in each 15 minutes. Nineteen patient was traumatic hemorrhagic shock and five was non traumatic. Twelve of 19 patients was blunt trauma, and remains were stab in injury mechanism. Mortality rate was 29.2%. Initial ScvO2 of nonsurvivor was 43.6%, and 51.3% in survivor groups(p>0.05). In the group of stab wound and non-traumatic hemorrhage, the ScvO2 was gradually increase by time. But ScvO2 in survivors of blunt trauma was increased first 30 minutes and decrease afterthen. Continuous monitoring of ScvO2 may by partly useful in resuscitation for hemorrhagic shock. It is more valuable in the blunt trauma than in the penetrating injury or non-traumatic hemorrhage.
Blood Pressure ; Catheterization, Swan-Ganz ; Catheters ; Emergencies ; Heart Rate ; Hemorrhage ; Humans ; Mortality ; Oxygen* ; Pulmonary Artery ; Resuscitation ; Shock, Hemorrhagic* ; Survivors ; Wounds, Stab

A clinical review was made on 2,191 cases of general pediatric surgery under the age of 15 years which were operated upon at the Divisionof Pediatric Surgery, Department of Surgery, Chonnam University Hospital from January 1988 to December 1997. The number of operations in pediatric age were 13,144 (13.2%) out of total 99,555 operations at Chonnam University Hospital and the most prevalent age group was under 1 year of age (14.3%). The number of operations in Divisionof General Pediatric Surgery were 2,191 (16.7%) out of total 13,144 operations in pediatric age and the incidence of patients under 1 year of age in general pediatric surgery was 42.9% (941/2,191). The prevalent diseases under 1 month of age were anorectal malformations (20.6%) and hypertrophic pyloric stenosis (20.3%) and between 1 month to 1 year of age were inguinal hernia (32.4%) and intussusception (19.6%). The total motality rate in neonatal intensive care unit was 31.3%. Gastroschisis presented highest mortality.
Gastroschisis ; Hernia, Inguinal ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Intussusception ; Jeollanam-do ; Mortality ; Pyloric Stenosis, Hypertrophic

Male urethral diverticulum is uncommon lesion, furthermore calculus formation within the male urethral diverticulum is very rare. Generally, urethral diverticula are classified as congenital and acquired. The majority of male urethral diverticula are acquired and approximately 10 to 20 per cent are congenital. Acquired urethral diverticula in the male may arise from many sources, including infection (prostatic abscess, infection of periurethral glands, hematoma or schistosomiasis), obstruction (stricture, impacted stone, Cunningham clamp or condom catheter) and trauma (instrumentation, external injury and pelvic fracture). Calculi formation is more common in the acquired diverticulum owing to stagnation of urine and infection. These calculi in the diverticulum usually are solitary and may attain considerable size with predisposing factors, 1) a ureteral or bladder calculus that is lodged in the urethra 2) urethral trauma or stricture, 3) calcification around a foreign body or hair. The treatment of urethral diverticulum combined with stone is excision of the diverticula with removal of stone. We treated two cases of urethral diverticulum combined with stone in the male, and report with review of literature.
Abscess ; Calculi ; Causality ; Condoms ; Constriction, Pathologic ; Diverticulum* ; Foreign Bodies ; Hair ; Hematoma ; Humans ; Male* ; Ureter ; Urethra ; Urinary Bladder Calculi