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영양불량환자의 중증도 적용 향상을 위한 영양지원팀 협의진료체계 개선활동의 중요성
권국환 ( Kuk Hwan Kwon ),이형순 ( Hyung Soon Lee ),유지형 ( Jee Hyoung Yoo ),지수나 ( Soo Na Chi ),박현희 ( Hyun Hee Park ),김소원 ( So Won Kim ),김경란 ( Kyung Ran Kim ),윤난희 ( Nan Hee Yun ),라경택 ( Kyoung Taek Ra ),송현정 ( H 한국정맥경장영양학회 2018 한국정맥경장영양학회지 Vol.10 No.1
Purpose: The grade of complexity in the diagnosis related group (DRG) payment system is influenced by the secondary diagnosis of specific complication and comorbidity level, in which moderate or severe malnutrition is included. This study examined an existing proportion of patients with malnutrition who were supposed to be qualified for the complexity level and devised quality improvement measures to increase the proportion of qualifying complexity payments. Methods: The goal of the activities was to increase the rate of complexity payment claims for patients with malnutrition (%). Cases ineligible for the DRG payment system and cases with no diagnosis of malnutrition were excluded. We established a collaborative system between the nutrition support team and departments related to each improvement factor (i.e., patient care, medical records, insurance review, and medical information). Results: Before implementing the activities, this study investigated the current level of complexity payment claims for malnutrition patients who were discharged within a specific period (June 1, 2015∼August 31, 2015). The results showed that complexity payment claims were filed in 10.00% (2 of the 20 malnutrition cases). After the activities, the rate of complexity payment claims for the patients with malnutrition within the study period (June 1, 2016∼August 31, 2016) was 46.43% (26 out of 56), showing an approximately 364% increase from the pre activity rate. This change was statistically significant according to the chi-square test on Microsoft Excel 2010 (P<0.01). Conclusion: Collaborative efforts by the related departments enabled the smooth implementation of each activity. In addition, moderate or severe malnutrition was revealed to be a variable in the complexity-specific payment system. In the future, hospital-wide awareness and effort are crucial to promot the steady practice of these activities and expand their implementation.
김춘규(Choon Kyu Kim),권국환(Kuk Hwan Kwon),박정수(Cheong Soo Park),김병로(Byung Ro Kim) 대한소화기학회 1984 대한소화기학회지 Vol.16 No.1
N/A Ulcerative colitis is a diffuse inflammatory disease of the mucosal lining of the colon and rectum without apparent cause. Ulcerative colitis is relatively frequent in the western countries but is extremely rare in Korea. This report is an analysis of 26 cases of ulcerative colitis which treated in the Yonsei Medical Center from Jan. 1970 to Aug. 1983. The results were as following: 1) The most prevalent age group was 5th decade and male to female ratio was 1.36:1%. 2) The most common clinical manifestation was bloody diarrhea. 3) According to the ariatomical site of the lesion, pancolitis was most common but proctitis was relatively rare than other reports. 4) By medical treatment, improvement was noted in 68.2%. 5) Operations were performed in 8 cases, and its indications were intractability 1 case, massive bleeding 1 case, suspected carcinoma 2 cases, toxic megacolon 2 cases and perforation 2 cases. 6) Postoperative mortality was 62.5% but all of the 5 cases, treated by emergency, were died and all of the 3 cases, treated by elective operation, were survied. 7) Cause of death was sepsis in all.
직장 및 항문암의 임상적 고찰 - 부위에 따른 수술식과 추적조사 중심으로 -
민진식(Jin Sik Min),김춘규(Choon Kyu Kim),권국환(Kuk Hwan Kwon),이경식(Kyong Sik Lee) 대한소화기학회 1984 대한소화기학회지 Vol.16 No.2
N/A Operations for carcinoma of the anus and rectum are considered on the anatomical locations, most importantly the lymphatic drainage. The lymphatic drainage of the rectum below 6-7cm from the anal verge may either be cephalad or caudad. Above this level, the drainage is cephalad, unless blocked by extensive lymphatic metastasis. Abdominoperineal resection has been the generally accepted procedure for carcinoma of the anus and lower two thirds of the rectum, and anterior resection with primary anastomosis are the most often used for carcinoma of the upper rectum. But recently, the case of sphincter saving procedures, anterior resection and pull-through operation, for lesions in the middle third, has increased significantly, theoretically offering as good a chance for long term survival as does abdominoperineal resection. In this regard, the author has reviewed 9 cases of anal cancer and 210 cases of surgically resected adenocarcinoma of the rectum from Jan. 1971 to Dec. 1982 at Severance Hospital, Yonsei Medical Center. The objectives of this paper are to study the recent trends toward sphincter saving procedures and the survival rate of carcinoma of the anus and rectum, especially in the middle third of the rectum. The results are as follows: 1) In all 9 cases of anal cancer, abdominoperineal resection was performed. For 3 cases, inguinal node dissection was performed synchronously. Follow up was possible in 8 cases; one had live 4 years, two had live over 2 years, and five had live over 1 year. 2) Lesions in rectum are divided according to the distance from the anal verge, with 99 patients having had a lesion located less than 6cm from the anal verge; in 89 patients, the lesion was between 6 and 11. 9 cm: in the remaining 22 patients, the lesion was more than 12 cm from the anal verge. 3) The distribution according to TNM classification by the Manual for Staging of Cancer was as follows: stage I, 1.9%, stage Ib 21.4%, stage II 30.5% stage III 37.6% and stage IV 8.6% 4) The type of operation was as follows: abdominoperineal resection 72%, anterior resection 21.4%, pull-through op=I ation 4.7%, and Hartmanna procedure 1.9%, The use of sphincter saving procedures, antorior resection and pulI-through operation, has increased recently: in 7l-76 21.1%, I '77-'82 29.1%. 5) The types of operation ac:cording to the distance from the anal verge were as follows: in the lower third; abdominep.rineal resection was performed in 99%, in the middle third; abdominoperineal resection in 1.1%, anterior resection in 31.5%, pull-through operation in 11.2%, and Hartmanns procedure in 1.1%, in the upper third; the anter ior resection was performed in 72.8%. In the middle third, the sphincter saving procedures, anterior resection and pull-through operatian, has increased significantly: in '71-'76 32.3%, and in '77-'82 49.1%. 6) The actuarial 5 year survival rate was 46.4%. The 5 year survival rate according to TNM classification was as follows: stage I, 100%, stage Ib 64.9%, stage II 55.6%. stage III 26.3% and stage IV 5.7%. The 5 year survival rate according to the distance from the anal verge was as follows: in the lower third 44.2%, in the middle third 48.1% and in the upper third 52.9%. The 5 year survival rate according to the type of operation was as follows: abdominoperineal resection 44.7% anterior resection 53.2%, pull-through operation 31.3%, and Hartmann' procedure 24.8%. 7) In the middle third, the 5 year survival rate according to the TNM classification was as follows: stage Ib 62.7%, stage II 59.4%, stage III 25.4% and stage IV 17.6%. The 5 year survival rate according to the type of operation was as follows: abdominope- rineal resection 49.5% anterior reaection 54.9%, pull-through operation 31.3%, and Hartmanns procedure 0%. In this regard, the abdominoperineal resection are generally accepted procedure for carcinoma of the anus and lower rectum, and anterior resection are the most often used for carcinoma of the upper rectum. Rut