Life-Sustaining Procedures, Palliative Care, and Cost Trends in Dying COPD Patients in U.S. Hospitals: 2005~2014

Kim, Sun Jung,Shen, Jay,Ko, Eunjeong,Kim, Pearl,Lee, Yong-Jae,Lee, Jae Hoon,Liu, Xibei,Ukken, Johnson,Kioka, Mutsumi,Yoo, Ji Won Korean Society for Hospice and Palliative Care 2018 한국호스피스.완화의료학회지 Vol.21 No.1

목적: 미국 병원에서 만성폐색성폐질환으로 사망하는 환자의 연명치료 및 완화의료에 대한 연구는 부족한 현실이다. 이 연구에서는 병원의 의료비 추세 및 완화의료 이용 및 연명치료 이용과의 관련성을 파악하고자 하였다. 방법: 이 연구는 2005~2014년 미국 입원환자 샘플(National Inpatient Sample, NIS)을 후향적 코호트 디자인으로 전환하였으며, ICD-9-CM (International Classification of Diseases, 9th revision) 코드를 활용하여 완화의료 및 집중치료(전신지지치료, 호흡기치료, 호흡기 수술)를 받은 환자를 구분하였다. 결과: 연평균성장률(Compound Annual Growth Rates, CAGR)을 활용하여 병원 의료비의 시계열변화를 확인하였으며, 다수준 다변량 회귀분석을 통해 병원의 의료비에 영향을 미치는 요소를 파악하였다. 전체 77,394,755 입원 건 중 79,314명의 환자가 최종 분석에 사용되었다. 병원 의료비는 연평균성장률이 5.83% (P<0.001)였으며, 전신지지치료와 완화의료의 연평균성장률은 각각 5.98%와 19.89% 였다(모두, P<0.001). 전신지지치료, 호흡기 치료, 호흡기 수술은 각각 59.04%, 72.00%, 55.26%의 병원 의료비 상승에 영향을(모두, P<0.001) 주었던 반면 완화의료는 28.71%의 병원 의료비 감소에 영향을 주었다(P<0.001). 결론: 미국에서 만성폐색성폐질환으로 사망하는 환자 중 전신지지 치료는 병원 의료비 상승의 주된 원인인 반면 완화의료 이용은 비용절감에 영향이 있는 것으로 파악되었다. Purpose: Little is known regarding the extent to which dying patients with chronic obstructive pulmonary disease (COPD) receive life-sustaining procedures and palliative care in U.S. hospitals. We examine hospital cost trends and the impact of palliative care utilization on the use of life-sustaining procedures in this population. Methods: Retrospective nationwide cohort analysis was performed using National Inpatient Sample (NIS) data from 2005 and 2014. We examined the receipt of both palliative care and intensive medical procedures, defined as systemic procedures, pulmonary procedures, or surgeries using the International Classification of Diseases, 9th revision (ICD-9-CM). Results: We used compound annual growth rates (CAGR) to determine temporal trends and multilevel multivariate regressions to identify factors associated with hospital cost. Among 77,394,755 hospitalizations, 79,314 patients were examined. The CAGR of hospital cost was 5.83% (P<0.001). The CAGRs of systemic procedures and palliative care were 5.98% and 19.89% respectively (each P<0.001). Systemic procedures, pulmonary procedures, and surgeries were associated with increased hospital cost by 59.04%, 72.00%, 55.26%, respectively (each P<0.001). Palliative care was associated with decreased hospital cost by 28.71% (P<0.001). Conclusion: The volume of systemic procedures is the biggest driver of cost increase although there is a cost-saving effect from greater palliative care utilization.

A Survey of Nursing Need and Patient Satisfaction among Patients Served by a Glaveston Home Health Agency

Kim, Sung Sil,Rains, Anna Pearl,Kilmon, Calor 한림대학교의료원 1992 人間科學 Vol.16 No.9

탈북 학생들의 고등학교와 그 이후 교육 경험에 대한 연구 - 능동적 노력과 구조적 제약의 상호작용 -

정진주(Pearl J. Chung),손다정(Dajung Sohn),김효선(Hyo-Sun Kim),홍원표(Won-Pyo Hong) 한국비교교육학회 2016 比較敎育硏究 Vol.26 No.5

본 연구의 목적은 한국에 거주하는 탈북 학생들의 고등학교 및 대학교에서의 학습경험을 능동적인 학습자의 관점에서 분석하고, 그들의 노력과 그 결과를 드러내는 것이다. 이를 위해 본 연구는 국내에서 고등학교를 졸업하고 대학교를 다닌 경험이 있는 11명의 탈북 학생들로부터 수집된 질적 면담 자료를 활용하고 있다. 연구 결과에 따르면, 탈북 학생들은 학업, 진로, 또래 및 교사와의 관계 형성을 위해 적극적인 노력을 기울이는 반면, 구조적·제도적 한계가 그들의 학업과 적응을 가로막고 있는 것으로 나타났다. 특히, 한국 학생들보다 제한된 교육기회와 여건, 입시에 대한 정보 부족, 탈북자들에 대한 편견 등이 연구에 참여한 탈북 학생들의 교육과 성장에 걸림돌이 되고 있었다. 이와 같은 결과를 토대로 본 연구는 탈북 학생들의 교육을 가로막고 있는 구조적 제약을 완화하기 위하여 일반 학교에서의 교육 문화와 여건의 개선, 대안고등학교의 교사 훈련과 교육과정의 체계화, 대학교에서의 탈북 학생 지원 프로그램 운영 등을 주요 방안으로 제시하고 있다. Based on qualitative interviews of eleven North Koreans, this research examined how school curriculum, post-secondary paths, and teacher and peer relationships affect their experiences in South Korean high schools and universities. Major findings revealed that North Korean students make efforts as active agents to overcome diverse obstacles they encounter in schools, yet structural limitations continued to hinder their academic success. In particular, lack of authentic learning opportunities, insufficient information about post-secondary opportunities, biases about North Koreans appeared to influence their experiences in schools. Based on these findings, this study proposes that making public schools more accessible, improving the quality of education in alternative high schools, assisting North Korean students in higher education institutes more systematically are necessary for their academic and social integration in South Korean schools.

Adsorption Site Selectivity for Thiophene on Reconstructed Si(5 5 12)–2 × 1 Surface

Hahn, Jae Ryang,Bharath, Satyaveda C.,Kim, Gyu-Hyeong,Kim, Ki Wan,Jeong, Sukmin,Pearl, Thomas P. American Chemical Society 2013 JOURNAL OF PHYSICAL CHEMISTRY C - Vol.117 No.21

<P>The covalent binding of thiophene molecules to a Si(5 5 12)–2 × 1 surface was investigated using scanning tunneling microscopy and density functional theory calculations. The molecular attachment occurred exclusively between the bonding of the 2,5 carbon atoms and the two silicon adatoms without the involvement of the sulfur atom (over 90%). The binding structure formed a di−σ bond with a planar butterfly-like configuration. Adsorption at other sites, including at the dimer, tetramer, or honeycomb rows, occurred much less frequently. Our calculations predicted that the adsorption energies of the thiophene molecules were 1.02–1.56 eV at the adatom, dimer, and tetramer sites. The molecules adsorbed on the honeycomb rows with a low adsorption energy (below 1 eV). The binding modes of the simple aromatic molecules onto the Si(5 5 12)–2 × 1 surface are compared and discussed.</P><P><B>Graphic Abstract</B> <IMG SRC='http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/jpccck/2013/jpccck.2013.117.issue-21/jp401932r/production/images/medium/jp-2013-01932r_0005.gif'></P>

Antioxidant supplements for vitiligo: a systematic review and meta-analysis of randomized controlled trials

( Han Mi Jung ),( Yu Seok Jung ),( Ji Hae Lee ),( Gyong Moon Kim ),( Pearl E. Grimes ),( Jung Min Bae ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Oxidative stress has addressed as one of the main factors in vitiligo pathogenesis. Emerging therapies targeting the elements of pathogenesis could be promising. Objectives: To ascertain the efficacy of antioxidant supplements in combination with phototherapy for vitiligo. Methods: All randomized controlled trials (RCTs) that assessed the treatment outcomes of phototherapy alone and in combination with antioxidant supplements for vitiligo were included. Of 398 studies initially identified, the full texts of 30 studies assessed for eligibility, and 5 were finally included in the analysis.The primary outcomes were the proportion of treatment success, defined as 50% or more repigmentation of whole lesion in a patient. Results: Five RCTs involving 141 patients were fulfilled the inclusion criteria for this review. The antioxidant supplements on phototherapy yields superior responses than phototherapy alone (5 studies: relative risk, 1.50; 95% confidence interval, 1.08-2.09; number needed to treat, 5). Conclusion: The use of antioxidant supplements could be promising therapeutic modality targeting one of the main factor in vitiligo pathogenesis.

Life-Sustaining Procedures, Palliative Care, and Cost Trends in Dying COPD Patients in U.S. Hospitals: 2005~2014

김선정,Ji Won Yoo,Jay Shen,Eunjeong Ko,Pearl Kim,Yong-Jae Lee,Jae Hoon Lee,Xibei Liu,Johnson Ukken,Mutsumi Kioka 한국호스피스완화의료학회 2018 한국호스피스.완화의료학회지 Vol.21 No.1

Purpose: Little is known regarding the extent to which dying patients with chronic obstructive pulmonary disease (COPD) receive life-sustaining procedures and palliative care in U.S. hospitals. We examine hospital cost trends and the impact of palliative care utilization on the use of life-sustaining procedures in this population. Methods: Retrospective nationwide cohort analysis was performed using National Inpatient Sample (NIS) data from 2005 and 2014. We examined the receipt of both palliative care and intensive medical procedures, defined as systemic procedures, pulmonary procedures, or surgeries using the International Classification of Diseases, 9th revision (ICD-9-CM). Results: We used compound annual growth rates (CAGR) to determine temporal trends and multilevel multivariate regressions to identify factors associated with hospital cost. Among 77,394,755 hospitalizations, 79,314 patients were examined. The CAGR of hospital cost was 5.83% (P<0.001). The CAGRs of systemic procedures and palliative care were 5.98% and 19.89% respectively (each P<0.001). Systemic procedures, pulmonary procedures, and surgeries were associated with increased hospital cost by 59.04%, 72.00%, 55.26%, respectively (each P<0.001). Palliative care was associated with decreased hospital cost by 28.71% (P<0.001). Conclusion: The volume of systemic procedures is the biggest driver of cost increase although there is a cost-saving effect from greater palliative care utilization.