RESUMEN
PURPOSE: Several insurance policies require the presence of hypertension, defined as blood pressure > 140 mmHg systolic (SBP), or 90 mmHg diastolic (DBP), despite concurrent use of >1 anti-hypertensive agents for patients with a BMI <40 kg/m2 to qualify for bariatric surgery (BS). The scientific validity of this requirement is assessed. MATERIAL AND METHODS: A total of 461 patients who underwent BS in a community hospital were included. Systolic (SBP) and diastolic (DBP) blood pressure BP (in mmHg) was assessed by an automated manometer at each office visit until 3 years postoperatively and recorded in a prospectively maintained database. RESULTS: Thirty-six (7.8%) patients with BMI <40 Kg/m2, treated by 1, 2, or three anti-hypertensive medications and BP below 140/90, would have been denied BS under such policies. Number of anti-hypertensive medications had no impact on SBP/DBP control preoperatively. Patients being treated preoperatively with < 3 anti-hypertensive medications had a significantly higher percentage of hypertension resolution at 1 (one-med: 66.2%, two-med: 50.9% vs. three-med: 12.5%, p<.0001), 2 (one-med: 63.9%, two-med: 52.8% vs. three-med: 15.4%, p=.0068), and 3 (one-med: 76.9%, two-med: 52.9% vs. three-med: 20%, p=.005) years postoperatively. Multivariate regression demonstrated a significant correlation between the number of preoperative anti-hypertensive medications, preoperative SBP or DBP, and %TBWL. CONCLUSION: Patients treated with fewer than 3 anti-hypertensive medications did not have a better BP control preoperatively but were more likely to resolve their hypertension postoperatively. Restricting access to BS of patients with hypertension treated by fewer than 3 anti-hypertensive medications is not supported by this study.
Asunto(s)
Cirugía Bariátrica , Hipertensión , Obesidad Mórbida , Antihipertensivos/uso terapéutico , Presión Sanguínea , Índice de Masa Corporal , Humanos , Hipertensión/cirugía , Obesidad Mórbida/cirugíaRESUMEN
PURPOSE: This study was done to help provide patients with information on medical insurance cost through medical insurance education for nurses, to increase effective management, check on omissions in treatment and appropriateness and accuracy of fees, and to contribute to the economic growth of hospital by providing nurses with necessary knowledge about medical insurance cost. METHOD: The participants in this study were clinical nurses in general hospitals. The study instrument was a questionnaire developed by the researcher through reference to data for medical insurance education. The data were analyzed with percentages, means, ANOVA, and Duncan method using SPSS PC+10. RESULT: The results on knowledge of medical insurance according to general characteristics of the nurses showed that there were significant differences according to age (p=.0036) highest level of education (p=.0007), position (p=.0010) and place where education on medical insurance was received (p=.0093). CONCLUSION: Continuous in-service education for clinical nurses is reflected in increased knowledge about medical insurance costs but special attention needs to be given to younger nurses and nurses with less education, as well as staff nurses, and those nurses who only received education on medical insurance during their schooling. Accordingly, in-service education is necessary for nurses at the time of orientation so that they have knowledge on standards for recuperation allowance, guidelines to calculate material costs, and guidelines to calculate drug rates. In addition, as medical insurance cost frequently change, all nurses need continuous in-service education.
Asunto(s)
Humanos , Desarrollo Económico , Educación , Honorarios y Precios , Hospitales Generales , Seguro , Encuestas y CuestionariosRESUMEN
PURPOSE: Gamma-globulin is effective in preventing coronary aneurysm, the primary complication of Kawasaki disease(KD). However, in order to predict high-risk cases which absolutely require gamma-globulin, because of its high expenses, Harada score(HS) was introduced in Japan in 1990. We attempted to compare HS scoring with the health insurance criteria currently used in Korea. METHODS: Retrospective studies were performed on 123 cases who did not receive gamma-globulin among 283 KD patients who had been treated in this hospital from 1990 to 1997. Chi-square analyses were used. RESULTS: Of the 123 subjects, 91(74%) had HS scores higher than 4, and 32(26%) had HS less than 4, whereas 56(45.5%) belonged to the high-risk group and 67(54.5%) to the low-risk group according to the insurance criteria, with both methods differing significantly(P<0.001). Of 18 cases with the coronary complications only 2 cases had an HS<4, whereas 4 patients belonged to the low-risk group. Even though both methods did not differ significantly in discriminating risky cases, twice as many patients may have been denied adequate treatment if the insurance criteria had been applied. Of various factors, the age and albumin level were found relevant to the coronary complication. CONCLUSION: No statistically significant difference was found between HS and the insurance criteria in predicting the incidence of coronary complications in 123 KD patients. But a less lenient criteria used in the current health insurance policy may result in more cases with coronary complications.