Analysis of New Patient's Willingness to Pay Additional Costs for Securing Satisfactory Consultation Time / 보건행정학회지

BACKGROUND: We evaluated new patient's satisfactory consultation time (SCT) and their willingness to pay additional costs (WPAC) for their SCT. METHODS: We surveyed medical service satisfaction, SCT, WPAC for their SCT, and payable amount to 612 new patients of single general hospital and measured their real consultation time (RCT). To compare WPAC and payable amount, we divided RCT into 4 groups (≤3 minutes, 3–5 minutes, 5–10 minutes, and >10 minutes), and SCT into 3 groups (≤5 minutes, 5–10 minutes, and >10 minutes). On the basis of WPAC, we estimated new patient's SCT. RESULTS: RCT was 6.2 minutes, SCT was 8.9 minutes, and medical service satisfaction score was 4.3 (out of 5). The number of patients having WPAC (payable group) was 381 (62.3%) and the amount was 5,853 Korean won. Their RCT and SCT were longer than non-payable group (6.4 minutes vs. 5.7 minutes, 9.3 minutes vs. 8.2 minutes). From multiple logistic regression analysis, WPAC of RCT 5–10 minutes was higher than that RCT ≤3 minutes (odds ratio=1.78). Payable amount was highest in RCT >10 minutes (6,950 Korea won) and SCT >10 minutes (7,458 Korean won). Intuitively we suggest 10 minutes as SCT, based on payable group's SCT (9.3 minutes) and cut-off time differentiating payable group with non-payable group (10 minutes). CONCLUSION: We found that new patient had WPAC for their SCT and the longer the SCT, the greater the amount. From this, we hope that current simplified new patient consultation fee calculating system should be modified combining the consultation time factor.

The Effects of On-line Hemodiafiltration on Oxidative Stress and beta2-Microglobulin in Comparison with High-Flux Hemodialysis / 대한신장학회잡지

OBJECTIVE: On-line hemodiafiltration (OL-HDF) is a method that combines diffusive and convective solute transport component. OL-HDF provides improved solute clearance for both low-and large molecular-weight uremic toxins by enhancing convective clearance through highly permeable membranes. The aim of this study is to evaluate the effect of OL-HDF on oxidative stress and beta2-microglobulin (beta2-MG) in comparison with high-flux hemodialysis (HF-HD). METHODS: Twenty-one patients on thrice-weekly low-flux hemodialysis (LF-HD) for at least 6 months were studied. Every patient underwent OL-HDF and HF-HD for four weeks, respectively. There were 2 weeks of wash-out period in which patients were treated with LF-HD, between different treatment periods. Predialysis and postdialysis solute (creatinine, BUN, phosphate, beta2-MG) concentrations were measured in the serum. In addition, predialysis solute (MDA, TAC, hsCRP) concentrations were measured. RESULTS: The urea reduction ratio (64.2+/-14.5 vs. 60.1+/-11.2%), Kt/V (1.4+/-0.2 vs. 1.3+/-0.3), beta2-MG reduction ratio (53.8+/-9.7 vs. 44.3+/-8.7%) and beta2- MG clearance (120.7+/-33.4 vs. 92.7+/-17.6 mL/min) were significantly higher in patients treated with on- line HDF compared with those treated with HF-HD. After 4 weeks of treatment, predialysis serum MDA levels were significantly lower in patients treated with OL-HDF compared with those treated with HF-HD (1.04+/-0.26 vs. 1.19+/-0.25 umol/L). After 4 weeks of treatment with 2 different dialysis modes, predialysis serum beta2-MG (3.7+/-1.0 vs. 2.2+/-0.4 mg/ dL), MDA (1.19+/-0.21 vs. 1.04+/-0.26 umol/L), TAC (265.9+/-21.1 vs. 290.2+/-23.9 umol/L) and log hsCRP (0.07+/-0.51 vs. -0.23+/-0.62) levels were significantly improved compared to the baseline in OL-HDF patients. However, for HF-HD patients, only predialysis serum beta2-MG level at 4 weeks was significantly lower than baseline (3.8+/-1.0 vs. 2.5+/-0.4 mg/dL). CONCLUSION: This study shows that OL-HDF has been significant increase in oxidative stress and inflammatory marker removal compared to HF-HD.

The Effect of Cyclic Compressive Strain on the Differentiation of Osteoblast-Like Cells (MC3T3-E1) in 3-D Scaffold / 대한정형외과연구학회지

We examined the effect of an applied cyclic compressive strain on the growth and differentiation of MC3T3-E1 cultured in a three-dimensional chitosan scaffold. The specially designed testing apparatus for mechanical stimulus was developed for uniaxial cyclic compressive strain. Cyclic compressive strain was applied over a period of 17 days with 150 cycles per day at a frequency of 0.5hz. Strain magnitude was 2.5% of the scaffold length. Control group and mechanically stimulated group were incubated and harvested at the indicated times. (day 3, 7, 10, 14, 17) The total amount of protein and alkaline phosphatase activity were examined. The total amount of protein of the control group was higher than that of the mechanically stimulated group. This was due to cell death for the nodule formation and calcium deposit of the mechanical stimuli group which resulted in cell differentiation. The alkaline phosphatase activity increased slightly in the control group. However, in the mechanical stimuli group, it increased significantly and reached its peak level on day 7 and subsequently its activity dropped to a level that was higher than the level at day 4(p < 0.05). Conclusively, it can be noted that the mechanical stimulus significantly accelerated the differentiation of MC3T3-E1 cells.