The Implementation and Effects of a Clinical Laboratory Accreditation Program in Korea from 1999 to 2006 / 대한진단검사의학회지

BACKGROUND: The Korean Laboratory Accreditation Program (KLAP) by the Korean Society of Laboratory Medicine (KSLM) was started in 1999. We summarized history and achievement of KLAP for the last 8 yr. METHODS: We analyzed 8 yr data (1999-2006) of historical events, trends of participating laboratories, and scores according to the impact of the question to the outcome of the tests. Inspection check lists are for 'laboratory management', 'clinical chemistry', 'diagnostic hematology', 'clinical microbiology', 'diagnostic immunology', 'transfusion medicine', 'cytogenetics', 'molecular genetics', 'histocompatibility', 'flow cytometry', and 'comprehensive laboratory test verification report'. The laboratories with score 90 or higher got 2-yr certificate and laboratories with score between 60 and 89 got 1-yr certificate. The laboratories with score below 60 failed accreditation. RESULTS: The number of accredited laboratories was 2.4 times higher in 2006 (n=227) than in 1999 (n=96). Inspection check lists have been revised 5 times till 2006. The average accreditation rate was 99.6% during these periods and the 2-yr accreditation rate was 32.4% in 2000, 45.6% in 2001, 53.3% in 2002, 47.3% in 2003, 68.5% in 2004, 37.7% in 2005, and 47.7% in 2006. Number of participants in inspector training workshops increased from 89 in 2000 to 766 in 2006. CONCLUSIONS: The KLAP has been in place successfully and stabilized over the past 8 yr. It seemed to enhance the laboratory quality. Efforts for improvement of quality control and inspector training workshops appeared to be in the main contributing factors.

Learning Styles in Medical School / 한국의학교육

PURPOSE: The purpose of this study is to investigate the learning styles of students at Kyungpook National University(KNU) School of Medicine and to assess its implications on teaching-learning methods in medical school. METHODS: 571 students in all years of medical school were invited to complete a questionnaire via online. For this study, Felder's Index of Learning Styles(ILS) was used, which included 49 items. Felder's ILS measures the learner's relative preference for each of the five dichotomous learning style dimensions. RESULTS: 242(42.3%) students completed the questionnaire. More than 80% preferred sensitive information and more than 60% preferentially took in visual information. Both males and females preferred sensing and visual learning materials. On average, The students at KNU school of Medicine were reflective, sensing, visual, global and inductive. CONCLUSION: From these results, we suggested some effective methods of teaching-learning based on the students' preferences and some perspectives for future works.

Clinical Document Repository System for Electronic Health Record / 대한의료정보학회지

OBJECTIVE: The needs of sharing clinical documents in order for health professionals to provide better diagnosis and treatment have been tremendously increasing. However, when a patient visits the hospital, current hospital information system doesn't allow for physicians to obtain patient's medical history even though she has some records in different hospital, because the lack of the standardization to overcome the incompatibility among heterogeneous systems. CDA(Clinical Document Architecture) of HL7(Health Level 7) is standardized technology in purpose of creating and exchanging various clinical documents. In this article, we discuss the method of exchanging, storing, and utilizing CDA and present the work of development and implementation based on CDR(Clinical Document Repository) framework reported earlier9). METHODS: We convert paper-based discharge summary from each health institutions into CDA format. And in order to exchange, manage, and utilize those CDA, Registry structure of ebXML is introduced and applied. RESULTS: The relationship among patients, physicians, clinical organizations, and clinical documents is well-organized and modeled. Because transfered CDA document can be easily registered and managed by complying with RIM structure of ebXML, this system can effectively exchange and share patient's CDA document when patient move to other area or among heterogenous systems. CONCLUSION: This system can be utilized to categorize and store various clinical documents such as, ECG and Radiology reading report. In addition, this system suggests the potential of Electronic Health Record system that is able to communicate among heterogenous systems and manage the CDA documents via this CDR system.

Electronic Health Record: Definition, Categories and Standards / 대한의료정보학회지

The demand for high quality, safe and quantity for healthcare is increasing while the resources remain unchanged. Adoption of better information technology can achieve significant improvements in quality and safety of healthcare delivery in the environment of increasing pressure on healthcare systems. This will also contribute to contain healthcare cost in the long run. Many developed and developing countries in the world pay attention on appropriate use of information communication technology(ICT) in healthcare domain. Some countries such as the US, UK, Australia, Canada and others adopted strategic plan of National Health Information Infrastructure for next 10 years. The objectives for ICT application of developed countries are summarized as: - To improve access to clinical records; - To reduce clinical errors and improve safety of patients; - To improve access to quality information on health for patients and healthcare professionals; - To improve efficiency of healthcare processes; and - To contain healthcare costs. The core of the ICT adoption in health is to have universal availability of electronic health and clinical records(EHR) at the point of care. This review, therefore, briefly described the definition, architectures, essential functionalities and applicable standards of EHR.

Development a New HL7 Interface Engine for Large-size Messages which Include Image Data based on Tree Structure and Streaming Algorithm / 대한의료정보학회지

The almost existing commercial HL7 interface engines apply the string array method which is run in the main memory to HL7 message parsing process. But, if the HL7 message is big, this method will be possible to cause the computer system to raise critical and fatal problems because a long string array can carry a too heavy load to the main memory and the processor. Therefore, the image and the multi-media data which are needed for the modern medical records could be limited to be included into a HL7 message because the size is usually too big in comparison with the main body of a HL7 message and in result, it make the size of the HL7 message expanded. The purpose of this study is to suggest a new HL7 interface algorithm which can solve this problem by the method of the 'Streaming Algorithm'. This new method for HL7 message parsing apply the character-stream object which process character by character between the main memory and hard disk device with the consequence that the processing load on main memory could be alleviated. The main functions of this new engine are generating, parsing, validating, browsing, sending, and receiving of message. And also, this can parse and generate XML-formated HL7 message. This engine had been practically tested in the Discharge Summary Information Exchange System between Kyungpook National University Hospital and Chonnam National University Hospital for the purpose of proofing its usability for a month. Overall, the preliminary results of this test is considered as good, but it is pointed out that some improvement is needed relating to the speed of parsing which was predicted because this engine partly used the memory of hard disk device instead of the main memory.

Laboratory Inspection and Accreditation in Korea II: Analysis of the First Round Inspection / 대한진단검사의학회지

BACKGROUND: The Korean Society of Laboratory Medicine (KSLM) Laboratory Inspection and Accreditation Program (IAP) has been developed after one year of study supported by a research grant from the Ministry of Health and Welfare (MOHW) of the Republic of Korea from June 1998 to May 1999 to assess objectively the quality of laboratory work and assist the laboratories in improving the quality of their work. The IAP is based on peer review and voluntary participation. The IAP has been continuously improved since the first laboratory inspection began in May 1999 and it was soon expanded nationwide. The improvement was made by updating the inspection checklists to reflect feedback from inspection activities and holding frequent inspectors training workshops. This paper describes the progress and outcome of the IAP. METHODS: The IAP has been implemented nationwide through the following steps: 1) preliminary review of application papers including laboratory quality control policies and external proficiency survey results, as well as on-site inspection by inspectors; 2) addition of newly approved "Inpatient Interpretive Summary Report"checklist (IISR); 3) inspectors training workshop for the "IISR"checklist; 4) continuation of the IAP for all checklist areas including "IISR"; and 5) the first revision of checklists. RESULTS: One hundred nineteen laboratories were accredited during the first year of the IAP. Due to the implementation of the MOHW approved health insurance reimbursement item for laboratory physicians, the "IISR"checklist was created. The mean score of the laboratory inspection results was 92.8 and hospital laboratories showed a higher score on routine testing areas, however, commercial reference laboratories showed a better score on special testing areas. The checklists were revised according to the feedback from the first round of inspections. CONCLUSIONS: The nationwide implementation of the KSLM laboratory IAP was accomplished through this study. The IAP appears to have provided a firm basis for the improvement of quality and efficiency of clinical laboratories in the country.

Laboratory Inspection and Accreditation in Korea II: Analysis of the First Round Inspection / 대한진단검사의학회지

BACKGROUND: The Korean Society of Laboratory Medicine (KSLM) Laboratory Inspection and Accreditation Program (IAP) has been developed after one year of study supported by a research grant from the Ministry of Health and Welfare (MOHW) of the Republic of Korea from June 1998 to May 1999 to assess objectively the quality of laboratory work and assist the laboratories in improving the quality of their work. The IAP is based on peer review and voluntary participation. The IAP has been continuously improved since the first laboratory inspection began in May 1999 and it was soon expanded nationwide. The improvement was made by updating the inspection checklists to reflect feedback from inspection activities and holding frequent inspectors training workshops. This paper describes the progress and outcome of the IAP. METHODS: The IAP has been implemented nationwide through the following steps: 1) preliminary review of application papers including laboratory quality control policies and external proficiency survey results, as well as on-site inspection by inspectors; 2) addition of newly approved "Inpatient Interpretive Summary Report"checklist (IISR); 3) inspectors training workshop for the "IISR"checklist; 4) continuation of the IAP for all checklist areas including "IISR"; and 5) the first revision of checklists. RESULTS: One hundred nineteen laboratories were accredited during the first year of the IAP. Due to the implementation of the MOHW approved health insurance reimbursement item for laboratory physicians, the "IISR"checklist was created. The mean score of the laboratory inspection results was 92.8 and hospital laboratories showed a higher score on routine testing areas, however, commercial reference laboratories showed a better score on special testing areas. The checklists were revised according to the feedback from the first round of inspections. CONCLUSIONS: The nationwide implementation of the KSLM laboratory IAP was accomplished through this study. The IAP appears to have provided a firm basis for the improvement of quality and efficiency of clinical laboratories in the country.

The Achievement of Medical Students Admitted after Baccalaureate Level / 한국의학교육

PURPOSE: Kyungpook National University School of Medicine initiated a pilot project to admit small number of qualified students who received BS degree or above in the field of sciences in 1996. This study was conducted to evaluate effectiveness of the pilot project. METHODS: Students' academic grades, outcome of their opinion surveys on adaptability to the school life, difficulties and problems from the classes of 1996 to 2001 were analyzed. RESULTS: A total of 57 students were admitted to this program over the past 7-year period, 54.8% of them from natural science major and 36.8% from engineering. Students admitted with BS degree were performing above average in the class by % rank. There was no significant difference in academic performance between the natural science and the engineering major. Of 20 graduated, only one took career in basic medical science (physiology). The students thought undergraduate education was helpful in maturing personal characters than in knowledge or skill attainment. CONCLUSION: The achievement of medical students admitted after baccalaureate level was comparable to that of students with two years of premedical education.

Development of HL7 Message Browser Based on Web Environment / 대한의료정보학회지

We have developed a prototype HL7(Health Level 7) message browser for web based healthcare networking. Because most of commercial HL7 interface tools have high price, the purpose of this study is to provide a message tool for those who are willing to exchange clinical data in an e fficient and cost-effective manner. The present development is based on HL7 v. 2.3.1 using HTML and JAVA servlet to be implemented on web environment. The preliminary results include 1) input message, 2) parsing and inter pretation via web browse r with HTML and XML, and 3) transf erring message to another site through the socket communication. Although we have found more efficient performance than we expected with numerous encouraging results, error correcting mechanism needs to be improved continuously throughout the on-going project development.

Introduction of the Communication Standard Health Level Seven and HL7 Korea / 대한의료정보학회지

The implementation of hospital information systems and inter-hospital collaborative strategies are becoming popular, therefore patients' information exchange among healthcare organizations has increasingly been an important issue in Korea. To improve the efficiency of communicating electronic data between information systems, standardization is required. To introduce the Health Level Seven(HL7) to health systems in Korea as a standard for messaging and communication, Korea recently joined to HL7 as an international affiliate. The HL7 refers to the application level, the highest level of ISO communication model for Open Systems Interconnection(OSI), and adheres to a strict and well-defined set of operating procedures that ensures consensus, openness and balance of interest. This paper focuses on the review and introduction of the HL7 and planned activities of HL7 Korea. The HL7 Korea initiates encouragement of implementation of HL7 in health informatics, the most widely used being a messaging standard that enables disparate healthcare applications to exchange key sets of clinical and administrative data of patients. The HL7 Korea will play a pivotal role in expanding the use of HL7 in Korea to establish a cost effective way of efficiently sharing electronic patients' information nationally. A stepwise strategies for future activities of HL7 Korea are suggested as follows: 1) studying HL7 and training potential users; 2) piloting inter-hospital message communications by using HL7 interface engine to find applicability and compatibility of HL7 in Korea; 3) adapting HL7 as a standard for health informatics messaging and communication in Korea; and 4) continuing expansion of HL7 application nationwide.

Clinical Pathology Laboratory Inspection and Accreditation in Korea I: Development of the System and Its Trial / 대한임상병리학회지

BACKGROUND: A policy development research project entitled "Feasibility study and development of clinical pathology laboratory inspection and accreditation system and its impact" was funded by the Ministry of Health and Welfare, Republic of Korea in 1998 to standardize and improve laboratory performances, hence to accomplish cost effectiveness of laboratory testing throughout the country. METHODS: The authors developed applicable inspection standards including 1) qualification and the role of laboratory director, 2) quality control and quality improvement, 3) facility and safety, and 4) inspection application requirements and detailed checklists for each laboratory discipline were developed accordingly. The College of American Pathologists Inspection and Accreditation Program was used as the model. Checklists for laboratory areas contain questionnaires with corresponding scores. The score is assigned from 2 to 4 according to the impact of the question to the outcome of the test. Checklists are for laboratory management (203 questions), hematology (146), routine chemistry (126), special chemistry (198), urinalysis (85), microbiology (282), immunology and serology (70), blood bank (246), HLA laboratory (117), flow cytometry (102), cytogenetics (137), molecular biology (232), and independent laboratory (542). The philosophy involved in the program was fairness, consistency, courteousness, consultation, and providing guidelines for future developments. Experts' consensus on subject matter was obtained before checklists were in use. Cut-off for accreditation was based on a score of 80%. Three dry and four wet workshops were held to produce 69 trained inspectors. While conducting wet workshops, 2 CAP accredited university hospital laboratories and 1 non-accredited university hospital laboratory as well as 1 CAP accredited large commercial laboratory were inspected by using newly developed checklists. RESULTS: All 4 laboratories were accredited with the mean score of 94%. The most common deficiencies were lack of proper documentation on quality control, outdated reagents in use, etc. CONCLUSIONS: The laboratory I and A program was successfully tested for its feasibility and we confirmed that its nationwide implementation was ready.

First Year Teaching Experience of Medical Informatics in School of Medicine / 대한의료정보학회지

In March 1999, we have inaugurated the first academic Department Of Medical Jnformatics (DOMI) at Kyungpook National University School of Medicine in Korea. The initial intent of DOMI is to cover the basics of information science for medical students in order to cope with future medical environment. The purpose of this study is to analyze student response from the medical informatics class to settle in as a regular course of medical education curriculum. The informatics lecture consists of series of 18 lectures to introduce computer and information sciences, basics of internet, laboratory, radiology, telemedicine, patient administration, clinical and management information systems. We conducted a survey before and after the lecture for 150 first year medical students. Both evaluation results were compared to observe any significant changes were acquired. Before the lecture, respondents were reluctant to have computer-related lecture due to resistance of curriculum changes. After the lecture, it is surprising to note that student attitude toward informatics lecture was dramatically changed. Positive views of medical informatics were dominant, and respondents strongly recommended medical informatics lecture to be continued. In addition, a new graduate study program of medical informatics is in operational beginning 2000. The graduate study is designed to offer master s degree for training information specialists in hospital, and doctoral degree for developing faculty and researchers to prepare for the progress of medical informatics in the future.

The Implementation of Problem-based Learning in Kyungpook National University School of Medicine and its Evaluation / 한국의학교육

The effectiveness of Problem-based Learning(PBL) in medical education has already been acclaimed widely. Representatives of the curriculum committee at Kyungpook National University School of Medicine paid a visit to McMaster University School of Medicine in Canada in May, 1994 in order to learn mechanics and effectiveness of PBL in its medical education and they were impressed by the efficacy of PBL. Soon after that the school launched a pilot PBL tutorial for two years from 1994 through 1996(4-semester) as a non-credit course for senior, junior and sophomore in medical school during one semester each, to introduce PBL to faculty members and students as well. After the pilot, opinion survey on PBL from both faculty and students revealed affirmative for PBL from 55.1% of seniors, 61.4% of juniors and 83.9% of faculty members. The faculty body at medical school was then encouraged by the pilot experience and decided to include the PBL as the part of medical education reform. During the fall semester in 1998, the senior at pre-medical course was given PBL experience to prepare for implementation of PBL at school of medicine. The PBL was implemented as an essential 2-credit-hour course in each semester commencing in 1999 to the freshmen class throughout the year; it was extended to the sophomore in 2000 and to the junior in 2001. Although there had been initial excitements of over expectations, confusion, and disappointments from faculty members and students, majority opinion of both parties on continuation of PBL was positive. The issues to be settled are preparation of study cases, students learning resources, and method of evaluating students' performance. The PBL was started as an essential course in medical school in 1999 after 4 years of preparation and on the basis of our interim evaluations the following conclusions were made: we have reached the following consensus that students seem to follow the objectives of PBL and new PBL tutorial has well been accepted by students; and enhancing the program by correcting currently known weaknesses, the PBL tutorials could further be expanded to be a major modality of teaching in our medical school.

New Curriculum at Kyungpook National University School of Medicine / 한국의학교육

The curriculum reform was undertaken at Kyungpook National University School of Medicine (KNUSM) to meet new educational objectives in order to cope with a rapid societal changes anticipated occurring in 21st century. The KNUSM Curriculum Development Committee was charged to formulate a new curriculum, which consisted of enhancement of patient-centered care based clerkship, integrated courses based on organ systems, problem-based learning, and additional teaching on social medicine, medical informatics and biomedical engineering. The philosophy of this curricular reform has been to modify methods of teaching medical students toward self-directed learning and student-centered. This whole concept was a drastic departure from the traditional lecturing. In the new curriculum, total of 180 credit courses, 4395 hours to graduate medical school were reduced to 170 credit courses, 4250 hours. As a part of the social medicine course, a 2 credit-hour course on patient-doctor relationship was taught and two credit-hour PBL tutorials were added to freshman, sophomore and junior years. In order to carry out this education reform, three new departments were inaugurated such as Biomedical Engineering, Medical Informatics and Medical Education. The school facility has also been improved during this preparatory period. The new curriculum has been implemented in 1999 academic year after approximately 4 years of preparatory period and annual faculty workshops have been held to monitor the progress of the reform and improve courses by evaluating impact of the change on both faculty members and students as well. The interim evaluation revealed several issues remained to be resolved. In conclusion, the acceptance of this reform was excellent from both faculty members and students although there have been continuous problem solving and adjustments necessary. The real assessment of the outcome of the reform requires many years to come and there has to be continuous monitoring of the progress and adjustment of curriculum are the pivotal of a success of the sort of education reform.

A Summary and Overview of the Current Status of International and Domestic Health Informatics Standardization / 대한의료정보학회지

The International Oranization for Standardization (ISO) was as created in 1947 to provide assistance to it members in harmonizing national technical standards. Today its role h as changed to produce international technical standards in order to promote trade international In 1998 a new ISO/Technical Committee (TC) 215 was established to standardize the Health informaties worldwide. The efforts have increasingly been intensified through TC 215 activities in formulating international health informatics standards in order to meet the demand from the industry within its member countries for their international trade. The Republic of Korea joined ISO/TC 215 as the P-member body in 1999 unit Korean experts started to participate actively in TC 215 work processes. However, domestic standardization in health informaties is in its infancy Therefore, current activities of ISO/TC 215 and current status of Korean Health informaties Standard Committee base been reviewed to be able to generate interests from experts and technical professionals in the field of health informaties

Implementation of a Computerized Hospital Equipment Utilization Review System / 대한의료정보학회지

A computerized hospital equipment utilization review system has been developed and implemented in a tertiary care utilization hospital in order to provide real-time equipment utilization with income information to be used in budgeting and strategic planning. Among various hospital fixed and clinical equipment, 283 (purchase price over US$15,000 per unit) were selected initially for utilization review. The application was written in Power Builder which was then loaded on Pentium client or on-line service. The data base management and statistical transactions were done by Oracle v 7.3.4 on NUMA Q2000 server. The utilization and associated income information of operating tables and other clinical equipment were automatically collected from physician order information in the hospital information system. Those information on other equipment which (lid not have direct utility information linked to physician order entry in the hospital information system were manually entered by users .Various utilization reports can be generated by users through computer menus; reports include name of equipment, using department, purchase price and year, frequency of use for inpatients and outpatients separately, income generated by such usage, and etc. The out put can also be generated by department, by instrument. by any interval as selected. The automated hospital equipment utilization review system has been developed and used since March, 2000 and is proven to he an essential tool for the hospital budget planners and managers. The outcome has been increasingly satisfactory.

Re-evaluation of Association between Thrombotic Diasthesis and Legg-Calve-Perthes Disease / 대한정형외과학회잡지

Legg-Calve-Perthes disease (LCP) has been reported to be associated with hypofibrinolysis and a deficiency in coagulation. The goal of this prospective study was to confirm or refute these findings and to establish a guide for a screening test. The coagulation systems of twenty-three patients with Legg-Calve-Perthes disease were evaluated by means of the tests which included prothrombin time, activated partial thromboplastin time, antithrombin-III (AT-III), protein C, protein S, lipoprotein(a), and anticardiolipin antibody (ACA). Study subjects were 21 males and 2 females. Mean age was 8.7 years. No abnormal results were found for Antithrombin-III and Protein S, but 2 patients had low Protein C level. Two of 23 patients had Lipoprotein(a) values greater than 30 mg/dl. Another two patients had positive finding for Anticardiolipin antibody. There were no statistical differences in all parameters between Catterall group stage in the patients with Legg-Calve-Perthes disease. We were unable to establish an association between thrombotic tendency and Legg-Calve-Perthes disease based on this prospective study. So, routine screening of patients with Legg-Calve-Perthes disease for abnormalities of antithrombotic factors would be not warranted.

A Case of BX / 대한수혈학회지

We report a case of BX in a 27-year-old woman admitted for Cessarian section after diagnosis of placenta previa. An ABO discrepancy was observed, such as, group O in cell typing but group B in serum typing. The patient's red cells were agglutinated by anti-H and show the mixed field agglutination by anti-A,B. The results of adsorption and elution test, saliva test and B transferase test show the presence of B antigen, absence of B substance in saliva and no activity of B-transferase. All of these findings were compatible with BX.

HLA-DQB1 allele frequencies and haplotypic associations with DRB1 genes in Koreans / 대한임상병리학회지

BACKGROUND: The HLA-DR and DQ genes are known to show in strong linkage disequilibrium. Authors investigated the allele frequencies of HLA-DQB1 genes and HLA-DQB1-DRB1 haplotypic associations in Koreans. METHODS: HLA-DRB1 and DQB1 typing were performed in 120 unrelated Koreans consisting of normal tissue donors and patients with hematologic diseases using polymerase chain reaction-reverse dot blot hybridization method with INNO-LiPA HLA-DRB and DQB kits (INNOGENETICS, Zwijndrecht, Belgium). Haplotypic associations between DRB1 and DQB1 alleles were calculated according to the formula from Mattiuz et al. RESULTS:1. Allele frequencies of the five most common DQB1 alleles were DQB1* 0301, 14.4%; 0303, 11.0%; 0302, 9.6%; 0601, 9.2%; 0401, 8.7%. 2. Haplotype frequencies (%) of the ten most common DQB1*-DRB1* haplotypes were 0303-0901, 9.17%; 0401-0405, 8.71%; 0602-1501/03/04, 7.35%; 0501-0101, 7.35%; 0601-0803, 5.98%; 0609-1302, 5.10%; 0503-1405, 4.69%; 0302-0406, 4.26%; 0301-1101/10/12 or 1104, 4.26%; 02-0701, 4.23%. They consisted 61.1% of total haplotypes in this study. CONCLUSIONS: The results of this study may be useful as basic data of Koreans for anthropology, accurate interpretaion of DRB1 and DQB1 typing and quality control of genotyping.

Analysis of Factors Related to the Prognosis of Patients with Massive Transfusion / 대한임상병리학회지

BACKGROUND: The prognostic indicators of patients who received massive transfusion were studied to assist management of high risk patients. METHODS: Medical records and laboratory data of 184 adult patients who received massive transfusions during 1996-1998 were reviewed. The indicators studied were outcome of treatment, cause of transfusion, age, sex, vital signs at admission, number of units of blood components, results of platelet counts (Plt), hematocrit (Hct), prothrombin time (PT), activated thromboplastin time (aPTT) and arterial blood pH (pH) performed within 24 hours after transfusion. RESULTS: The percent and mean age of survivor were 60.3% and 44.8 years old and nonsurvivor were 39.7 and 49.7, respectively. The frequency and survival rate by causative disorders were as follows: trauma 33.2% and 56%; liver disease 23.9% and 57%, cancer 13.6% and 56%, cardiovascular disorders 7.5% and 78.6%. Nonsurvivors had lower systolic and diastolic pressures in liver disease and cancer, and lower body temperature in trauma patients than those of survivors. In trauma patients nonsurvivors had lower Plt counts and pH, and prolonged PT and aPTT results than those of survivors. In cancer patients nonsurvivors showed lower Hct and pH, but those of liver disease patients showed only lower Plt counts. The average unit of blood components transfused per patient in nonsurvivors were 27.3 of RBC, 13.4 of FFP, and 15.2 of platelet concentrate, respectively. The percent of patients who were transfused more than 20 units of RBC was 28% in survivors, but 55% in nonsurvivors. CONCLUSIONS: It is concluded that the patients transfused with more than 20 units of RBC showed low systolic and diastolic pressures, body temperature, Plt counts, Hct and arterial blood pH, and prolonged PT and aPTT results appeared to be poor prognostic indicator of massive transfusions.