• Title/Summary/Keyword: Clinical Effectiveness

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Evaluation of Applications of Adaptation of the Evidence-Based Nursing Practice Guidelines Patients with Acute Stroke (급성 뇌졸중 환자 대상 근거중심 간호 가이드라인 수용개작의 적용 평가)

  • Song, So-Lee;Cho, Myoung-Sook;Kim, Ji-Hyun;Han, Yun-Kyang;Yan, Hye-Min
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.19 no.1
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    • pp.87-97
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    • 2012
  • Purpose: This study was done to evaluate nursing guidelines for patients with acute stroke, developed by adapting the guidelines of Registered Nurses Association of Ontario, Canada to clinical settings on a large scale and evaluating the effectiveness as a research study. Method: The general characteristics of the 319 patients and the effectiveness of guideline application were evaluated in terms of structure, process, and outcome using questionnaires on the guidelines application with reference to the medical records of patients with acute stroke hospitalized on a ward of the stroke center of S General Hospital in Seoul. Results: Structures as a guidance system for assessment were consistent with the recommendations. With respect to the process of the guidelines, for items on nursing assessment, improved performance was found to be statistically significant. For outcomes of the guidelines, complications occurred in 8 patients (5.3%) prior to application of the guidelines and 11 patients (6.5%) after application of the guidelines, but this result was not statistically significant (p=.841). Conclusion: The results of the study indicate that for the effectiveness of the guidelines, accessibility to the guidelines and effectiveness of quality improvement need to be evaluated, in addition to complications of a stroke.

Clinical Assessment of Usefulness, Effectiveness and Safety of Kyejibokryung-hwan on Various Neuropathies

  • Park, Seong-Uk;Jung, Woo-Sang;Kim, Yun-Kyung;Moon, Sang-Kwan;Kim, Young-Suk;Bae, Hyung-Sup;Cho, Ki-Ho;Ko, Chang-Nam
    • The Journal of Korean Medicine
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    • v.27 no.4
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    • pp.135-141
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    • 2006
  • We were to assess clinical effectiveness, safety and usefulness of Kyejibokryung-hwan (KBH), which has been used for Er-hyul similar with vascular or neurologic disorders causing sensory or motor abnormalities. This study is a retrospective single case series. Two hundred ninety five patients were treated with KBH for various neuropathies in our hospital. Of them, 120 cases were excluded because of insufficient medical records or failure to follow up; the remaining 175 were included in the analysis. There were 18 patients with sensory abnormalities and 28 with motor abnormalities after stroke. Of peripheral type, there were 14 with diabetic neuropathy, 12 with carpal tunnel syndrome, 41 with spinal radiculopathies, and 62 with idiopathic neuropathies, for which the effectiveness was assessed as 55.6%, 21.4%, 64.3%, 83.3%, 45.0%, and 56.5%, respectively. Adverse effects including indigestion or diarrhea were seen in 3.4% of the total patients. Taking the effectiveness and the safety together into consideration, the usefulness was assessed as 55.6%, 21.4%, 64.3%, 83.3%, 45.0%, and 54.8% for treating post-stroke sensory and motor abnormalities, diabetic neuropathy, carpal tunnel syndrome, spinal radiculopathies, and idiopathic neuropathies, respectively. In conclusion, we suggest that KBH is a useful herbal medicine for various neuropathies, especially of sensory type.

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Cost-Effectiveness Analysis of Granisetron-Based versus Standard Antiemetic Regimens in Low-Emetogenic Chemotherapy: A Hospital-based Perspective from Malaysia

  • Keat, Chan Huan;Ghani, Norazila Abdul
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.12
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    • pp.7701-7706
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    • 2013
  • Background: In a prospective cohort study of antiemetic therapy conducted in Malaysia, a total of 94 patients received low emetogenic chemotherapy (LEC) with or without granisetron injections as the primary prophylaxis for chemotherapy-induced nausea and vomiting (CINV). This study is a retrospective cost analysis of two antiemetic regimens from the payer perspective. Materials and Methods: This cost evaluation refers to 2011, the year in which the observation was conducted. Direct costs incurred by hospitals including the drug acquisition, materials and time spent for clinical activities from prescribing to dispensing of home medications were evaluated (MYR 1=$0.32 USD). As reported to be significantly different between two regimens (96.1% vs 81.0%; p=0.017), the complete response rate of acute emesis which was defined as a patient successfully treated without any emesis episode within 24 hours after LEC was used as the main indicator for effectiveness. Results: Antiemetic drug acquisition cost per patient was 40.7 times higher for the granisetron-based regimen than for the standard regimen (MYR 64.3 vs 1.58). When both the costs for materials and clinical activities were included, the total cost per patient was 8.68 times higher for the granisetron-based regimen (MYR 73.5 vs 8.47). Considering the complete response rates, the mean cost per successfully treated patient in granisetron group was 7.31 times higher (MYR 76.5 vs 10.5). The incremental cost-effectiveness ratio (ICER) with granisetron-based regimen, relative to the standard regimen, was MYR 430.7. It was found to be most sensitive to the change of antiemetic effects of granisetron-based regimen. Conclusions: While providing a better efficacy in acute emesis control, the low incidence of acute emesis and high ICER makes use of granisetron as primary prophylaxis in LEC controversial.

Cost-Effectiveness Analysis of Glimepiride or Pioglitazone in Combination with Metformin in Type-2 Diabetic Patients (제2형 당뇨병 환자에 대한 메트포르민-글리메피리드 병합요법과 메트포르민-피오글리타존 병합요법의 비용-효과분석)

  • Lim, Kyung-Hwa;Shin, Hyun-Taek;Sohn, Hyun-Soon;Oh, Jung-Mi;Lee, Young-Sook
    • Korean Journal of Clinical Pharmacy
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    • v.19 no.2
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    • pp.96-104
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    • 2009
  • 배경: 당뇨병 환자에게 관상동맥심질환은 생존률, 건강 상태 유지 및 삶의 질에 주요한 영향을 미치는 합병증이며 적극적인 당뇨병 치료는 이러한 심혈관 합병증을 예방할 수 있으나 당뇨병의 적극적 치료와 관리에는 많은 비용이 소요된다. 목적: 제2형 당뇨병 환자를 대상으로 메트포르민과 글리메피리드 병합요법과 메트포르민과 피오글리타존 병합요법의 비용-효과성을 비교하고자 하였다. 연구방법: 마르코프 코호트 프로세스(Markov Cohort Process Model) 모형을 이용하여 비용-효과분석을 실시하였다. 연장된 수명 (life years gained, LYG)과 삶의 질(quality)을 보정하여 증가된 QALYs를 주요 효과 지표로 측정하였고, 총비용으로는 직접의료비용과, 환자와 가족의 교통비를 직접비의료비용으로 고려하였고 환자와 가족의 시간비용을 간접비용으로 포함하였다. 연구결과: 비용-효과분석 결과, 메트포르민과 글리메피리드 병합요법의 경우 총 비용은 5,962,288원, 효과는 7.94LYG, 6.43QALY이었다. 반면 메트포르민과 피오글리타존 병합요법은 총 비용 10,982,243원, 효과 8.62LYG, 6.99QALY으로, 점증적 비용-효과비(ICER)는 7,402,663원/LYG과 8,934,546원/QALY 이었다. 결론: 우리 사회의 연장된 수명(LYG)에 따른 지불의사가 700만원 이하인 경우는 메트포르민과 글리메피리드 병합요법이 비용-효과적인 대안이며 700만원 이상인 경우에는 메트포르민과 피오글리타존 병합요법이 비용-효과적인 대안이 될 수 있다.

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Cost-Effectiveness of Denosumab for Post-Menopausal Osteoporosis in South Korea (폐경기 골다공증 환자에서 데노수맙 사용에 대한 비용-효과 분석)

  • Bae, Green;Kwon, Hye-Young
    • Korean Journal of Clinical Pharmacy
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    • v.28 no.2
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    • pp.131-137
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    • 2018
  • Background: In South Korea, 22.3% of women ${\geq}50years$ of age and 37% of women ${\geq}70years$ of age visit the doctor to obtain treatment for osteoporosis. According to the analysis of the National Health Insurance Services claim data between 2008 and 2012, the number and incidence of hip and vertebral fractures increased during the same period. Denosumab, a newly marketed medicine in Korea, is the first RANK inhibitor. Methods: A cost-utility analysis was conducted from a societal perspective to prove the superiority of denosumab to alendronate. A Markov cohort model was used to investigate the cost-effectiveness of denosumab. A 6-month cycle length was used in the model, and all patients were individually followed up through the model, from their age at treatment initiation to their time of death or until 100 years of age. The model consisted of eight health states: well; hip fracture; vertebral fracture; wrist fracture; other osteoporotic fracture; post-hip fracture; post-vertebral fracture; and dead. All patients began in the well-health state. In this model, 5% discounted rate, two-year maximum offset time, and persistence were adopted. Results: The total lifetime costs for alendronate and denosumab were USD 5,587 and USD 6,534, respectively. The incremental cost-effectiveness ratio (ICER) for denosumab versus alendronate was USD 20,600/QALY. Given the ICER threshold in Korea, the results indicated that denosumab was remarkably superior to alendronate. Conclusion: Denosumab is a cost-effective alternative to the oral anti-osteoporotic treatment, alendronate, in South Korea.

Application and Effectiveness of a Preceptorship for the Improvement of Clinical Education (임상실습 교육개선을 위한 일 실습지도자 활용모델 (preceptorship model)의 적용 및 효과에 관한 연구 -암센타, 재활센타, 중환자실 실습을 중심으로-)

  • 이원희;김소선;한신희;이소연;김기연
    • Journal of Korean Academy of Nursing
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    • v.25 no.3
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    • pp.581-596
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    • 1995
  • Clinical practice in nursing education provides an opportunity for students, through the process of ap-plying theoretical knowledge to practice, and to learn nursing skills as well as being socialized into nursing and as such decrease the reality shock of actual nursing practice. Because of a shortage of nursing faculty, the job of achieving the objectives of the clinical practice had been turned over to the head nurses. This resulted in many problems, such as, unclear location of responsibilities and inadequate feedback from head nurses. Therefore this study was done to introduce and evaluate the use of preceptors as a way to minimize the above problems, and to maximize the achievement of the clinical practice objectives. Using an adaptation of Zerbe's (1991) three-tiered team model, clinical practice was done using a preceptor, a head nurse and a clinical instructor, each with different and well defined roles. The subjects of this study were 67 senior students of the College of Nursing of Y University in Seoul whose clinical practice in adult nursing was carried out between May 1, 1994 and December 8, 1994. There were 22 preceptors who had at least two years of clinical experience and who were recommended by their head nurses. They were given additional education on the philosophy and objectives of the College of Nursing, on communication skills, on the theory and practice of education, and on nursing diagnosis and education evaluation. The role of the preceptor was to work one-to-one with students in their practice. The role of the head nurse was to supervise and evaluate the preceptors. The role of the clinical instructor was to provide the education program for the preceptors, to provide ad-vice and suggestions to the preceptors and to maintain lines of communication with the college. With each of these roles in place, it was thought that the effectiveness and efficiency of the clinical practice could be increased significantly. To evaluate the effectiveness of the preceptorship, the three - tiered model, Lowery's Teacher Evaluation Opinion Form translated and adapted to Korea was used to measure student statisfaction. The Clinical Practice Compentency Evaluation Tool developed by Lee et ai was also used to measure student competencies. The results of this study are as follows 1. The satisfaction with clinical practice was higher with the introduction of the perceptors than it was before they were used. (t=-5.96, p=<.005) 2. The clinical practice competencies were higher with the introduction of the preceptors than it was before they were used(t=-5.l3, p<.005) 3. In order to analyze areas not measured by the quantitative tools additional analysis of the open questions was done. The results of this analysis showed that : 1) The students felt positive about their sense of security, confidence, handling of responsbility, and being systematic. They also felt positive about improvements in knowledge, opportunities for direct care, and socialization. 2) The students felt negative about the technical part of their role, lack of knowledge by the preceptor, unprofessional attitudes on the part of the preceptor, difficulty in the role of the professional nurse(student). 3) The preceptors felt positive about their responsibility, motivation, and relationship with the college. 4) The preceptors felt negative about their bur-den. Introduction of the preceptorship model will lead to change and improvement in the negative factors discussed above, solve problems in the present clinical education system, increase continuity in the education of the students, help with socialization of the students and motivation of the preceptors to up-grade their education and increase their confidence. These objectives must be obtained to further the development of professional nursing, and thus, making the preceptorship a reality is our job for the future.

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Effectiveness of Simulation Integrated with Problem Based Learning on Clinical Competency and Self-efficacy in Nursing Students (문제기반학습 연계 시뮬레이션 교육이 간호대학생의 임상수행능력 및 자기 효능감에 미치는 효과)

  • Lee, Mijin;Ahn, Youngmee;Cho, Insook;Sohn, Min
    • Child Health Nursing Research
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    • v.20 no.2
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    • pp.123-131
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    • 2014
  • Purpose: This study was conducted to examine the effects of simulation education integrated with problem based learning (SIM-PBL) on clinical competency and self-efficacy in post operation nursing care for children. Methods: This study was a quasi-experimental design. Thirty six students in the third year of a 4-year baccalaureate nursing program were recruited conveniently and assigned to the control or intervention groups using time difference. Students were all in a pediatric nursing clinical practicum. The control group received the regular clinical practicum in a hospital setting. For the intervention group, a SIM-PBL education replaced 150 minutes of their clinical practicum. Results: The intervention group showed greater improvement in two areas of clinical competency compared with the control group; physical assessment (t= 3.019, p=.005) and post operation advice (t=2.428, p=.021). However, no statistically significant differences in improvement in any areas of self-efficacy were found between two groups. Conclusion: The results indicate that the SIM-PBL education is effective in improving some areas of clinical competence, but not self-efficacy in post operation nursing care for children. Further study is needed to develop SIM-PBL programs for various clinical topics and evaluate the effectiveness on the learning outcomes.

A COMPARATIVE STUDY OF THE DIFFUSIBILITY AND ANTIMICROBIAL EFFECTIVENESS OF INTRACANAL MEDICATIONS (근관용 약제의 근관내 확산성 및 항균효과에 관한 비교연구)

  • Park, Young-Sook;Lee, Chung-Suck
    • Restorative Dentistry and Endodontics
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    • v.12 no.1
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    • pp.25-37
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    • 1986
  • This study was undertaken to measure the diffusibility and antimicrobial effectiveness of the medication used in clinical practice. To study the diffusibility of the root canal medicament, loss of formocresol and camphorated phenol from a cotton pellet after insertion into the pulp chamber of 260 molars prepared as routine endodontic treatment was measured. Measurement was done for the one time insertions and for the reinsertions using ultraviolet spectrophotometer. Antibacterial effectiveness against three microoganisms, Staphylococcus aureus, Staphylococcus epidermidis and a-hemolytic streptococcus, on the blood agar plate was observed by measurement of the inhibition zone with. various amount of medicaments. The following results were observed. 1. Nearly all of the medication were lost in the first day after insertion and the residual amount of camphorated phenol was greater than that of formocresol. 2. Residual amounts of medication in the reinsertion group were greater than that of the one time insertion group. 3. Within the pulp chamber diffusibility of formocresol was greater than that of camphorated phenol. 4. The amount of formocresol diffusing out from the tooth was greater than that of camphorated phenol. 5. Antibacterial effectiveness was observed from the residual amount of formocresol in the reinsertion group and in other groups no antibacterial effectiveness was observed.

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Clinical efficacy of ranicef$\circledR$ in the treatment of empyema thoracis (농흉에 대한 Ranicef 투여의 임상 효과)

  • Choe, Se-Yeong;Yu, Yeong-Seon
    • Journal of Chest Surgery
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    • v.23 no.5
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    • pp.894-898
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    • 1990
  • Ranicef\ulcorner[Cefpimizole sodium] is a new semisynthetic cephalosporin C derivative, was administered to 30 patients with empyema thoracis to evaluate its efficacy from Nov. 1989 to May 1990 at Department of Thoracic & Cardiovascular Surgery, Dongsan Medical Center, Keimyung University. The results were as follows. 1. The clinical efficacy of therapy was excellent in 15 cases, effective in 11 cases and failure in 4 cases. The effectiveness rate was 86.7%, respectively. 2. Among 30 cases organisms were cultured in 19 cases and 24 clinical strains were isolated. \ulcorner-hemolytic streptococcus[5], S. epidermidis[4], Pseudomonas aeruginosa[3], E. coli[3 of 5 cases], S. aureus[3 of 4 cases] and Klebsiella pneumoniae[1 of 2 cases] were effective to Ranicef\ulcorner 3. Abnormal clinical values, a decrease in platelet was observed in 3 cases and slight increases of s-GOT/GPT in 2 cases. But they were not so severe that they improved without. There were two cases of mild gastrointestinal symptom.

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Clinical Guidelines for Hwabyung V. (Oriental Psychotherapy and Management) (화병 임상진료지침 V. (한방정신요법과 관리))

  • Lee, Seung-Gi;Kang, Hyung-Won
    • Journal of Oriental Neuropsychiatry
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    • v.24 no.spc1
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    • pp.47-54
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    • 2013
  • Objectives : The Hwabyung Research Center of The Korean Society Of Oriental Neuropsychiatry has attempted to develop the 'Clinical Guidelines for Hwabyung'. Methods : The Hwabyung Research Center constructed a committee of experts and advisory group. Relevant literature was collected and evaluated in order to discover effective oriental psychotherapy as well as the management of Hwabyung. Results : We found some evidences that proved the effectiveness of oriental psychotherapy in the treatment of Hwabyung. The principles of management were also reviewed. Conclusions : Psychotherapy and management for Hwabyung were studies. We hope that the 'Clinical Guidelines for the Treatment of Hwabyung' is helpful for both oriental medical doctors and patients.