• Title/Summary/Keyword: Outcome

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The Spot Sign Predicts Hematoma Expansion, Outcome, and Mortality in Patients with Primary Intracerebral Hemorrhage

  • Han, Ju-Hee;Lee, Jong-Myong;Koh, Eun-Jeong;Choi, Ha-Young
    • Journal of Korean Neurosurgical Society
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    • v.56 no.4
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    • pp.303-309
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    • 2014
  • Objective : The purpose of this study was to retrospectively review cases of intracerebral hemorrhage (ICH) medically treated at our institution to determine if the CT angiography (CTA) 'spot sign' predicts in-hospital mortality and clinical outcome at 3 months in patients with spontaneous ICH. Methods : We conducted a retrospective review of all consecutive patients who were admitted to the department of neurosurgery. Clinical data of patients with ICH were collected by 2 neurosurgeons blinded to the radiological data and at the 90-day follow-up. Results : Multivariate logistic regression analysis identified predictors of poor outcome; we found that hematoma location, spot sign, and intraventricular hemorrhage were independent predictors of poor outcome. In-hospital mortality was 57.4% (35 of 61) in the CTA spot-sign positive group versus 7.9% (10 of 126) in the CTA spot-sign negative group. In multivariate logistic analysis, we found that presence of spot sign and presence of volume expansion were independent predictors for the in-hospital mortality of ICH. Conclusion : The spot sign is a strong independent predictor of hematoma expansion, mortality, and poor clinical outcome in primary ICH. In this study, we emphasized the importance of hematoma expansion as a therapeutic target in both clinical practice and research.

The Role of the Concept of Competence in Korean Outcome-based Medical Education (국내 성과바탕의학교육에 대한 비판적 논의: 역량의 개념을 중심으로)

  • Lee, Yo Ba
    • Korean Medical Education Review
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    • v.15 no.3
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    • pp.144-150
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    • 2013
  • Before Outcome-based curriculum reform, medical graduate school and medical schools of korea need to understand limit or threshold of outcome-based education's point of view. This article examines the multi-dimensional concept of competence suggested by Stoof and colleagues and discusses about implication for outcomebased education in medical education of Korea. Because Stoof and colleagues's five dimensions of competence reveal various concepts and educational methods of competence. Therefore, It is possible to use to identify the strengths and weaknesses of outcome-based education of Korea as a reference standard. Five dimensions of competence suggested by Stoof and colleagues is consist of 'personal vs. task characteristics,' 'individual vs. distributed competence,' 'specific vs. general competence,' 'levels of competence vs. competence as a level,' and 'teachable vs. non-teachable.' Implication for outcome-based education in medical education of Korea is, first, that It should recognize to outcome-based education as a one of educational models approaching to competence. Second, discussion about competence should be expanded from pre-medical education to graduated medical education and continuing medical education.

Understanding Internet Banking in China : Focused on Process Quality, Outcome Quality, Customer Satisfaction, Reuse and Word of Mouth

  • Kim, Kyoung-Hwan;Jin, Shi;Chang, Young-Il
    • Journal of Information Technology Applications and Management
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    • v.16 no.3
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    • pp.45-58
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    • 2009
  • This paper is an empirical study especially to understand recent Chinese internet banking users' behavior and intentions through the process quality, outcome quality, customer satisfaction, reuse and word of mouth on internet banking service. The results of this study are as follows. First, percieved process quality of internet banking service affects the outcome quality, and both quality have a direct relation to customer satisfaction. It is found that Chinese internet users perceive a difference between process quality and outcome quality of internet banking service. And the reuse of the internet banking is decided by customer satisfaction as well as the word of mouth of the internet banking. For successful internet banking business in China, internet marketers should recognize that the service quality consists of the process quality and the outcome quality, and they should organize a new campaign that takes this information into consideration. And considering the process quality effect, they should pay attention to service process as well as the direct merit of services.. And if an internet banking service properly meets customer demands, internet users would constantly use internet services and would share good experiences with their neighbors. Therefore the result of our study will be of working-level help for financial company in China.

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Treatment of Cerebral Arteriovenous Malformations by Preoperative Embolization and Microsurgery (술전 색전술과 미세수술을 이용한 뇌동정맥기형의 치료)

  • Kim, Kyu Hong;Rho, Myung Ho;Lee, Woon Gi;Choi, Jeong Hoon;Lee, In Chang;Bae, Sang Do
    • Journal of Korean Neurosurgical Society
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    • v.29 no.4
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    • pp.500-506
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    • 2000
  • Objective : To determine the role of preoperative embolization on postoperative neurological outcome in the treatment of cerebral AVMs, we retrospectively evaluated an effectiveness of combining preoperative embolization and microsurgery for arteriovenous malformations(AVM) of the brain. Method : Two groups(10 patients who underwent preoperative superselective embolization and surgery versus 27 patients who underwent surgery only) were compared and categorized by Spetzler-Martin grade, the size of AVM and postoperative clinical outcome using Glasgow Outcome Scale. The 37 patients included 23 males and 14 females, ranging in age from 11 to 74 years(mean 36 years). Results : The arteriovenous malformations in preoperative embolization and surgery group had a larger average greatest diameter(4.45cm versus 3.83cm) and were of higher Spetzler-Martin grade(80% versus 52% grade III through V). At 1 week after surgery, the preoperative embolization and surgery group represented a better outcome(60% versus 44% with Glasgow Outcome Scale score of 5). And over 6 months after surgery, the embolization and surgery group displayed more favorable clinical outcome(80% versus 63% with Glasgow Outcome Scale score of 5). Conclusion : Combined treatment with superselective preoperative embolization using N-butyl cyanoacrylate and direct surgery may help neurosurgeon treating the high grade AVMs thus improving the postsurgical outcome.

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Outcome of Low-Back Pain and Sciatica : Relationship among Self-reported Pain Intensity, Disability, Sleep Disturbance and Fatigue (요통 및 좌골신경통 환자의 치료결과 : 수면장애 및 피로감과 자각적 통증 및 장애정도의 관계)

  • Lee, Kyeong-Seok;Yoon, Seok-Mann;Doh, Jae-Won;Bae, Hack-Gun
    • Journal of Korean Neurosurgical Society
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    • v.29 no.3
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    • pp.324-329
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    • 2000
  • Objective : Psychological factors may have a major influence on the outcome of treatment for back pain. We investigated the relationship between the outcome and some psychological factors, such as self-reported pain intensity, disability, sleep disturbance and fatigue. Method : The study was conducted as a survey using a questionnaire and telephone interviews. The survey included consecutive 294 patients who visited the neurosurgical out-patient department complaining of low back pain and contacted by telephone on average seven months after the first visit. Pain intensity was measured by visual analog scale, and disability was assessed by Waddell's chronic disability index. Results : The outcome of treatment for back pain was recovered in 36.7%, improved in 30.6%, almost same in 28.6%, and aggravated in 4.1%. Overall rate of improvement was 67.3%. The rate of improvement was related to the duration, patterns and intensity of the symptom, and Waddell index. It was not influenced by the doctors, special studies, and methods of treatment. When the duration was more than 6 months, there were the symptoms of both back and legs, and the self-reported Waddell index was 1-3, the rate of improvement was relatively low. Although the intensity of the pain and disability was closely related to the degree of sleep disturbance, fatigue, appetite, or indigestion, the outcome of treatment for back pain was not always bad in patients with high psychological stress. Actually the outcome of the patients who complained severe pain and disability was better than the outcome of the others. Conclusion : The outcome of the back pain can be predicted by the duration, patterns and intensity of the symptom, and Waddell index. The multidisciplinary treatment will be necessary for the patients whose expected outcome is not good to reduce not only the physical symptoms but also the psychological stress.

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Initial D-dimer level as early prognostic tool in blunt trauma patients without significant brain injury (중증 뇌손상이 없는 둔상 환자에서 초기 중증도 예측인자로서 D-dimer의 역할)

  • Sohn, Seok Woo;Lee, Jae Baek;Jin, Young Ho;Jeong, Tae Oh;Jo, Si On;Lee, Jeong Moon;Yoon, Jae Chol;Kim, So Eun
    • Journal of The Korean Society of Emergency Medicine
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    • v.29 no.5
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    • pp.430-436
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    • 2018
  • Objective: The purpose of this study was to evaluate whether or not the d-dimer level indicating hyperfibrinolysis could be a predictor of early poor outcome (massive transfusion, death within 24 hours) associated with trauma-induced coagulopathy in blunt trauma without significant brain injury. Methods: This study was a retrospective observational study using 516 blunt trauma patients without significant brain injury. The poor outcome group, including patients receiving massive transfusion and those who died within 24 hours, consisted of 33 patients (6.4%). The variables were compared between the poor outcome group and good outcome group, and logistic regression analysis was performed using statistically significant variables. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the poor outcome prediction ability of the initial d-dimer level. Results: The poor outcome group showed more serious anatomical, physiological, and laboratory data than the good outcome group. In the ROC curve analysis for evaluation of the poor outcome prediction of the d-dimer level, the area under the curve value was 0.87 (95% confidence interval [CI], 0.84-0.90) while the cut-off value was 27.35 mg/L. In the logistic regression analysis, the high d-dimer level was shown to be an independent predictor of poor outcome (adjusted odds ratio, 14.87; 95% CI, 2.96-74.67). Conclusion: The high d-dimer level (>27.35 mg/L) can be used as a predictor for the poor outcome of patients with blunt trauma without significant brain injury.

Linkages of nursing Diagnosis, Nursing Intervention and Nursing Outcome Classification of Breast Cancer Patients using Nursing Database (간호데이터베이스를 이용한 유방암환자의 간호진단, 간호중재, 간호결과 분류연계)

  • Chi, Mi-Kyung;Chi, Sung-Ai
    • Journal of Korean Academy of Nursing Administration
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    • v.9 no.4
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    • pp.651-661
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    • 2003
  • Purpose: This is the descriptive research project of which purpose is to acquire the practice, research, and educational data by establishing the database after confirming, classifying, and relating the nursing diagnosis, nursing intervention, and nursing outcome of Breast cancer patients by using the Yoo Hyung-sook's(2001) related 3N database model as the tool. Method : The Nursing Data occurring on Breast cancer patients nursing process was mapped to nursing diagnosis of NANDA, nursing interventions of NIC, nursing outcomes of NOC the 3N database linkage database which is related with the nursing process that was developed by using Yoo Hyung-sook's(2001). Result : 1. The nursing diagnosis were totally 505, and 26 articles of the nursing diagnosis were applied among 149 nursing diagnosis classification systems. 2. As for the nursing intervention, 250 articles(5l.4%) of nursing intervention were applied among 486 nursing intervention classification systems. 3. Regarding the nursing outcome, 28 articles(1l.2%l of the nursing outcome were applied among 250 nursing outcome classification systems. Conclusion: The result of this research in which the relating among the nursing diagnosis, nursing intervention, and nursing outcome of Breast cancer patients by using 3N nursing database was established is thought to be applied in the research and practice as well as to be utilized in the lecture or practice of the nursing process.

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The Improvement and Completion of Outcome index: A new assessment system for quality of orthodontic treatment

  • Hong, Mihee;Kook, Yoon-Ah;Kim, Myeng-Ki;Lee, Jae-Il;Kim, Hong-Gee;Baek, Seung-Hak
    • The korean journal of orthodontics
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    • v.46 no.4
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    • pp.199-211
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    • 2016
  • Objective: Given the considerable disagreement between the Peer Assessment Rating (PAR) index and the American Board of Orthodontics Cast-Radiograph Evaluation, we aimed to develop a novel assessment system-the Improvement and Completion of Outcome (ICO) index-to evaluate the outcome of orthodontic treatment. Methods: Sixteen criteria from 4 major categories were established to represent the pretreatment malocclusion status, as well as the degree of improvement and level of completion of outcome during/after treatment: dental relationship (arch length discrepancy, irregularity, U1-SN, and IMPA); anteroposterior relationship (overjet, right and left molar position, ANB); vertical relationship (anterior overbite, anterior open-bite, lateral open-bite, SN-MP); and transverse relationship (dental midline discrepancy, chin point deviation, posterior cross-bite, occlusal plane cant). The score for each criterion was defined from 0 or -1 (worst) to 5 (ideal value or normal occlusion) in gradations of 1. The sum of the scores in each category indicates the area and extent of the problems. Improvement and completion percentages were estimated based on the pre- and post-treatment total scores and the maximum total score. If the completion percentage exceeded 80%, treatment outcome was considered successful. Results: Two cases, Class I malocclusion and skeletal Class III malocclusion, are presented to represent the assessment procedure using the ICO index. The difference in the level of improvement and completion of treatment outcome can be clearly explained by using 2 percentage values. Conclusions: Thus, the ICO index enables the evaluation of the quality of orthodontic treatment objectively and consecutively throughout the entire treatment process.

Methods Measuring the Outcome of Patients with Low Back Pain in the Papers of Journal of Korean Neurosurgical Society (대한신경외과학회지에 발표된 요통 환자의 치료결과 평가방법)

  • Lee, Kyeong-Seok;Doh, Jae-Won;Yoon, Seok-Man;Bae, Hack-Gun;Yun, Il-Gyu
    • Journal of Korean Neurosurgical Society
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    • v.30 no.5
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    • pp.581-585
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    • 2001
  • Objectives : Criteria for evaluating the results of treating low back pain vary widely. We examined the methods measuring the outcome in the papers of Journal of Korean Neurosurgical Society. Methods : We selected all published articles describing the methods measuring the outcome of low back pain in the journal. They were classified into 3 periods such as period 1 for volume 1-20, 2 for volume 21-25, and 3 for volume 26-28. Results : There are 25 articles in period 1, 44 in period 2, and 30 in period 3. The outcome was classified into 0 to 5 classes by more than 15 different methods. Although the terms and descriptive criteria differ, 4 classes were the most common classification, being 16 in period 1, 39 in period 2, and 19 in period 3. The outcome was usually measured by authors' own method in period 1. In period 2, criteria by Gill et al was most commonly used along with many different criteria. Criteria by Prolo et al became a common method in period 3. Conclusion : Varying methods compromised comparative analyses of outcome. A more simple and universally applicable criteria is necessary to facilitate comparisons among various methods of treatment.

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Psychosocial Outcome after Head Injury (두부외상후 심리사회적 예후)

  • Park, Ki-Chang;Kim, Hun-Joo
    • Journal of Korean Neurosurgical Society
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    • v.29 no.2
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    • pp.196-202
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    • 2000
  • Objective : This study was designed to evaluate the relationship between the initial neurosurgical or psychosocial factors and the psychosocial outcome. Patients and Methods : We analyzed 123 head-injured patients who were referred to the department of psychiatry for the evaluation of psychosocial function. We analyzed initial neurosurgical variables such as Glasgow Coma scale(GCS) score, skull fracture, CT finding, and psychosocial outcomes with regards to psychosis, personality change, depression, anxiety and IQ on Intelligence Scale. Results : Patients with mild head injury(GCS score 13-15, N=94, 76.4%) had better recovery rate on Glasgow Outcome Scale(GOS), less personality change than those with moderate or severe head injury. However, depression, anxiety and intelligence were not significantly different between two groups. The skull fracture(N=37, 30.1%) did not influence on the psychosocial outcome with reference to personality change, depression, anxiety and intelligence. The patients with abnormal CT findings(N=64, 52%) had lower recovery rate on GOS, more frequent tendency in psychosis, personality change and severe depression, less frequent in anxiety and mild depression, than patients with normal CT finding. However, levels of intelligence were not different between two groups. The patients with industrial accidents(IA) had lower educational level, milder head injury, more delay for the psychiatric evaluation (longer treatment period) than those with motor vehicular accidents(MVA). The psychosocial outcome with reference to personality change, depression, anxiety, intelligence were not different between two groups. Conclusion : These findings indicate that the more severe initial trauma, the poorer psychosocial outcome. However, it was frequently observed that patients with mild head injury suffered from mild anxiety and depression. Therefore mild head injury appeared to be more complicated by psychosocial stressors. The patients with IA, despite the fact that initial head injury was mild, required longer treatment period than MVA.

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