• Title/Summary/Keyword: Program Outcome Assessment

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Validation of the ACS NSQIP Surgical Risk Calculator for Patients with Early Gastric Cancer Treated with Laparoscopic Gastrectomy

  • Alzahrani, Saleh M;Ko, Chang Seok;Yoo, Moon-Won
    • Journal of Gastric Cancer
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    • v.20 no.3
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    • pp.267-276
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    • 2020
  • Purpose: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk calculator is useful in predicting postoperative adverse events. However, its accuracy in specific disorders is unclear. We validated the ACS NSQIP risk calculator in patients with gastric cancer undergoing curative laparoscopic surgery. Materials and Methods: We included 207 consecutive early gastric cancer patients who underwent laparoscopic gastrectomy between January 2018 and January 2019. The preoperative characteristics and risks of the patients were reviewed and entered into the ACS NSQIP calculator. The estimated risks of postoperative outcomes were compared with the observed outcomes using C-statistics and Brier scores. Results: Most of the patients underwent distal gastrectomy with Roux-en-Y reconstruction (74.4%). We did not observe any cases of mortality, venous thromboembolism, urinary tract infection, renal failure, or cardiac complications. The other outcomes assessed were complications such as pneumonia, surgical site infections, any complications requiring re-operation or hospital readmission, the rates of discharge to nursing homes/rehabilitation centers, and the length of stay. All C-statistics were <0 and the highest was for pneumonia (0.65; 95% confidence interval: 0.58-0.71). Brier scores ranged from 0.01 for pneumonia to 0.155 for other complications. Overall, the risk calculator was inconsistent in predicting the outcomes. Conclusions: The ACS NSQIP surgical risk calculator showed low predictive ability for postoperative adverse events after laparoscopic gastrectomy for patients with early gastric cancer. Further research to adjust the risk calculator for these patients may improve its predictive ability.

A Systematic Review on Nurse-Led Transitional Care Programs for Discharged Patients from Hospital to Home (퇴원환자를 위한 간호사 주도 전환 프로그램의 내용과 효과에 관한 체계적 문헌고찰)

  • Lee, Hyun Joo;Kim, Yukyung;Oh, Eui Geum
    • Journal of Korean Clinical Nursing Research
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    • v.23 no.3
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    • pp.376-387
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    • 2017
  • Purpose: This study was to systematically review the contents and effects of nurse-led transitional care programs for discharged patients from hospital to home. Methods: Randomized controlled trials published between 2005 and 2015 were searched in Pubmed, Embase, Cochrane(Central Register of Controlled Trials) and CINAHL. Data were analyzed using Cochrane Review Manager(Revman) software 5.3. Results: Nine studies were selected and analyzed. Patient assessment, education and discharge planning were included in pre-discharge phase. Referring, communication and care planning were performed by nurses in transition phase. Home and phone visits, monitoring and multidisciplinary advices were included in post-discharge phase. Various outcome measures such as hospital utilization(30 days readmission and emergency department visit), quality of life, and cost were used to identify effectiveness of nurse-led transitional care programs. 30 days readmission(OR=.73, 95% CI 0.54, 0.98; p=.03) and emergency department visit(OR=.67, 95% CI 0.50, 0.88; p=.005) were statistically significant in meta-analysis. However, participant blinding was not done in seven studies which put at the risk of performance bias. Conclusion: The results indicated that nurse-led transitional care program is effective in reducing unnecessary hospital utilization. Nevertheless, small sample size and risk at performance bias are the limitation of this study. Thus, we suggest that well-designed randomized controlled trials need to be conducted.

Meta-Analysis on the Effect of Therapeutic Horseback Riding on Children with Developmental Disabilities and Neural Patients

  • Noh, Hyunju;Kim, Jiyoung;Park, Jiwon
    • The Journal of Korean Physical Therapy
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    • v.32 no.5
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    • pp.312-318
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    • 2020
  • Purpose: This study aimed to investigate the evidence that therapeutic horseback riding can improve balance, muscle, ADL, equivalenc, GMFM, gait, emotion with developmental disabilities and neural patients. Methods: To conduct meta-analysis, the search focused on studies that employed therapeutic horseback riding for developmental disabilities and neural patients for which eight databases (KIS, RISS, DBpia, National Assembly Library, Pubmed, Embase, Google scholar and Cochrane Library) were used to extract literature published from 2002 to September 2019. The data were analyzed the RevMan 3.5.3 program. Results: As a result of meta-analysis, therapeutic horseback riding total effect size is 0.552 for children with developmental disabilities and neural patients. And effect size result of according to assessment type variable first, balance effect size is 0.594. Second, muscle activities effect size is 0.425. Third, ADL effect size is 0.430. Fourth, equivalance effect size is 0.640. Fifth, GMFM effect size is 0.482. Sixth, gait effect size is 0.400 and seventh emotion effect size is 0.876. Conclusion: These findings is horseback riding is effective The effect size by outcome was observed to be the effective for children with developmental disabilities and neural patients. and also the horseback riding provided the positive effects of balance, muscle activities, ADL, equivalance, GMFM, gait, emotion for children with developmental disabilities and neural patients. It is hoped that this study will contribute to the development of effective treatments for children with developmental disabilities and neural patients therapeutic horseback riding and the development of study.

A Stochastic Model to Quantify the Risk of Introduction of Abalone Herpes-like Virus Through Import of Abalones (활 전복 수입에 의한 전복허피스바이러스감염증 (abalone herpes-like virus) 유입 위험평가)

  • Pak, Son-Il
    • Journal of Veterinary Clinics
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    • v.31 no.1
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    • pp.40-45
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    • 2014
  • Abalone herpes-like virus (AbHV) is a fatal disease of abalones that impose severe economic impacts on the industry of infected regions due to high mortality. The aim of this study was to quantify the risk of introducing AbHV into Korea through the importation of live abalones for human consumption by import risk analysis (IRA). Monte Carlo simulation models were developed to provide estimates of the probability that a ton of imported abalone contains at least one AbHV-infected individual, using historical trade data and relevant literatures. A sensitivity analysis with 5,000 iterations was also conducted to determine the extent to which input parameters affect the outcome of the model. Although many uncertainties were present in the data, the results indicated that, if 5,000 tons of abalone were imported from a hypothetical exporting country with low prevalence of AbHV (model 1), there would be at least one AbHV-infected abalones in 4,816 of those tons (96.3%), while there would be at least one AbHV-infected abalones in 100% of those tons imported from country with high prevalence (model 2). Sensitivity analysis indicated that for model 1, prevalence was the strongest influence factor on the predicted number of infections. For model 2, background mortality and washing to reduce the risk of surface contamination during processing were the major contributing factors. Risk management strategies need to be enforced to reduce the risk of AbHV introduction in that at least one infected abalone would remain in a consignment from country even with a low prevalence of AbHV infection. The methodology and the results presented here will contribute to improve the development of AbHV management program, and with more accurate data this IRA model will aid science-based decision-making on mitigation strategies to reduce the risk of AbHV introduction in Korea.

A Case Study on the Application of Visual merchandising (PBL) for Shop Manager (샵매니저를 위한 비주얼 머천다이징 수업에의 문제중심학습 (PBL) 적용 사례 연구)

  • Lee, Jisoo;Lee, Yoonjung;Noh, Hyekyun
    • Human Ecology Research
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    • v.56 no.1
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    • pp.71-84
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    • 2018
  • This study presents a case of a visual merchandising course adopting a problem-based learning (PBL) model, as a part of shop manager training program for high school students. Various vocational training classes are actively developed for vocational high schools, yet programs in the home economics area are relatively lacking. In particular, education programs for shop manager training are urgently required due to the high demand of this job in the fashion industry. The PBL model, which reflects constructionist learning theory, is considered for this visual merchandising course in order to help develop the ability of students to creatively apply their knowledge on real-world problems through self-driven learning. For the purpose of job analysis, two problem areas were identified through interviews conducted with shop managers who work for apparel shops in department stores. Based on the results of the interviews, professors and high school teachers developed two PBL instructional modules. The developed module courses were implemented with 2 classes of vocational high school students. The learning outcome was examined through the analysis of a student survey and reflection journals. It was apparent that the PBL courses effectively attracted the interests of learners in vocational training and improved their understanding of the contents as well as cooperation skills. The results of this study indicate that implementing the PBL model for the training of store managers can contribute to the vocational training programs for high school students.

Trends of Korean Medicine Treatment after Musculoskeletal Disorder Surgery: A Literatural Review (근골격계 질환 수술 후 한방치료 동향(국내 학술지를 중심으로))

  • Lee, Kang-Joon;Park, Chang-Hyun;Lee, Yoon-Jae;Lee, Jung-Han;Cho, Jae-Heung;Park, Tae-Yong;Yang, Na-Rae;Hwang, Eui-Hyoung;Song, Yun-Kyung
    • Journal of Korean Medicine Rehabilitation
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    • v.27 no.3
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    • pp.61-70
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    • 2017
  • Objectives The purpose of this review is to analyse the trend in papers related with Korean Medicine Treatment after musculoskeletal disorder surgery. Methods We reviewed Korean Medicine papers by searching Korean web databases 'Korea Traditional Knowledge Portal', 'Scientific and Technological Information Integration Service (NDSL)', 'Academic Research Information Service (RISS)', 'Korea Medical Informati on Portal (OASIS)'. We classified the papers by the year of publishment, the title of journals, the type of study, surgery region, chief complain after surgery, main treatment, periods after surgery, assessment for outcomes. Results 1. Korean Medicine treatment after musculoskeletal disorder surgery has received more attention than in the past and there are attempts to do various studies besides the case reports. 2. 41 research papers were divided in to 3 original articles, 3 review articles, 35 case reports. But almost presented a low level of evidence. 3. Pain was the most common symptom after the musculoskeletal disorder surgery. Pain should be the primary goal of Korean rehabilitation treatment after musculoskeletal disorder surgery. 4. Assessment tools for outcome were concentrated in questionnaries, VAS and NRS. In order to evaluate better, it is necessary to evaluate the overall condition of the patient such as the quality of life evaluation and patient satisfaction. Conclusions In this study, we expect that the development and clinical application of Korean rehabilitation treatment program after musculoskeletal disorder surgery will be actively pursued.

Auditory brainstem response (ABR) results in NICU graduates (신생아 집중치료실 퇴원아의 청성뇌간반응(ABR) 결과에 미치는 위험인자 및 경과)

  • Choi, Hee-Joung;Lee, Tae-ho;Oh, Ki-Won;Kim, Heng-Mi
    • Clinical and Experimental Pediatrics
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    • v.49 no.12
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    • pp.1301-1307
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    • 2006
  • Purpose : Hearing loss is one of the most common birth defects, and early detection and intervention positively impact language/speech and cognitive development. It has been reported that NICU graduates have a high incidence of hearing loss. So we investigated the incidence, risk factors and clinical outcome of hearing loss in NICU graduates. Methods : This study involved neonatal auditory brainstem response (ABR) testing of newborn infants who graduated from the NICU of Kyungpook National University Hospital during a 3-year period (between July 2002 and June 2005) and subsequent follow-up of these infants. Results : ABR evaluations were performed on 474 infants. Of these infants, 64 showed abnormal ABR (13.5 percent). Of 128 ears from these 64 infants, two ears (1.6 percent) and 10 ears (7.8 percent) were classified as severe and profound hearing loss, respectively. The infants with abnormal ABR had higher incidence of prematurity, low birth weight, very low birth weight, neonatal asphyxia, cranio-facial malformation and amikacin treatment over 15 days (P<0.05). In infants with hyperbilirubinemia, the peak level of serum bilirubin, duration of phototherapy and exchange transfusion were not associated with the higher incidence of hearing loss. Follow-up ABR evaluation was performed on 15 infants with abnormal ABR at $8.8{\pm}4.4months$. In follow-up ABR, 80.0% showed improvement or normalization of threshold sensitivity. Conclusion : NICU graduates exhibit high risk for hearing loss. Systemic and effective hearing assessment program is needed for these high risk infants.

Survey on Educational Needs for Workers in Social Welfare Facilities in Jeju Special Self-Governing Province (제주특별자치도 사회복지시설종사자의 교육요구 조사)

  • Hwang, Seong-Joon
    • The Journal of the Korea Contents Association
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    • v.20 no.1
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    • pp.271-284
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    • 2020
  • The purpose of this study is to identify the educational needs among social workers in social welfare facilities in Jeju province concerning lack of knowledge, skill and attitude, and establish the systematic education for prosecuting diverse training and suggest fundamental data for designing future curriculum. The results of analyzing top 10 educational needs for the workers are as follows: firstly technics for managing crises, understanding and practice for clients (characteristics, human right, safety and health), case management (basic), counseling technique (basic), case management (advanced), counseling technique (advanced), planning and operating social welfare program, managing client response and emotional labor, improving competence for communication (between staffs and clients, etc.), and finally assessing project outcome (project plan, execution, management and assessment, etc.). Social workers in social welfare facilities in the area have highly recognized the necessity of profession centred education. However, they had low satisfaction with the diversity of profession education in the Jeju island and the systematic training courses. This survey suggests the various results concerning qualitative growth of profession education, expansion of job-centred curriculum and security of professional instructors to fulfil systematic education training for social workers.

Changes in Electrophysiological Activation Due to Different Levels of Cognitive Load (인지부하의 정도에 따른 뇌신경생리학적 변화)

  • Kwon, Joo-Hee;Kim, Euijin;Kim, Jeonghui;Im, Chang-Hwan;Kim, Do-Won
    • Journal of Biomedical Engineering Research
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    • v.43 no.1
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    • pp.52-60
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    • 2022
  • Purpose: For now, cognitive load is assessed based on survey-based methods, which can be difficult to track the amount of cognitive load in real-time. In this study, we investigated the difference in electrophysiological activation due to different levels of cognitive load not only at sensor-level but also at source-level using electroencephalogram that might be potentially used for quantitative cognitive load evaluation. Materials and Methods: In this study, ten healthy subjects (mean age 24.3 ± 2.1, three female) participated the experiment. All participants performed 4 sessions of n-back task in different difficulties: 0-, 1-, 2-, and 3-back during electroencephalogram recording. For sensor-level analysis, we calculated the event-related potential and event-related spectral perturbation while low resolution brain electromagnetic tomography (LORETA) to estimate the source activation. Each result was compared between different workload conditions using statistical analysis. Results: Statistical results revealed that the accuracy of the task performance was significantly different between different cognitive loads (p = 0.018). The post-hoc analysis confirmed that the accuracy of the 3-back task was significantly decreased compared to 1-back condition (p = 0.018), but not with 2-back condition (p = 0.180). ERP results showed that P300 target amplitude between 1-back and 3-back had a marginal difference in Cz (p = 0.059) and Pz(p = 0.093). A significant inhibition in Cz high-beta activation (p = 0.017) and decrease in source activation of right parahippocampal gyrus was found in 3-back condition compared to 1-back condition (p < 0.05). Conclusion: In this study, we compared the sensor- and source-level differences in electroencephalogram between different levels of cognitive load, that were found to be in line with the previous reports related to cognitive load evaluation. We expect that the outcome of the current study can be used as a feature to establish a quantitative cognitive load assessment system.

A Study on the Risk Factors for Maternal and Child Health Care Program with Emphasis on Developing the Risk Score System (모자건강관리를 위한 위험요인별 감별평점분류기준 개발에 관한 연구)

  • 이광옥
    • Journal of Korean Academy of Nursing
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    • v.13 no.1
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    • pp.7-21
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    • 1983
  • For the flexible and rational distribution of limited existing health resources based on measurements of individual risk, the socalled Risk Approach is being proposed by the World Health Organization as a managerial tool in maternal and child health care program. This approach, in principle, puts us under the necessity of developing a technique by which we will be able to measure the degree of risk or to discriminate the future outcomes of pregnancy on the basis of prior information obtainable at prenatal care delivery settings. Numerous recent studies have focussed on the identification of relevant risk factors as the Prior infer mation and on defining the adverse outcomes of pregnancy to be dicriminated, and also have tried on how to develope scoring system of risk factors for the quantitative assessment of the factors as the determinant of pregnancy outcomes. Once the scoring system is established the technique of classifying the patients into with normal and with adverse outcomes will be easily de veloped. The scoring system should be developed to meet the following four basic requirements. 1) Easy to construct 2) Easy to use 3) To be theoretically sound 4) To be valid In searching for a feasible methodology which will meet these requirements, the author has attempted to apply the“Likelihood Method”, one of the well known principles in statistical analysis, to develop such scoring system according to the process as follows. Step 1. Classify the patients into four groups: Group $A_1$: With adverse outcomes on fetal (neonatal) side only. Group $A_2$: With adverse outcomes on maternal side only. Group $A_3$: With adverse outcome on both maternal and fetal (neonatal) sides. Group B: With normal outcomes. Step 2. Construct the marginal tabulation on the distribution of risk factors for each group. Step 3. For the calculation of risk score, take logarithmic transformation of relative proport-ions of the distribution and round them off to integers. Step 4. Test the validity of the score chart. h total of 2, 282 maternity records registered during the period of January 1, 1982-December 31, 1982 at Ewha Womans University Hospital were used for this study and the“Questionnaire for Maternity Record for Prenatal and Intrapartum High Risk Screening”developed by the Korean Institute for Population and Health was used to rearrange the information on the records into an easy analytic form. The findings of the study are summarized as follows. 1) The risk score chart constructed on the basis of“Likelihood Method”ispresented in Table 4 in the main text. 2) From the analysis of the risk score chart it was observed that a total of 24 risk factors could be identified as having significant predicting power for the discrimination of pregnancy outcomes into four groups as defined above. They are: (1) age (2) marital status (3) age at first pregnancy (4) medical insurance (5) number of pregnancies (6) history of Cesarean sections (7). number of living child (8) history of premature infants (9) history of over weighted new born (10) history of congenital anomalies (11) history of multiple pregnancies (12) history of abnormal presentation (13) history of obstetric abnormalities (14) past illness (15) hemoglobin level (16) blood pressure (17) heart status (18) general appearance (19) edema status (20) result of abdominal examination (21) cervix status (22) pelvis status (23) chief complaints (24) Reasons for examination 3) The validity of the score chart turned out to be as follows: a) Sensitivity: Group $A_1$: 0.75 Group $A_2$: 0.78 Group $A_3$: 0.92 All combined : 0.85 b) Specificity : 0.68 4) The diagnosabilities of the“score chart”for a set of hypothetical prevalence of adverse outcomes were calculated as follows (the sensitivity“for all combined”was used). Hypothetidal Prevalence : 5% 10% 20% 30% 40% 50% 60% Diagnosability : 12% 23% 40% 53% 64% 75% 80%.

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