Objectives : To assess the degree of quality improvement (QI) implementation and to identify its associated factors. Methods : A mailed questionnaire survey of the QI staffs at hospitals with 400 beds or more was conducted between September 15 and October 30, 2000. Of the 108 hospitals eligible for inclusion in our study, 79 participated, yielding a response rate of 73.1%. After excluding 12 hospitals that did not perform any QI activities, 117 responses from 67 hospitals were used in our analysis. The degree of QI implementation was measured using the Malcolm Baldrige National Quality Award Criteria (MBNQAC). Factors evaluated for association with the degree of QI implementation were cultural, technical, strategic, and structural factors of the hospitals. Results : The average 01 implementation score across the 7 dimensions of MBNQAC was 3.34 on a 5-point scale, with the highest score for the area of customer satisfaction (3.88) followed by information and analysis (3.59) and quality management (3.35). The results of regression analysis showed that hospitals with a ofter information system (p<0.05) and using scientific and systematic problem solving approach (p<0.01) tended to perform a higher degree of QI implementation. While statistically insignificant, positive associations were observed for the factors of group or developmental culture, the degree of employee empowerment, and the use of prospective strategy. Conclusions : It appears that the most important factors contributing to active implementation of QI in Korean hospitals were the use of scientific skills in decision making, and having a quality information system to produce precise and valid information.
Park, Chun Kun;Lee, Kwan Sung;Choi, Yung Gun;Ryu, Kyung Sig;Park, Choon Keun;Cho, Kyung Suck;Kang, Joon Ki
Journal of Korean Neurosurgical Society
/
v.29
no.3
/
pp.365-371
/
2000
Objectives : To describe a technique for percutaneous vertebroplasty of osteoporotic vertebral body compression fractures and to report preliminary results of its use. Methods : The technique was used over a 8-month period in 9 patients with 10 painful vertebral fractures. The technique involves percutaneous puncture of the involved vertebrae with a Jamshidi needle via a transpedicular approach followed by injection of polymethylmethacrylate(PMMA) into the vertebral body. Results : The procedure was technically successful in all patients, with an average injection amount of 5.9 cc per vertebral body. One patient complained of flank pain postoperatively in spite of improvement in back pain caused by the fractured vertebra. Remaining eight patients reported significant pain relief early after treatment. The patients were followed up for 3 to 15 months(average 7.2 months) and demonstrated no recurrence of pain or aggravation of deformity. Conclusion : Vertebroplasty appears to be a valuable tool in the treatment of painful osteoporotic vertebral fractures, providing acute pain relief and early mobilization in appropriate patients. However, it needs to have more extensive prospective clinical study to confirm its definitive role in the management of this condition.
Purpose: The aim of this retrospective study was to determine the prevalence of early implant failure using a single implant system and to identify the factors contributing to early implant failure. Methods: Patients who received implant treatment with a single implant system ($Luna^{(R)}$, Shinhung, Seoul, Korea) at Dankook University Dental Hospital from 2015 to 2017 were enrolled. The following data were collected for analysis: sex and age of the patient, seniority of the surgeon, diameter and length of the implant, position in the dental arch, access approach for sinus-floor elevation, and type of guided bone regeneration (GBR) procedure. The effect of each predictor was evaluated using the crude hazard ratio and the adjusted hazard ratio (aHR) in univariate and multivariate Cox regression analyses, respectively. Results: This study analyzed 1,031 implants in 409 patients, who comprised 169 females and 240 males with a median age of 54 years (interquartile range [IQR], 47-61 years) and were followed up for a median of 7.2 months (IQR, 5.6-9.9 months) after implant placement. Thirty-five implants were removed prior to final prosthesis delivery, and the cumulative survival rate in the early phase at the implant level was 95.6%. Multivariate regression analysis revealed that seniority of the surgeon (residents: aHR=2.86; 95% confidence interval [CI], 1.37-5.94) and the jaw in which the implant was placed (mandible: aHR=2.31; 95% CI, 1.12-4.76) exerted statistically significant effects on early implant failure after adjusting for sex, age, dimensions of the implant, and type of GBR procedure (preoperative and/or simultaneous) (P<0.05). Conclusions: Prospective studies are warranted to further elucidate the factors contributing to early implant failure. In the meantime, surgeons should receive appropriate training and carefully select the bone bed in order to minimize the risk of early implant failure.
Background: Although neuropathic pain is a severe and common pain, its pathophysiology has not been elucidated yet. Studies in recent years have focused on the immune system's role in the pathogenesis of neuropathic pain. The aim of this study was to investigate the role of immunological mechanisms in neuropathic pain and the effect of pregabalin by measuring immunological marker levels in peripheral blood before and after pregabalin treatment in postherpetic neuralgia (PHN) patients with neuropathic pain. Methods: Forty patients diagnosed with PHN were included in the study. CD4, T follicular cells (Tfh: CD4+CXCR5+PD1+), Th17 (CD4+CCR6+ and CD4+IL17A+), regulatory T cells (Treg: CD4+ CD25+foxp3+), Th1 (CD4+ CXCR3+ and CD4+ IFN-γ+) and Th2 (CD4+ IL-4+) cell ratios were measured in peripheral blood samples before treatment and after 3 months of treatment. Results: When immunological marker and inflammation parameter levels were compared before and after treatment, the helper T cell ratio (CD3+, CD4+) was 30.28 ± 12.27% before treatment and 34.93 ± 11.70% after treatment, so there was a statistically significant increase (P = 0.028). Th17 was 4.75 ± 5.02% before treatment and 5.80 ± 3.13% after treatment, and there was a statistically significant increase (P = 0.036). Conclusions: Immunological mechanisms play an essential role in the pathogenesis of neuropathic pain, immunologically based treatment approach will be the critical point of treatment.
Dhillan, Rishi;Bhalla, Alok;Kumar Jha, Sushil;Singh, Hakam;Arora, Aman
Journal of Trauma and Injury
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v.32
no.2
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pp.93-100
/
2019
Purpose: Penetrating vascular trauma though less common poses a challenge to all Surgeons. This study was designed to analyse the profile, management modalities of vascular trauma and the outcomes thereof at a Trauma Care Centre in a Tertiary care setting in hostile environment in India. Methods: A prospective review of all patients with arterial and venous injuries being transferred to the Trauma Center at out Tertiary Care Center between June 2015 and May 2018 was done. Demographics, admission data, treatment, and complications were reviewed. Results: There were a total of 46 patients with 65 vascular injuries, 39 arterial injuries and 26 venous injuries. The age range was 21 to 47 years. Nineteen patients had both arterial and venous injuries. A total of 42 cases presented within 12 hours of injury and complete arterial transections were found in 33 cases (80.49%). There were three mortalities (6.52%) and three amputations (8.33%). The overall limb salvage rate was 91.67% with popliteal artery being the commonest injured artery. Poor prognosticators for limb salvage were increasing time to present to the trauma centre, hypovolemic shock, multi-organ trauma and associated venous injuries. Conclusions: Penetrating missile trauma leading to vascular injuries has not been widely reported. Attempting limb salvage even in cases with delayed presentation should be weighed with the threat to life before revascularisation and should preferably be done at a centre with vascular expertise. A team approach with vascular, orthopaedic, general surgeons, and critical care anaesthesiologists all aboard improve the outcomes manifold. Use of tourniquets and early fasciotomies have been emphasized as is the use of native veins as the bypass conduit. This is probably the largest study on penetrating Vascular trauma in anti-terrorism ops from the Indian subcontinent. It highlights the significance of prompt recognition and availability of vascular expertise in optimally managing cases of vascular trauma.
Lee, June;Lee, Ji Yun;Choi, Jung Suk;Sung, Sook Whan
Journal of Chest Surgery
/
v.52
no.3
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pp.141-147
/
2019
Background: Uniportal video-assisted thoracoscopic surgery (VATS) has proven safe and effective for pulmonary wedge resection and lobectomy. The objective of this study was to evaluate the safety and feasibility of uniportal VATS segmentectomy by comparing its outcomes with those of the multiportal approach at a single center. Methods: The records of 84 patients who underwent VATS segmentectomy from August 2010 to August 2018, including 33 in the uniportal group and 51 in the multiportal group, were retrospectively reviewed and analyzed. Results: Anesthesia and operative times were similar in the uniportal and multiportal groups (215 minutes vs. 220 minutes, respectively; p=0.276 and 180 minutes vs. 198 minutes, respectively; p=0.396). Blood loss was significantly lower in the uniportal group (50 mL vs. 100 mL, p=0.013) and chest tube duration and hospital stay were significantly shorter in the uniportal group (2 days vs. 3 days, p=0.003 and 4 days [range, 1-14 days] vs. 4 days [range, 1-62 days], p=0.011). The number of dissected lymph nodes tended to be lower in the uniportal group (5 vs. 8, p=0.056). Conclusion: Our preliminary experience indicates that uniportal VATS segmentectomy is safe and feasible in well-selected patients. A randomized, prospective study with a large group of patients and long-term follow-up is necessary to confirm these results.
KSII Transactions on Internet and Information Systems (TIIS)
/
v.13
no.2
/
pp.751-770
/
2019
Action recognition is an essential task in computer vision due to the variety of prospective applications, such as security surveillance, machine learning, and human-computer interaction. The availability of more video data than ever before and the lofty performance of deep convolutional neural networks also make it essential for action recognition in video. Unfortunately, limited crafted video features and the scarcity of benchmark datasets make it challenging to address the multi-person action recognition task in video data. In this work, we propose a deep convolutional neural network-based Effective Hybrid Learning (EHL) framework for two-person interaction classification in video data. Our approach exploits a pre-trained network model (the VGG16 from the University of Oxford Visual Geometry Group) and extends the Faster R-CNN (region-based convolutional neural network a state-of-the-art detector for image classification). We broaden a semi-supervised learning method combined with an active learning method to improve overall performance. Numerous types of two-person interactions exist in the real world, which makes this a challenging task. In our experiment, we consider a limited number of actions, such as hugging, fighting, linking arms, talking, and kidnapping in two environment such simple and complex. We show that our trained model with an active semi-supervised learning architecture gradually improves the performance. In a simple environment using an Intelligent Technology Laboratory (ITLab) dataset from Inha University, performance increased to 95.6% accuracy, and in a complex environment, performance reached 81% accuracy. Our method reduces data-labeling time, compared to supervised learning methods, for the ITLab dataset. We also conduct extensive experiment on Human Action Recognition benchmarks such as UT-Interaction dataset, HMDB51 dataset and obtain better performance than state-of-the-art approaches.
The Journal of Korean Academic Society of Nursing Education
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v.27
no.3
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pp.227-239
/
2021
Purpose: This study used an exploratory sequential approach (mixed methods) design to explore essential meaning through comparing and analyzing the experiences of nursing students in virtual simulation practice and high fidelity simulation practice education in parallel. Methods: The study participants were 20 nursing students, and data were collected through focus group meetings from July 17 to August 5, 2020, and via online quantitative data from November 10 to November 15, 2020. The qualitative data were analyzed using Giorgi's phenomenological method, and the quantitative data were analyzed using descriptive statistics, the Mann-Whitney U test, Kruskal-Wallis H test analysis of variance and Spearman's ρ correlation. Results: The comparison between the two simulation training experiences was shown in five contextual structures, as follows: (1) reflection of the clinical field, (2) thinking theorem vs. thinking expansion, (3) individual-centered learning vs. team-centered learning, (4) attitudes toward participating in practical training, (5) metacognition of personal competency as a prospective nurse, and (6) revisiting the method of practice training. There was a positive correlation between satisfaction with the practice and the clinical judgment ability of high fidelity simulation, which was statistically significant (r=.47, p=.036). Conclusion: Comparing the experiences between virtual simulation practice training and high fidelity simulation practice training, which has increased in demand due to the Coronavirus Disease-2019 pandemic, is meaningful as it provides practical data for introspection and reflection on in-campus clinical education.
Purpose As the use of social network services has become common, it has become possible to freely communicate and establish relationships with other people anytime, anywhere for communication and information sharing. Influencers who have a strong influence on consumers' perceptions and attitudes through their own opinions and stories have appeared on various social media channels such as YouTube. Recently, companies utilize influencers with a large number of followers to check interactions with customers to understand customer attitudes and opinions about products in real time. Start-ups with insufficient resources need to quickly examine customer responses to reduce the probability of failure after product planning. The Lean process of creating an MVP and quickly confirming and learning the market response should be repeated over and over again. Findings In this paper, we try to suggest that the YouTube platform can play a sufficient role as a customer experiment space through examples. The case company is a company that has successfully commercialized products by continuously interacting with customers through the YouTube platform for the first four months of its founding. This paper is expected to be helpful in the experimental process for prospective founders and early founders to examine customer responses to reduce the probability of market failure before commercialization. Design/methodology/approach This paper analyzed the YouTube channel data of case companies based on the netnography methodology and presented the contents of the lean process management carried out in the experimental stage and the post-production stage through interview research.
Background: The treatment for acromioclavicular joint injuries (ACJI) ranges from a conservative approach to extensive surgical reconstruction, and the decision on how to manage these injuries depends on the grade of acromioclavicular (AC) joint separation, resources, and skill availability. After a thorough review of the literature, the researchers adopted a simple cost-effective technique of AC joint reconstruction for acute ACJI requiring surgery. Methods: This was a prospective single-center study conducted between April 2017 and April 2018. For patients with acute ACJI more than Rockwood grade 3, the researchers performed open coracoclavicular ligament reconstruction using synthetic sutures along with an Endobutton and a figure of 8 button plate. This was followed by AC ligament repair augmenting it with temporary percutaneous AC K-wires. Clinical outcomes were evaluated using the Constant Murley shoulder score. Results: Seventeen patients underwent surgery. The immediate postoperative radiograph showed an anatomical reduction of the AC joint dislocation in all patients. During follow-up, one patient developed subluxation but was asymptomatic. The mean follow-up period was 30 months (range, 24-35 months). The mean Constant score at 24 months was 95. No AC joint degeneration was noted in follow-up X-rays. The follow-up X-rays showed significant infra-clavicular calcification in 11 of the 17 patients, which was an evidence of a healed coracoclavicular ligament post-surgery. Conclusions: This study presents a simple cost-effective technique with a short learning curve for anatomic reconstruction of acute ACJI. The preliminary results have been very encouraging.
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