• The Journal of Korean Medicine
• /
• v.42 no.3
• /
• pp.1-8
• /
• 2021

Objectives: A critical pathway defines the optimal care process, sequencing and timing of intervention by multi-disciplinary health care teams for a particular diagnosis and procedure. It plays an important role as a cost-effective health care delivery system and a tool for quality control of medical and dental services by means of standardizing medical practices. The aim of this study is to investigate the satisfaction of patients and medical staff after implementation of a critical pathway for Korean medical treatment of lumbar disc herniation in integrative medical. Methods and Results: The pre-critical pathway group included 3 patients who underwent the implementation procedure from October 2020. All three patients have successfully been applied critical pathways during inpatient and outpatient treatment. Additionally, medical staff members were satisfied with the usefulness of the critical pathway. Conclusions: The implementation of critical pathway for the Korean medical treatment with lumbar disc herniation in integrative medical hospital can appraise possible applicability in actual clinical field.

• Journal of Korean Academy of Nursing Administration
• /
• v.10 no.3
• /
• pp.345-364
• /
• 2004

Purpose: This is develop a critical pathway as an useful alternative to the previous management system in order to restriction of medical resources, high expectation of ordinary people to health and application for DRG. Method: In order to preliminary critical pathway, we analyzed 30 cases of medical records of patients who had lobectomy and pneumonectomy at the Yonsei Medical Center in Seoul. An expert validity test was taken for the preliminary critical pathway, and clinical validity test was also done. After these processes, the final critical pathway was developed. Result: Among 10 cases, one was excluded in this study due to the complication after operation. 7 of total 9 patients were discharged earlier than the expected day, 1 patient was just discharged at the expected day, and 1 patient was discharged 4 days later than the expected day at the 12th day after operation. Conclusion: The critical pathway is developed without difficulty because the posoperative management for patients with lobectomy and pneumonectomy is uncomplicated. Therefore, if it is more researched on the clinical application, then the activity of C.Q.I. will be able to sustain the patient oriented management system.

• Journal of Oriental Neuropsychiatry
• /
• v.34 no.1
• /
• pp.1-12
• /
• 2023

Objectives: To standardize treatment, improve quality of medical service, and reduce medical costs of patients with depression by developing a clinical pathway (CP) of Korean medicine. Methods: CP was developed based on clinical practice guideline (CPG) for depression. To consider the degree of economic burden and satisfaction, the current status of management for patients with depression was examined. After CP was primarily developed, contents of the CP were supplemented by referring to previously developed CPs. Results: Based on CPG, current status survey and previous CP, four types of CP (Korean medicine clinics, Korean medicine hospitals, Western-Korean medicine collaborative hospitals, public medical center) were developed and shown in the algorithm version. However, in the case of Korean medicine hospitals and Western-Korean medicine collaborative hospitals, CPs were detailed according to different clinical scenes of outpatients and inpatients. This study also shows six different time task matrix version. Conclusions: CP for depression is expected to not only reduce financial burden of patients and health insurance, but also increase the quality of treatment and satisfaction.

• Journal of radiological science and technology
• /
• v.43 no.1
• /
• pp.35-43
• /
• 2020

The purpose of this study was to study on radiologic technologist's license system and primary pathway education curriculum in the United States American (USA), focused on one case of college in Texas. We were collected and analyzed through class participation at a community college in Tarrant, interviews with professors of radiologic science and clinical radiographers, field trips, an internet search, and literature reviews. As a result, first, the American radiologic technologists license system is composed of fifteen chapters, and the professional education courses for each field are being carried out through three courses of a primary pathway, a post primary pathway and a physician extender. Second, the primary pathway courses consisted the radiography, the radiation therapy, the nuclear medicine, the magnetic resonance imaging, the sonography. Third, the USA had about 30 times more clinical practice time than Korea. In clinical practice, students had done actually examination through X-ray exposure on patients. Last radiographers in the USA was able to perform intravenous injection of radiopharmaceutical agents on patient, so that he could perform rapid examination and efficient manpower operation. This study could be used as basic data for the globalization of radiologic technologists license system in Korea.

• Journal of Korean Academy of Nursing Administration
• /
• v.16 no.1
• /
• pp.59-72
• /
• 2010

Purpose: This study is a descriptive research to analyze prognostic factors of barbiturate coma therapy (BCT) for severe brain damage patients, to develop a critical pathway (CP) based on the results of analysis and to examine the effect of its clinical application. Method: We analyzed medical records of 76 patients who received BCT for more than three days between January 1999 to July 2005. Based on the results of the analysis, we developed a CP and applied it to 12 people during August-December of 2005. Result: By application of BCT CP, the mortality rate decreased from 31.6% to 16.7%. It was found that the period of staying at ICU and total period of hospitalization were shortened by 2.78 (13.9%) days and 16.43 (29.4%) days, respectively. The Glasgow coma scale of the recovery group by CP application was 9.03 (4.64) at 72 hours post of BCT and 14.28 (1.82) at discharge from hospital, and DRS was 6.62 (6.38) points. Conclusion: By verifying clinical validity of the suggested CP, we believe that we have obtained visible effects standardizing the treatment pathway of BCT for brain damage patients.

• Journal of Gastric Cancer
• /
• v.12 no.2
• /
• pp.126-131
• /
• 2012

Purpose: We developed a standardized critical pathway for gastric cancer surgery and then determined the increase of application, which resulted in an improvement in terms of measurable indices, such as hospital stay and cost. Materials and Methods: A critical pathway was revised and used widely from the 2nd quarter of 2009. We collected clinical data, such as length of stay and complication rate, as clinical indices of quality prospectively. The total cost paid at the patient's discharge, as well as the daily hospital income, were calculated and compared by each quarter from January 2008 to December 2009. Results: The application rate of critical pathway was 11.8% and 87.8% in 2008 and 2009, respectively. There were no perioperative deaths. There was no difference in the complication rates between 2008 and 2009 (P=0.45). However, the mean length of stay was significantly different between the 2 years (P<0.05). Although the total cost was not different, the daily hospital income was significantly higher in the latter year (P<0.05). Conclusions: An increase in the application of critical pathway for gastrectomy resulted in significant decreases in length of stay and increases in the daily hospital income without a compromise on the clinical indices.

• Journal of Korean Academy of Nursing Administration
• /
• v.8 no.1
• /
• pp.123-135
• /
• 2002

Purpose: In this study, the critical pathway for laparoscopic cholecystectomy patients was developed and applied for clinical study. The effectiveness of the critical pathway was analyzed. Method: The subjects with no critical pathway services of this study were 30 laparoscopic cholecystectomy operation patients, who were hospitalized in B General Hospital in Busan from Nov. 28. 2000 to May 2. 2001. The subjects with critical pathway services of this study were 30 laparoscopic cholecystectomy operation patients, who were hospitalized in B General Hospital in Busan from June. 11. 2001 to Oct. 31. 2001. Results: 1. Development for critical pathway Preliminary critical pathway for the laparoscopic cholecystectomy patients was developed though analysis of the reference and 34 case of medical record. The items on the y-axis were assessment, test, treatment, diet, fluid, consult, medication, activity and education and the items on the x-axis were till 3days after operation. The developed critical pathway was applied in clinical field. 2.　Effectiveness of application on developed critical pathwayPost operational complication was not found in neither the critical pathway using Group nor Non-using Group. Hospitalization period mean was 4.63 days for the using Group and 5.93 days for the Non-using Group(P=.001). The mean cost for medical examination and treatment for the using Group was 786,270 won, 117,454 won(12.9%) less than that of the Non-using Group, 903,724 won(P=.000). The degree of satisfaction for the using group was 3.7 points, for the Non-using Group, 3.15 points. The degree of satisfaction for the used Group was 0.55 points higher than that for the Non-using Group and there was a statistically significant difference(P=.000). Concousion: From results of this study, Using the critical pathway in the laparoscopic cholecystectomy operational patients was effective in decreasing the hospitalization period and cost, and increasing the satisfaction about the medical service.

• Journal of Oriental Neuropsychiatry
• /
• v.34 no.4
• /
• pp.359-368
• /
• 2023

Objectives: This study aims to establish a Korean medicine doctor's range of services in the dementia relief primary care system based on the previously developed dementia clinical practice guidelines (CPGs). Developing a dementia relief primary care Clinical Pathway (CP) can aid clinically when the Korean medicine primary care doctor conducts treatment. Methods: We analyzed Dementia Korean Medicine Primary Care Model Data and then applied CP Methodology to develop the configuration of the Korean Medicine Primary Care Model. For patients with Alzheimer's dementia (AD), vascular dementia (VD), and mild cognitive impairment (MCI), the Korean Medicine Primary Care Model focuses on improving cognitive function, everyday living abilities and easing symptoms through interventions described in CPGs. The contents of the draft model later include references to already-existing CPs. Results: The study sites were chosen as Korean medical clinics connected to primary care physicians in the dementia-friendly model. The CP used a time task matrix version to arrange the clinical chronology, which included all examinations, diagnoses, and treatment procedures, from the initial appointment to follow-ups and the end of therapy. Conclusions: It anticipates that Korean primary care doctors familiar with dementia can use the offered therapies for the first time by creating the dementia Korean medicine primary care model in this study. This is expected to maximize the range of medical services provided by Korean medicine and improve the standard of medical treatment.

• Journal of Ginseng Research
• /
• v.47 no.4
• /
• pp.515-523
• /
• 2023

Background: 20(S)-protopanaxadiol (PPD), one of the main components of ginseng, has anti-inflammatory, anti-estrogenic, and anti-tumor activities. It is known that activated hepatic stellate cells (HSCs) are the primary producers of extracellular matrix (ECM) in the liver, and the Wnt/β-catenin pathway participates in the activation of HSCs. We aimed to explore whether PPD inhibits liver fibrosis is associated with the Wnt/β-catenin pathway inactivation. Methods: The anti-fibrotic roles of PPD were examined both in vitro and in vivo. We also examined the levels of Wnt inhibitory factor 1 (WIF1), DNA methyltransferase 1 (DNMT1) and WIF1 methylation. Results: PPD obviously ameliorated liver fibrosis in carbon tetrachloride (CCl₄)-treated mice and reduced collagen deposition. PPD also suppressed the activation and proliferation of primary HSCs. Notably, PPD inhibited the Wnt/β-catenin pathway, reduced TCF activity, and increased P-β-catenin and GSK-3β levels. Interestingly, WIF1 was found to mediate the inactivation of the Wnt/β-catenin pathway in PPD-treated HSCs. WIF1 silencing suppressed the inhibitory effects of PPD on HSC activation and also restored α-SMA and type I collagen levels. The downregulation of WIF1 expression was associated with the methylation of its promoter. PPD induced WIF1 demethylation and restored WIF1 expression. Further experiments confirmed that DNMT1 overexpression blocked the effects of PPD on WIF1 expression and demethylation and enhanced HSC activation. Conclusion: PPD up-regulates WIF1 levels and impairs Wnt/β-catenin pathway activation via the downregulation of DNMT1-mediated WIF1 methylation, leading to HSC inactivation. Therefore, PPD may be a promising therapeutic drug for patients with liver fibrosis.

• Biomolecules & Therapeutics
• /
• v.21 no.5
• /
• pp.323-331
• /
• 2013

TGF-${\beta}$ pathway is being extensively evaluated as a potential therapeutic target. The transforming growth factor-${\beta}$ (TGF-${\beta}$) signaling pathway has the dual role in both tumor suppression and tumor promotion. To design cancer therapeutics successfully, it is important to understand TGF-${\beta}$ related functional contexts. This review discusses the molecular mechanism of the TGF-${\beta}$ pathway and describes the different ways of tumor suppression and promotion by TGF-${\beta}$. In the last part of the review, the data on targeting TGF-${\beta}$ pathway for cancer treatment is assessed. The TGF-${\beta}$ inhibitors in pre-clinical studies, and Phase I and II clinical trials are updated.