• Title, Summary, Keyword: clinical outcomes

Search Result 2,849, Processing Time 0.043 seconds

Multimodal Therapy for Patients with Acute Ischemic Stroke : Outcomes and Related Prognostic Factors

  • Jeong, Seung-Young;Park, Seung-Soo;Koh, Eun-Jeong;Eun, Jong-Pil;Choi, Ha-Young
    • Journal of Korean Neurosurgical Society
    • /
    • v.45 no.6
    • /
    • pp.360-368
    • /
    • 2009
  • Objective : The objectives of this study were to analyze the recanalization rates and outcomes of multimodal therapy that consisted of sequential intravenous (IV)/intra-arterial (IA) thrombolysis, mechanical thrombolysis including mechanical clot disruption using microcatheters and microwires, balloon angioplasty, and stenting for acute ischemic stroke, and to evaluate the prognostic factors related to the outcome. Methods : Fifty patients who were admitted to the hospital within 8 hours from ischemic symptom onset were retrospectively analyzed. Initial IV thrombolysis and subsequent cerebral angiography were performed in all patients. If successful recanalization was not achieved by IV thrombolysis, additional IA thrombolysis with mechanical thrombolysis, including balloon angioplasty and stenting, were performed. The outcomes were assessed by the National Institute of Health Stroke Scale (NIHSS) change and modified Rankin scale (mRS) and prognostic factors were analyzed. Results : Successful recanalization was achieved in 42 (84%) of 50 patients, which consisted of 8 patients after IV thrombolysis, 19 patients after IA thrombolysis with mechanical clot disruption, and 15 patients after balloon angioplasty or stenting. Symptomatic hemorrhage occurred in 4 (8%) patients. Good outcomes were achieved in 76% and 70% of patients upon discharge, and 93% and 84% of patients after 3 months according to the NIHSS change and mRS. The initial clinical status, recanalization achievement, and presence of symptomatic hemorrhage were statistically related to the outcomes. Conclusion : Multimodal therapy may be an effective and safe treatment modality for acute ischemic stroke. Balloon angioplasty and stenting is effective for acute thrombolysis, and produce higher recanalization rates with better outcomes.

The Analysis of the Treatment Outcomes of Proximal Humeral Fractures with Locking Plates

  • Lee, Kwang-Won;Hwang, Yoon-Sub;Kim, Choon-Myeon;Yang, Dae-Suk;Park, Tae-Soo
    • Clinics in Shoulder and Elbow
    • /
    • v.17 no.1
    • /
    • pp.10-17
    • /
    • 2014
  • Background: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes. Methods: Fifty six patients who were treated with locking plates for proximal humeral fractures and had been followed for more than 1 year were enrolled in this study. We performed functional evaluation using the Constant score and analyzed radiographic results. The following factors that may potentially influence the clinical outcomes were assessed: age, gender, type of fracture, presence of medial metaphyseal comminution, bone mineral density, anatomical reduction, restoration of medial mechanical support, and postoperative complications. Results: The mean Constant score was 70.1 points at the final follow-up. Female gender, 4-part fractures, AO type-C fractures, and fractures with medial metaphyseal comminution were associated with a poor clinical outcome. On the other hand, restoration of medial mechanical support and accurate anatomical reduction had a positive influence on clinical outcomes. Postoperative complications resulted in 3 patients (intra-articular screw perforation: 1 patient, varus deformity with screw loosening: 1 patient, nonunion: 1 patient). Conclusions: When treating proximal humeral fractures with locking plate fixation, following factors: a female gender, Neer type 4-part fracture, AO type C fracture, and medial metaphyseal comminution are important risk factors that surgeons should take into consideration. Factors that contribute to better clinical outcomes of operative treatment for humeral fractures are accurate anatomical reduction and restoration of medial mechanical support.

Sagittal Alignment of a Strut Graft Affects Graft Subsidence and Clinical Outcomes of Anterior Cervical Corpectomy and Fusion

  • Yamauchi, Koun;Fushimi, Kazunari;Miyamoto, Kei;Hioki, Akira;Shimizu, Katsuji;Akiyama, Haruhiko
    • Asian Spine Journal
    • /
    • v.11 no.5
    • /
    • pp.739-747
    • /
    • 2017
  • Study Design: Retrospective study. Purpose: The purpose of this study was to investigate the influence of sagittal alignment of the strut graft on graft subsidence and clinical outcomes after anterior cervical corpectomy and fusion (ACCF). Overview of Literature: ACCF is a common technique for the treatment of various cervical pathologies. Although graft subsidence sometimes occurs after ACCF, it is one cause for poor clinical results. Malalignment of the strut graft is probably one of the factors associated with graft subsidence. However, to the best of our knowledge, no prior reports have demonstrated correlations between the alignment of the strut graft and clinical outcomes. Methods: We evaluated 56 patients (33 men and 23 women; mean age, 59 years; range, 33-84 years; 45 with cervical spondylotic myelopathy and 11 with ossification of the posterior longitudinal ligament) who underwent one- or two-level ACCF with an autogenous fibular strut graft and anterior plating. The Japanese Orthopaedic Association (JOA) score recovery ratio for cervical spondylotic myelopathy was used to evaluate clinical outcomes. The JOA score and lateral radiograms were evaluated 1 week and 1 year postoperatively. Patients were divided into two groups (a straight group [group I] and an oblique group [group Z]) based on radiographic assessment of the sagittal alignment of the strut graft. Results: Group I showed a significantly greater JOA score recovery ratio (p<0.05) and a significantly lower graft subsidence than group Z (p<0.01). Conclusions: Our findings suggest that a straight alignment of the strut graft provides better clinical outcomes and lower incidence of graft subsidence after ACCF. In contrast, an oblique strut graft can lead to significantly increased strut graft subsidence and poor clinical results.

Sample size calculation for comparing time-averaged responses in K-group repeated binary outcomes

  • Wang, Jijia;Zhang, Song;Ahn, Chul
    • Communications for Statistical Applications and Methods
    • /
    • v.25 no.3
    • /
    • pp.321-328
    • /
    • 2018
  • In clinical trials with repeated measurements, the time-averaged difference (TAD) may provide a more powerful evaluation of treatment efficacy than the rate of changes over time when the treatment effect has rapid onset and repeated measurements continue across an extended period after a maximum effect is achieved (Overall and Doyle, Controlled Clinical Trials, 15, 100-123, 1994). The sample size formula has been investigated by many researchers for the evaluation of TAD in two treatment groups. For the evaluation of TAD in multi-arm trials, Zhang and Ahn (Computational Statistics & Data Analysis, 58, 283-291, 2013) and Lou et al. (Communications in Statistics-Theory and Methods, 46, 11204-11213, 2017b) developed the sample size formulas for continuous outcomes and count outcomes, respectively. In this paper, we derive a sample size formula to evaluate the TAD of the repeated binary outcomes in multi-arm trials using the generalized estimating equation approach. This proposed sample size formula accounts for various correlation structures and missing patterns (including a mixture of independent missing and monotone missing patterns) that are frequently encountered by practitioners in clinical trials. We conduct simulation studies to assess the performance of the proposed sample size formula under a wide range of design parameters. The results show that the empirical powers and the empirical Type I errors are close to nominal levels. We illustrate our proposed method using a clinical trial example.

Development of Clinical Scenarios and Rubrics for a Program Outcome-based Evaluation for Students' Adult Health Nursing Practice (학습성과 기반 성인간호 임상실습 운영을 위한 임상시나리오 및 루브릭 개발)

  • Yang, Hee Mo;Hwang, Seon Young
    • Korean Journal of Adult Nursing
    • /
    • v.26 no.6
    • /
    • pp.653-667
    • /
    • 2014
  • Purpose: This study was aimed to develop frequently-used clinical scenarios and scoring rubrics to assess core basic nursing skills in adult health nursing clinical practice for clinical evaluation based on program learning outcomes (PO). Methods: This study was a methodological research combining focus group interviews and questionnaires to select and construct scenarios. Data were collected from clinical practitioners, adult health nursing professors, and new nurses from November, 2013 to April, 2014. The developed scenarios and rubrics were applied to nursing students by way of showing an example. Results: The 12 frequently-used clinical scenarios were developed. The proportion of the evaluation rubrics were 30% for clinical instructors where as 70% for college instructors. In order for students to achieve the important learning outcomes from the courses for clinical practice, four program outcomes (POs) were selected as well as a rubric for each POs was developed. Students who had situation-based clinical practices showed higher levels of satisfaction on mastery of core basic nursing skills and communication skills. Conclusion: This findings of the study suggested the strategies for complementing pitfalls in clinical setting and achieving PO during students' clinical practicum.

Clinical outcomes of single versus double blastocyst transfer in fresh and vitrified-warmed cycles

  • Eum, Jin Hee;Park, Jae Kyun;Kim, So Young;Paek, Soo Kyung;Seok, Hyun Ha;Chang, Eun Mi;Lee, Dong Ryul;Lee, Woo Sik
    • Clinical and Experimental Reproductive Medicine
    • /
    • v.43 no.3
    • /
    • pp.164-168
    • /
    • 2016
  • Objective: Assisted reproductive technology has been associated with an increase in multiple pregnancies. The most effective strategy for reducing multiple pregnancies is single embryo transfer. Beginning in October 2015, the National Supporting Program for Infertility in South Korea has limited the number of embryos that can be transferred per in vitro fertilization (IVF) cycle depending on the patient's age. However, little is known regarding the effect of age and number of transferred embryos on the clinical outcomes of Korean patients. Thus, this study was performed to evaluate the effect of the number of transferred blastocysts on clinical outcomes. Methods: This study was carried out in the Fertility Center of CHA Gangnam Medical Center from January 2013 to December 2014. The clinical outcomes of 514 women who underwent the transfer of one or two blastocysts on day 5 after IVF and of 721 women who underwent the transfer of one or two vitrified-warmed blastocysts were analyzed retrospectively. Results: For both fresh and vitrified-warmed cycles, the clinical pregnancy rate and live birth or ongoing pregnancy rate were not significantly different between patients who underwent elective single blastocyst transfer (eSBT) and patients who underwent double blastocyst transfer (DBT), regardless of age. However, the multiple pregnancy rate was significantly lower in the eSBT group than in the DBT group. Conclusion: The clinical outcomes of eSBT and DBT were equivalent, but eSBT had a lower risk of multiple pregnancy and is, therefore, the best option.

Subtype classification of Human Breast Cancer via Kernel methods and Pattern Analysis of Clinical Outcome over the feature space (Kernel Methods를 이용한 Human Breast Cancer의 subtype의 분류 및 Feature space에서 Clinical Outcome의 pattern 분석)

  • Kim, Hey-Jin;Park, Seungjin;Bang, Sung-Uang
    • Proceedings of the Korean Information Science Society Conference
    • /
    • /
    • pp.175-177
    • /
    • 2003
  • This paper addresses a problem of classifying human breast cancer into its subtypes. A main ingredient in our approach is kernel machines such as support vector machine (SVM). kernel principal component analysis (KPCA). and kernel partial least squares (KPLS). In the task of breast cancer classification, we employ both SVM and KPLS and compare their results. In addition to this classification. we also analyze the patterns of clinical outcomes in the feature space. In order to visualize the clinical outcomes in low-dimensional space, both KPCA and KPLS are used. It turns out that these methods are useful to identify correlations between clinical outcomes and the nonlinearly protected expression profiles in low-dimensional feature space.

  • PDF

Validation of Nursing Care Sensitive Outcomes related to Knowledge (지식에 관한 간호결과도구의 타당성 조사)

  • 이은주
    • Journal of Korean Academy of Nursing
    • /
    • v.33 no.5
    • /
    • pp.625-632
    • /
    • 2003
  • Purpose: The purpose of this study was to assess the importance and sensitivity to nursing interventions of four nursing sensitive nursing outcomes selected from the Nursing Outcomes Classification (NOC). Outcomes for this study were 'Knowledge: Diet', 'Knowledge: Disease Process', 'Knowledge: Energy Conservation', and 'Knowledge: Health Behaviors'. Method: Data were collected from 183 nurses working in 2 university hospitals. Fehring method was used to estimate outcome and indicators' content and sensitivity validity. Multiple and stepwise regression were used to evaluate relationships between each outcome and its indicators. Result: Results confirmed the importance and nursing sensitivity of outcomes and their indicators. Key indicators of each outcomes were found by multiple regression. 'Knowledge: Diet' was suggested for adding new indicators because the variance explained by indicators was relatively low. Not all of the indicators selected for stepwise regression model were rated for highly in Fehring method. The R² statistics of the stepwise regression models were between 18 and 63% in importance by selected indicators and between 34 and 68% in contribution by selected indicators. Conclusion: This study refined what outcomes and indicators will be useful in clinical practice. Further research will be required for the revision of outcome and indicators of NOC. However, this study refined what outcomes and indicators will be useful in clinical practice.

Manual Aspiration Thrombectomy Using Penumbra Catheter in Patients with Acute M2 Occlusion : A Single-Center Analysis

  • Park, Jung Soo;Kwak, Hyo Sung
    • Journal of Korean Neurosurgical Society
    • /
    • v.59 no.4
    • /
    • pp.352-356
    • /
    • 2016
  • Objective : The efficacy and safety of manual aspiration thrombectomy using Penumbra in an acute occlusion of large intracranial arteries has been proven in many previous studies. Our study aimed to retrospectively assess the efficacy and safety of manual aspiration thrombectomy using Penumbra in patients with small vessel occlusions (M2 segment of the MCA). Methods : We conducted a retrospective review of 32 patients who underwent manual aspiration thrombectomy using the Penumbra 4 MAX Reperfusion Catheter for treatment of an M2 occlusion between January 2013 and November 2014. We evaluated immediate angiographic results and clinical outcomes through review of patient electronic medical records. Results : There were slightly more men in this study (M : F=18 : 14) and the median age was 72.5 (age range : 41-90). The rate of successful recanalization (TICI grade ${\geq}2b$) was 84% (27/32). NIHSS at discharge and favorable clinical outcomes at 3 months were significantly improved than baseline. Median initial NIHSS score was 10 (range : 4-25) and was 4 (range : 0-14) at discharge. Favorable clinical outcomes (mRS score ${\leq}2$ at 3 months) were seen in 25 out of 32 patients (78%). There were no procedure-related symptomatic intracerebral hemorrhages. One patient expired after discharge due to a cardiac problem. Conclusion : Manual aspiration thrombectomy might be safe and is capable of achieving a high rate of successful recanalization and favorable clinical outcomes in patients with distal cerebral vessel occlusion (M2).

Endovascular Treatment of 429 Anterior Communicating Artery Aneurysms Using Bare-Platinum Coils : Clinical and Radiologic Outcomes at the Long-term Follow-up

  • Lee, Jong Young;Seo, Jeong Hwa;Cho, Young Dae;Kang, Hyun-Seung;Han, Moon Hee
    • Journal of Korean Neurosurgical Society
    • /
    • v.57 no.3
    • /
    • pp.159-166
    • /
    • 2015
  • Objective : We reviewed the feasibility, safety and efficacy as well as the clinical outcome and long-term angiographic results of endovascular treatment (EVT) of the anterior communicating artery (ACoA) aneurysms. Methods : A total of 429 ACoA aneurysms in 426 patients were treated using coil embolization between March 1996 and October 2010 in a single institution. Pretreatment aneurysmal features were checked using angiogram. We had usually used tailored steam shaped microcatheter according to individual angiographic architectures. Immediate postembolization outcomes were evaluated using an angiographic outcome scale and clinical evaluation was performed using the Glasgow Outcome Scale (GOS). Results : Postembolization angiograms demonstrated total occlusion of aneurysm in 290 of 429 (67.6%) aneurysms, neck remnant in 80 (18.6%) and body filling in 59 (13.8%). Dome direction and aneurysm angle was not associated with initial angiographic outcomes. The procedure-related morbidity rate was 0.9% (4 of 429). Clinical and imaging follow-up more than 6 months were available in 382 (89.0%) patients with a mean of 26.2 months. Overall rate of major recanalization was 7.9% (30 of 382) and all of them were retreated without complications. At the last follow-up, 233 (99.2%) of 235 patients had GOS of 5 in unruptured group, and 152 (79.5%) of 191 patients showed good clinical outcomes (GOS of 4 or 5) in ruptured group. Conclusion : Tailored steam shaping of the microcatheter is vital to achieve good angiographic outcomes regardless of aneurysmal direction. EVT is feasible and safe for most ACoA aneurysms with acceptable immediate and long-term outcomes.