• Title, Summary, Keyword: clinical outcomes

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Outcome-Based Curriculum Development at Inje University College of Medicine (인제대학교 의과대학의 성과바탕교육과정 개발실례 및 결과 소개)

  • Lee, Jong-Tae;Rhee, Byoung Doo;Roh, Hye Rin
    • Korean Medical Education Review
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    • v.15 no.1
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    • pp.31-38
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    • 2013
  • This paper focuses on the outcome-based curriculum of Inje University College of Medicine to describe our curriculum development process and results. Starting in 2006, we have revised the curriculum based on the competency-based clinical presentation curriculum. We stated clearly the learning outcomes from the social needs and educational goal of our university. We defined 8 exit outcomes and specified phase outcomes, course outcomes, lesson outcomes, and outcome objectives. By 2012, we identified 128 clinical presentations and 149 basic scientific concepts. Various evaluation and assessment methods and teaching-learning strategies were assigned to each outcome. Problem-based learning, standardized patient practice, and learning portfolios are the main strategies of our curriculum. We have performed a progress test to assess the level of achievement of students' outcomes. We have also collected feedback from students and faculty members about the curriculum, including every lesson, course, and the overall curriculum. To maintain this change of the curriculum, we reorganized the curriculum committee, educational faculty and teams, and administrative support system. To fine tune this curriculum, we have held three 3-day workshops on curriculum development and weekly meetings. We believe this is just the beginning of developing the curriculum of Inje University. Further upgrades will be necessary to continue to improve medical education.

Prognostic factors of neurological outcomes in late-preterm and term infants with perinatal asphyxia

  • Seo, Sun Young;Shim, Gyu Hong;Chey, Myoung Jae;You, Su Jeong
    • Clinical and Experimental Pediatrics
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    • v.59 no.11
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    • pp.440-445
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    • 2016
  • Purpose: This study aimed to identify prognostic factors of neurological outcomes, including developmental delay, cerebral palsy and epilepsy in late-preterm and term infants with perinatal asphyxia. Methods: All late-preterm and term infants with perinatal asphyxia or hypoxic-ischemic insults who admitted the neonatal intensive care unit of Inje University Sanggye Paik Hospital between 2006 and 2014 and were followed up for at least 2 years were included in this retrospective study. Abnormal neurological outcomes were defined as cerebral palsy, developmental delay and epilepsy. Results: Of the 114 infants with perinatal asphyxia, 31 were lost to follow-up. Of the remaining 83 infants, 10 died, 56 had normal outcomes, and 17 had abnormal outcomes: 14 epilepsy (82.4%), 13 cerebral palsy (76.5%), 16 developmental delay (94.1%). Abnormal outcomes were significantly more frequent in infants with later onset seizure, clinical seizure, poor electroencephalography (EEG) background activity, lower Apgar score at 1 and 5 minutes and abnormal brain imaging (P<0.05). Infants with and without epilepsy showed significant differences in EEG background activity, clinical and electrographic seizures on EEG, Apgar score at 5 minutes and brain imaging findings. Conclusion: We should apply with long-term video EEG or amplitude integrated EEG in order to detect and management subtle clinical or electrographic seizures in neonates with perinatal asphyxia. Also, long-term, prospective studies with large number of patients are needed to evaluate more exact prognostic factors in neonates with perinatal asphyxia.

Effect of red blood cell transfusion on short-term outcomes in very low birth weight infants

  • Lee, Eui Young;Kim, Sung Shin;Park, Ga Young;Lee, Sun Hyang
    • Clinical and Experimental Pediatrics
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    • v.63 no.2
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    • pp.56-62
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    • 2020
  • Background: Red blood cell (RBC) transfusion improves cardiorespiratory status of preterm infants by increasing circulating hemoglobin, improving tissue oxygenation, and reducing cardiac output. However, RBC transfusion itself has also been suggested to negatively affect short-term outcomes such as intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) in premature infants. Purpose: This study aimed to analyze the relationship between RBC transfusion and short-term outcomes in very low birth weight (VLBW) infants (birth weight, <1,500 g). Methods: We retrospectively reviewed the medical records of VLBW infants admitted to the Soonchunhyang University Bucheon Hospital between October 2010 and December 2017. Infants who died during hospitalization were excluded. The infants were divided into 2 groups according to RBC transfusion status. We investigated the relationship between RBC transfusion and short-term outcomes including BPD, ROP, NEC, and IVH. Results: Of the 250 enrolled VLBW infants, 109 (43.6%) underwent transfusion. Univariate analysis revealed that all short-term outcomes except early-onset sepsis and patent ductus arteriosus were associated with RBC transfusion. In multivariate analysis adjusted for gestational age, birth weight and Apgar score at 1 minute, RBC transfusion was significantly correlated with BPD (odds ratio [OR], 5.42; P<0.001) and NEC (OR, 3.40; P= 0.009). Conclusion: RBC transfusion is significantly associated with adverse clinical outcomes such as NEC and BPD in VLBW infants. Careful consideration of the patient's clinical condition and appropriate guidelines is required before administration of RBC transfusions.

Comparison of the Mortality and In-Hospital Outcomes of Preterm Infants Treated with Ibuprofen for Patent Ductus Arteriosus with or without Clinical Symptoms Attributable to the Patent Ductus Arteriosus at the Time of Ibuprofen Treatment

  • Yoo, Hani;Lee, Jin A;Oh, Sohee;Jung, oung Hwa;Sohn, Jin A;Shin, Seung Han;Choi, Chang Won;Kim, Ee-Kyung;Kim, Han-Suk;Kim, Beyong Il
    • Journal of Korean Medical Science
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    • v.32 no.1
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    • pp.115-123
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    • 2017
  • The aim of this study was to assess the differences in the mortality and in-hospital outcomes of preterm infants with < 28 weeks of gestation who received ibuprofen treatment according to the presence of clinical symptoms (any of oliguria, hypotension, or moderate to severe respiratory difficulty) attributable to hemodynamically-significant patent ductus arteriosus (hsPDA) at the time of first ibuprofen treatment. In total, 91 infants born from April 2010 to March 2015 were included. Fourteen infants (15.4%) received ibuprofen treatment when there were clinical symptoms due to hsPDA (clinical symptoms group). In clinical symptoms group, infants were younger (25 [23-27] vs. 26 [23-27] weeks; P = 0.012) and lighter (655 [500-930] vs. 880 [370-1,780] grams; P < 0.001). Also, the clinical risk index for babies (CRIB)-II scores were higher and more infants received invasive ventilator care ${\leq}2$ postnatal days. More infants received multiple courses of ibuprofen in clinical symptoms group. Although the frequency of secondary patent ductus arteriosus (PDA) ligation and the incidence of bronchopulmonary dysplasia (BPD) was higher in the clinical symptoms group in the univariate analysis, after multivariate logistic regression analysis adjusting for the CRIB-II score, birthweight, birth year, and the invasive ventilator care ${\leq}2$ postnatal days, there were no significant differences in mortality, frequency of secondary ligation and in-hospital outcomes including necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), BPD or death. Our data suggest that we can hold off on PDA treatment until the clinical symptoms become prominent.

Clinical outcomes and prognostic factors in patients with mycosis fungoides who underwent radiation therapy in a single institution

  • Jang, Bum-Sup;Kim, Eunji;Kim, Il Han;Kang, Hyun-Cheol;Ye, Sung-Joon
    • Radiation Oncology Journal
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    • v.36 no.2
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    • pp.153-162
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    • 2018
  • Purpose: We aimed to evaluate clinical outcomes including progression-free survival (PFS), overall survival (OS), partial response, and complete response in patients who underwent radiation therapy (RT) for mycosis fungoides (MF). Also, we sought to find prognostic factors for clinical outcomes. Materials and Methods: Total 19 patients confirmed with MF between 1999-2015 were retrospectively reviewed. Clinical and treatment characteristics, clinical outcomes, and and toxicities were analyzed. Results: Eleven patients were treated with total skin electron beam radiotherapy (TSEBT) and 8 patients with involved field radiation therapy (IFRT) with median dose of 30 Gy, respectively. The median time interval from diagnosis to RT was 2.6 months (range, 0.4 to 87.3 months). The overall response rate was 100%; 11 patients (57.9%) had a complete response and 8 patients (42.1%) a partial response. The presence of positive lymph node at the time of consultation of RT was associated with lower OS (p = 0.043). In multivariate analysis, PFS was significantly lower for patients with increased previous therapies experienced following RT (p = 0.019) and for patients showing PR during RT (p = 0.044). There were no reported grade 3 or more skin toxicities related with RT. Conclusion: Both IFRT and TSEBT are effective treatment for MF patients. Patients with short disease course before RT or complete response during RT are expected to have longer PFS. Positive lymph node status at the initiation of RT was associated woth poor OS, suggesting other treatment modalities such as low-dose RT for patients with low life-expectancy.

Mid-term Clinical and Radiological Outcomes of Latissimus Dorsi Tendon Transfer in Massive Rotator Cuff Tears

  • Suh, Dongwhan;Ji, Jong-Hun;Tankshali, Kirtan;Kim, Eung-Sic
    • Clinics in Shoulder and Elbow
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    • v.22 no.4
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    • pp.220-226
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    • 2019
  • Background: This retrospective study was undertaken to evaluate mid-term clinical and radiological outcomes of lattisimus dorsi (LD) tendon transfer in patients with irreparable massive rotator cuff tears (MRCT). We hypothesize that LD tendon transfer would provide safe and satisfactory clinical outcomes at mid-term follow-up. Methods: From November 2008 to December 2016, 23 patients ($57.5{\pm}4.4years$; 20 male, 3 female) who underwent LD tendon transfer for massive tears, were enrolled. Inclusion criteria were irreparable MRCT. Exclusion criteria included full thickness subscapularis tear, rotator cuff arthropathy, anterosuperior rotator cuff tear, and osteoarthritis. Mean follow-up period was $4.7{\pm}4.0years$ (range, 2-12 years). Clinical assessment (American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA], Simple Shoulder Test [SST]) and radiographic assessment (osteoarthritis [OA], acromiohumeral distance [AHI]) were evaluated. Results: ASES, UCLA and SST scores, and range of motion (ROM), except internal rotation, improved significantly at the last followup (p<0.05). Also, AHI was significantly improved at the last follow-up, from 6.6 mm to 8.2 mm (p=0.008). At the final follow-up, the radiologic stages of the glenohumeral osteoarthritis were determined as stage 1 in 9 patients, stage 2 in 10 patients, stage 3 in 2 patients, and stage 4 in 2 patients. Complications were observed in 21.7% cases: 3 re-tears and 2 infections were noted in our study. Conclusions: LD tendon transfer for irreparable MRCT provides satisfactory clinical outcomes at mid-term follow-up. Mild degenerative osteoarthritis (stage 1, 2) of the shoulder joint are common at the mid-term follow-up. Also, complications such as tear, infection should be considered.

Fracture Analysis of Wild Birds in South Korea

  • Jang, Hyun-Kyu;Park, Jong-Moon;Ahmed, Sohail;Seok, Seong-Hoon;Kim, Ho-Su;Yeon, Seong-Chan
    • Journal of Veterinary Clinics
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    • v.36 no.4
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    • pp.196-199
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    • 2019
  • This study was conducted to evaluate and analyze fractures types, sites and surgical approach of wild birds in Korea. The study was conducted on data collected for fracture lesion sites, species, outcomes, surgical methods, treatments and medical records from wildlife centers in South Korea. All birds were subjected to clinical examination, followed by surgical invasion and post-operative care. Fractures were more common in adult non-raptor species (51.57%) as compared to raptors (48.43%). Of the 254 cases evaluated, maximum cases comprised ulnar fractures (29.70%), followed by radial (21.76%) and humeral fractures (17.35%). Treatment procedures at 340 fracture sites were maximally treated with figure-8 bandage (33.07%), external skeletal fixator-intramedullary pin (ESF+IM tie-in fixation) (20.86%), and other varied procedures. All birds were kept indoors till recovery. Treatment outcomes were dependent on the type of bone fractured and surgical method applied. Based on the surgical treatments and outcomes, birds were kept hospitalized, and released or euthanized. The findings of this study provide information for veterinarians regarding the fractures sites, basic database for the species and outcomes of fracture repair in wild birds.

Clinical Outcomes according to Primary Treatment in Gastric Cancer Patients with Peritoneal Seeding

  • Bae, Jung-Min;Yeo, Kyoung-Joon;Kim, Se-Won;Kim, Sang-Woon;Song, Sun-Kyo
    • Journal of Gastric Cancer
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    • v.11 no.3
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    • pp.167-172
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    • 2011
  • Purpose: Peritoneal seeding of gastric cancer is known to have a poor prognosis. With the diagnosis of peritoneal seeding, there is no effective treatment modality. Gastrectomy with chemotherapy or primary chemotherapy is basically one of major options for this condition. This study was conducted to compare the clinical outcomes of these treatments and to identify the better way to improve the prognosis of patients with peritoneal seeding. Materials and Methods: Between 2001 and 2007, gastric cancer patients with peritoneal seeding by preoperative or intraoperative diagnosis were reviewed retrospectively. The enrolled patients were divided as primary gastrectomy and primary chemotherapy group. Clinicopathologic characteristics and clinical outcomes of groups were analyzed and compared. Results: Fifty-four patients were enrolled. 21 patients belonged to the group of primary gastrectomy and 33 patients were to the primary chemotherapy group. Among 33 patients of the primary chemotherapy group, 17 patients were received only chemotherapy and 16 patients were received gastrectomy due to the good responses of primary chemotherapy. The 3 years survival rates were 14% in primary gastrectomy group, 55% in patients who received gastrectomy after primary chemotherapy, and 0% in patients with primary chemotherapy only. Conclusions: Although this study had many limitations, some valuable information was produced. In terms of survival benefits for the gastric cancer patients with peritoneal seeding, primary gastrectomy and additional gastrectomy after primary chemotherapy revealed the better clinical outcomes. But, prospective randomized clinical study and multi-center study should be performed to decide proper treatment for gastric cancer patients with peritoneal seeding.

Treatment Outcome for Head and Neck Squamous Cell Carcinoma in a Developing Country: University Malaya Medical Centre, Malaysia from 2003-2010

  • Wong, Yoke Fui;Yusof, Mastura Md;Ishak, Wan Zamaniah Wan;Alip, Adlinda;Phua, Vincent Chee Ee
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.7
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    • pp.2903-2908
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    • 2015
  • Background: Head and neck cancer (HNC) is the eighth most common cancer as estimated from worldwide data. The incidence of HNC in Peninsular Malaysia was reported as 8.5 per 100,000 population. This study was aimed to determine the treatment outcomes for HNC patients treated in the Oncology Unit of University Malaya Medical Centre (UMMC). Materials and Methods: All newly diagnosed patients with squamous cell carcinoma of head and neck (HNSCC) referred for treatment to the Oncology Unit at UMMC from 2003-2010 were retrospectively analyzed. Treatment outcomes were 5-year overall survival (OS), cause specific survival (CSS), loco-regional control (LRC) and radiotherapy (RT) related side effects. Kaplan-Meier and log rank analyses were used to determine survival outcomes, stratified according to American Joint Committee on Cancer (AJCC) stage. Results: A total of 130 cases were analysed. Most cases (81.5%) were at late stage (AJCC III-IVB) at presentation. The 5-year OS for the whole study population was 34.4% with a median follow up of 24 months. The 5-year OS according to AJCC stage was 100%, 48.2%, 41.4% and 22.0% for stage I, II, III and IVA-B, respectively. The 5-year overall CSS and LCR were 45.4% and 55.4%, respectively. Late effects of RT were documented in 41.4% of patients. The most common late effect was xerostomia. Conclusions: The treatment outcome of HNSCC at our centre is lagging behind those of developed nations. Efforts to increase the number of patients presenting in earlier stages, increase in the use of combined modality treatment, especially concurrent chemoradiotherapy and implementation of intensity modulated radiotherapy, may lead to better outcomes for our HNC patients.

Clinical Outcomes after Modified Fasting Therapy Supplied with Gamrosu: A Retrospective Observational Study (감로수(甘露水)를 이용한 절식요법의 임상결과에 관한 후향적 관찰연구)

  • Shin, Seung-Uoo;Kim, Dong-Hwan;Shin, Hyun-Taeg;Oh, Dal-Seok
    • Journal of Korean Medicine for Obesity Research
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    • v.16 no.1
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    • pp.36-49
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    • 2016
  • Objectives: Two historical evidence supported the concept of Gamrosu. The first one was Jeho-tang, a selected thirst quencher in Chosun Dynasty and the second one was Saeng-Maek-san, Dongeuibogam's recommendation as one of the qi-vigorating summer beverages. Gamrosu is a modified fasting therapy beverage which is manufactured from those two prescriptions and the carbohydrates (420.6 kcal/d). A retrospective observational study was conducted to evaluate the clinical outcomes. Methods: Thirty-three cases were reviewed at three local Korean Medical clinics that each site's participant has finished the modified fasting for 10 consecutive days. Clinical outcomes were reviewed at pre- and post-fasting sessions by retrieving the changes of body composition, blood pressure, blood chemistries & urine tests, and subjective symptoms & fatigue scores. Results: Demographics of the observed participants were 17 of male and 16 of female. Post-Gamrosu session, -6.89% of body weight, -8.97% of body fat mass were reduced with the nutrition indices being improved (P<0.001). -8.72% of systolic blood pressure, -39.86% of serum triglyceride, -6.75% of fast blood sugar and -8.12% of waist circumference were improved (P<0.05). The levels of high sensitivity C-reactive protein (-58.34%), CRP (-43.55%) and eosinophil (-21.30%) showed the significant diminished profiles (P<0.05). Liver/kidney functions and the standard of electrolytes were maintained within normal range in stable manners. The fatigue scale scores indicated significant lower scores. Conclusions: Taken together, obesity-related clinical outcomes after a modified fasting therapy with Gamrosu were sufficiently feasible and the observed findings should be considered for further prospective clinical studies.