• Title/Summary/Keyword: Clinical Practice study

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Is antibiotic prophylaxis necessary after endoscopic ultrasound-guided fine-needle aspiration of pancreatic cysts?

  • Seifeldin Hakim;Mihajlo Gjeorgjievski;Zubair Khan;Michael E. Cannon;Kevin Yu;Prithvi Patil;Roy Tomas DaVee;Sushovan Guha;Ricardo Badillo;Laith Jamil;Nirav Thosani;Srinivas Ramireddy
    • Clinical Endoscopy
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    • v.55 no.6
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    • pp.801-809
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    • 2022
  • Background/Aims: Current society guidelines recommend antibiotic prophylaxis for 3 to 5 days after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions (PCLs). The overall quality of the evidence supporting this recommendation is low. In this study, we aimed to assess cyst infection and adverse event rates after EUS-FNA of PCLs among patients treated with or without postprocedural prophylactic antibiotics. Methods: We retrospectively reviewed all patients who underwent EUS-FNA of PCLs between 2015 and 2019 at two large-volume academic medical centers with different practice patterns of postprocedural antibiotic prophylaxis. Data on patient demographics, cyst characteristics, fine-needle aspiration technique, periprocedural and postprocedural antibiotic prophylaxis, and adverse events were retrospectively extracted. Results: A total of 470 EUS-FNA procedures were performed by experienced endosonographers for the evaluation of PCLs in 448 patients, 58.7% of whom were women. The mean age was 66.3±12.8 years. The mean cyst size was 25.7±16.9 mm. Postprocedural antibiotics were administered in 274 cases (POSTAB+ group, 58.3%) but not in 196 cases (POSTAB- group, 41.7%). None of the patients in either group developed systemic or localized infection within the 30-day follow-up period. Procedure-related adverse events included mild abdominal pain (8 patients), intra-abdominal hematoma (1 patient), mild pancreatitis (1 patient), and perforation (1 patient). One additional case of pancreatitis was recorded; however, the patient also underwent endoscopic retrograde cholangiopancreatography. Conclusions: The incidence of infection after EUS-FNA of PCLs is negligible. Routine use of postprocedural antibiotics does not add a significant benefit.

A Systematic Review and Meta-Analysis of the Effects of Action Learning-Based Education Program on Nursing Students (간호대학생의 액션러닝 기반 교육프로그램 효과에 대한 체계적 문헌고찰 및 메타분석)

  • Mi-Hyeon Park;Yong-Joo Cho
    • Journal of Practical Engineering Education
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    • v.16 no.4
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    • pp.587-598
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    • 2024
  • This study aimed to evaluate the effectiveness of an action learning-based educational program for domestic nursing students. A systematic review and meta-analysis were conducted following PRISMA guidelines. Limited to the period from January 2013 to December 2023, a search conducted across the electronic databases DBpia, RISS, KCI, KISS, and SCIENCE ON identified a total of 779 documents. From these, 13 documents that met the established selection criteria were ultimately included. Thirteen documents meeting the selection criteria were identified, and quality evaluation was independently performed by two researchers using ROBINS-I. The effect size of the action learning-based education program was analyzed using the 'Meta package' in the R program. The effect size for problem-solving was ESr=.68 (95% CI=.30 to 1.06). For communication skills, the effect size was ESr=.39 (95% CI=-.08 to .85), and for critical thinking, the effect size was ESr=.26 (95% CI=.02 to .50). Action learning-based educational programs have been shown to be an effective method for enhancing problem-solving skills and critical thinking among nursing students. Therefore, there is a need for the active implementation of action learning techniques to further develop nursing students' clinical practice capabilities within nursing education.

Clinical Convergence Angle of Prepared Tooth for full Veneer Crowns (전부 피개관의 치아 형성 시 축면 경사각에 대한 조사)

  • Kim, Sung-Jin;Pae, Ah-Ran;Woo, Yi-Hyung;Kim, Hyeong-Seob
    • Journal of Dental Rehabilitation and Applied Science
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    • v.26 no.1
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    • pp.21-32
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    • 2010
  • The convergence angle of a prepared tooth is a very important factor in the retention and resistance of a crown restoration. But various intraoral environments and clinician's techniques make it difficult to obtain the ideal inclination. Therefore, in this study, clinical convergence angle of a prepared tooth was investigated. The data was collected from the patient models of prosthodontic residents and the patient models of general practitioners. The images of mesiodistal and buccolingual surfaces were taken with a digital camera to evaluate the convergence angle on 'ImageJ' program. The images were classified according to the criteria (1. Clinician group, 2. Position in the dental arch, 3. The purpose of abutment preparation)and then analyzed. The mean convergence angle of a prepared tooth for Korean clinicians was $15.02^{\circ}$ (${\pm}10.13^{\circ}$). 1. It was significant in the convergence angle between the general practitioner group and the prosthodontic resident group(p<0.05). 2. It was significant between the mesiodistal and buccolingual surface in the the prosthodontic resident group(p<0.05). 3. For the general practitioner group, it was significant when anteriors and premolars were compared with molars(p<0.05). For the prosthodontic resident group, it was significant when anteriors and premolars were compared with molars (p<0.05). 4. When divided into upper and lower arches, for the general practitioner group, it showed significant difference in the buccolingual aspect(p<0.05). Also in the prosthodontic resident group, it showed significant difference in the buccolingual aspect(p<0.05). 5. Dividing left and right sides of the arches, there was no significant difference in the general practitioner group and the prosthodontic resident group(p>0.05). 6. In the general practitioner group, it was significant in the mesiodistal axial convergence angle of single crown abutment and 3 unit bridge abutment(p<0.05). In the prosthodontic resident group, it was significant in the mesiodistal and overall axial convergence angle of single crown abutment and 3 unit bridge abutment(p<0.05). Clinical convergence angle of prepared tooth in Korea was included in agreement with other studies investigating convergence angle that ranged from 10 to 22 degrees, achieved in clinical practice.

Relationship between Low Back Pain and Lumbar Paraspinal Muscles Fat Change in MRI (편측 요통을 호소하는 환자에 있어서 척추 주위 근육의 지방량과 통증과의 관계)

  • Kim, Ha-Neul;Kim, Kyoung-Hun;Kim, Joo-Won;Jin, Eun-Seok;Ha, In-Hyuk;Koh, Dong-Hyun;Hong, Soon-Sung;Kwon, Hyeok-Joon
    • Journal of Korean Medicine Rehabilitation
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    • v.19 no.1
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    • pp.135-143
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    • 2009
  • Objectives : Low back pain(LBP) is a common disabling disease in clinical practice and loss of working hours due to this condition is huge. The aim of this study was to determine if there was an association between fat deposit of paraspinal muscles as observed on MRI scans in patients presenting with unilateral LBP. Methods : 24 patients who visiting our hospital with a clinical presentation of unilateral LBP were recruited to the study. Patients were between 20 and 30 years and had a history of unilateral LBP within 12 months. After MRI scaning, the images were saved in DICOM file format for Picture Archiving and Communication System(PACS). The percentage of fat infiltrated area was measured using a pseudocoloring technique. Data were analyzed comparing the fat deposits of the muscles on the symptomatic and asymptomatic sides. Paired t-test was used to find the difference between the measurements of fat tissue in individual patients. Results : The amount of fat in the symptomatic side was $7.6{\pm}4.51%$, asymptomatic side was $6.7{\pm}4.29%$. There were increases, statistically significant, in the fat changes of the paraspinal muscles at the L4-5 disc level(P <0.05). Also, men were likely than women to have more fat deposit in symptomatic side(men $8.5{\pm}5.1%$, women $6.5{\pm}3.6%$). Conclusions : The amount of fat in the symptomatic side shows significantly increased than asymptomatic side in the paraspinal muscles at the L4-5 disc level. It suggested that fat infiltration in the muscles associated with LBP. Further studies will be needed to confirm the relationship between the muscle fatty changes and LBP in the large sample size. In addition, the correlation of pain severity with fat infiltration needs to be addressed.

Shear bond strength of rebonded ceramic brackets (세라믹 브라켓의 재접착이 전단 결합 강도에 미치는 영향)

  • Sung, Ji-Young;Kang, Kyung-Hwa
    • The korean journal of orthodontics
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    • v.39 no.4
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    • pp.234-247
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    • 2009
  • Objective: The purpose of this study was to evaluate the shear bond strength of rebonded ceramic brackets according to each condition and find an appropriate method to rebond ceramic brackets with proper shear bond strength in clinical practice. Methods: The study consisted of 12 experimental groups, according to the types of brackets, debonding methods, and treatment methods of the bracket base. Shear bond strength was measured, and adhesive residues left on the tooth surface were assessed. The base of the bracket was examined under scanning electron microscopy. Results: The shear bond strength of the monocrystalline ceramic bracket group was significantly higher than thatof the polycrystalline bracket group with only sandblasting (p < 0.05). There was no significant difference in shear bond strength between groups that used rebonded brackets which were debonded with shear force and debonded with laser (p > 0.05). The shear bond strength of the sandblasted/silane group was significantly higher than that of the selectively grinded group with a low-speed round bur and the sandblasted only group (p < 0.001). The retentive structure was more presented in groups where laser was applied than in groups where shear force was applied to debond brackets prior to rebonding. The bracket bases which were treated before rebonding presented smoother surfaces than new brackets. Conclusions: Shear bond strength could be increased by applying a silane coupling agent after sandblasting before rebonding. Also, the bond strength of the selectively grinded group with a low-speed round bur and the sandblasted group showed acceptable bond strength for clinical orthodontic treatment.

The Characteristics of Pain Coping Strategies in Patients with Chronic Pain by Using Korean Version-Coping Strategies Questionnaire(K-CSQ) (한국판 대처 전략 질문지 (K-CSQ)를 이용한 만성 통증 환자의 통증대처 특성)

  • Song, Ji-Young;Kim, Tae;Yoon, Hyun-Sang;Kim, Chung-Song;Yeom, Tae-Ho
    • Korean Journal of Psychosomatic Medicine
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    • v.10 no.2
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    • pp.110-119
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    • 2002
  • Objectives : Numbers of patients who have chronic pain seem to be increasing in the psychiatric practice. Many investigators have used models of stress and coping to help explain the differences in adjustment found among persons who experience chronic pain. Coping strategies appear to be associated with adjustment in chronic pain patients. The objectives of this study were to develop a self-report questionnaire which is the most widely used measures of pain coping strategies, Coping Strategies Questionnaire (CSQ) into Korean version and to study the different coping strategies with which chronic pain patients frequently use when their pain reaches a moderate or greater level of intensity. Methods : One hundred twenty-eight individuals with chronic pain conditions and two hundred fifty-two normal controls were administered the Korean version-Coping Strategies Questionnaire(KCSQ) to assess the frequency of use and perceived effectiveness of a variety of cognitive and behavioral pain coping strategies. We also obtained their clinical features in chronic pain patients. Reliability of the questionnaire were analyzed and evaluated differences of coping strategies between two groups. Results : Data analysis revealed that the questionnaire was internally reliable. Chronic pain patients reported frequent use of a variety of pain coping strategies, such as coping self-statements, praying and hoping, catastrophizing, and increase behavior scales which were higher compared to the normal controls. Conclusion: K-CSQ revealed to be a reliable self-report questionnaire which is useful for the assessment of coping strategies in clinical setting on chronic pain. And analysis of pain coping strategies may be helpful in understanding pain for chronic pain patients. The individual K-CSQ may have greater utility in terms of examining coping, appraisals, and pain adjustment. A consideration of pain coping strategies may allow one to design pain coping skills training interventions so as to fit the individual chronic pain patient. Further research is needed to determine whether cognitive-behavioral intervention designed to decrease maladaptive coping strategies can reduce pain and improve the physical and psycho-social functioning of chronic patients.

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Study on the Correlation between Refractive error and Components of Eye's Optical system in Children and Teenagers in an Optometric Practice (안과 병원을 내원한 소아 청소년의 굴절이상과 안광학 성분간의 상관관계 연구)

  • Ha, Na-Ri;Kim, Hyun Jung
    • Journal of Korean Ophthalmic Optics Society
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    • v.17 no.1
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    • pp.67-74
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    • 2012
  • Purpose: The purpose of this study to evaluate visual acuity and refractive state and measure and analyze the components of eye's optical system in children and teenagers. Methods: With subjects of 124 (230 eyes) children and teenagers who had no eye diseases, correlation between the correlation between refractive errors and component's of eye's optical system was investigated. The spherical equivalent power of cycloplegic clinical refraction or manifest clinical refraction(SE), corneal power(CP), corneal radius(CR), axial length(AL), anterior chamber depth(ACD) and axial length to corneal radius (AL/CR) ratio were measured and analysed. Results: the SE was negatively correlated with the AL(r = -0.80, p = 0.00), the ACD(r = -0.35, p = 0.00) and the CR(r = -0.11, p=0.00) and positively correlated with the CP(r = +0.11, p=0.00). The AL was positively correlated with the AL/CR ratio (r = +0.84, p = 0.00), the ACD(r = +0.47, p=0.00) and the CR(r = +0.38, p = 0.00) and negatively correlated with the CP(r = -0.38, p=0.00). The CR was negatively correlated with CP(r = -1.00, p = 0.00), the AL/CR ratio(r = -0.19, p = 0.00) and the ACD(r = -0.06, p = 0.39). The CP was positively correlated with the AL/CR ratio(r = +0.19, p = 0.00) and the ACD(r = +0.06, p = 0.39). The ACD was positively correlated with the AL/CR ratio(r = 0.53, p = 0.00). Conclusions: the highest change of refractive errors was shown that the AL/CR ratio was a very important indicator for diagnosing the refractive errors of the children and teenagers.

Complication and Failure Analysis of Fixed Restorations (고정성 보철물과 연관된 합병증과 실패에 관한 조사)

  • Yun, Mi-Jung
    • Journal of Dental Rehabilitation and Applied Science
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    • v.27 no.2
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    • pp.149-159
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    • 2011
  • Restoring and replacing teeth with fixed prostheses commonly used in dental practice. Because of improper oral hygiene care and inaccurate laboratory procedure, complication of fixed prostheses was found in the mouth of patient. Although many efforts have been continually made to obtain the data of long term prognosis of fixed prostheses, it was difficult to do it. The purpose of this study was to evaluate the clinical status of fixed prostheses to improve the quality of dental care. In order to assess the clinical status of fixed prostheses, a total of 154 individuals (aged 22-82, 88 women and 66 men loaded with 578 unit of fixed prostheses, and 423 abutments) who visited the Department of Prosthodontics, Pusan National University Hospital, between January 2009 to December 2009 and removed old fixed prostheses were examined. The results of this study were as follows: 1. Length of service of fixed prostheses was $10.3{\pm}05.5$ years (mean), 10.0 years (median). 2. Location of fixed prostheses was found to have statistically significant influence on longevity of fixed prostheses (P<.05). The longevity of fixed prostheses was high in anterior-posterior combination region (mean:13.1, median:13.5) than anterior and posterior region. 3. Longevity of fixed prostheses made of metal was longest (mean:13.3, median:12.3). 4. Number of units in fixed prostheses was found to have no statistically significant influence on longevity of fixed prostheses (P>.05). 5. Condition of opposing dentition was found to have statistically significant influence on longevity of fixed prostheses (P>.05). The fixed prostheses lasted longest when opposed by complete denture (mean:17.1, median:19.7), removable partial denture, fixed prosthesis and natural dentition trailing behind (P<.05) 6. Periodontal disease (37.5%), dental caries (19.0%), defective margin (18.4%) were frequent complications. In 33.1% of the cases, abutment state after removing fixed prostheses was needed to be extracted.

The Aspect of Music Therapists' Experiences in Countertransference and Countertransference Management Ability (음악치료사의 역전이 경험 양상과 역전이 관리 능력)

  • Yi, So Young
    • Journal of Music and Human Behavior
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    • v.5 no.1
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    • pp.19-45
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    • 2008
  • The purpose of this study was to offer fundamental data to manage countertransference, and to research into countertransference management ability by aspects in therapists' experiences in countertransference and their professional characters. For the paper, a survey was conducted on 62 music therapists who provided professional music therapy after finishing graduate school of music therapy through clinical practice and internship, and the result was drawn as follows. Around 84% of participants answered that they had been in trouble by countertransference in the analysis of a questionnaire regarding experience in countertransference. 48% among them first experienced countertransference during the practice in graduate school. 27% and 14% respectively answered that they experienced it within 3 years after graduation and during internship. Also, the result showed that therapists usually had difficulty with adults with mental disease, and the second most difficult clients were children with developmental disabilities. 76% of participants who had difficulty by countertransference answered that they were able to manage it to some degree, and almost all who answered thought that research into countertransference and management were necessary. About the question as to how to manage countertransference, 54% suggested self-analysis and self-therapy. 33% answered that countertransference should be treated through supervision. Finally, 13% of participants answered that it should be handled in graduate school. In this paper, which empirically examined therapists' experience in countertransference and countertransference management ability had meaning in providing essential basic data for music therapists to apply and manage countertransference for therapists themselves, as well as for clients.

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Factors Associated with Critical Thinking Disposition in Dental Hygiene Students (치위생(학)과 학생의 비판적 사고 성향과 관련 요인)

  • Cho, Young-Sik;Bae, Hyun-Sook;Hwang, Hye-Rim
    • Journal of dental hygiene science
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    • v.11 no.6
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    • pp.543-551
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    • 2011
  • Critical thinking is recognized as core competency for dental hygiene practice. The purpose of this study was to investigate relationship between critical thinking disposition and grade, types of educational programs and satisfaction with interpersonal relationship, major, clinical practice. Total 909 students in associate and baccalaureate dental hygiene educational program completed self-reported questionnaire on critical thinking disposition inventory developed by Yoon(2004). The mean score for critical thinking disposition was 3.38~3.39 on a 5 point scale. There was no difference in critical thinking disposition scores between students of associate and baccalaureate programs. There was no difference in critical thinking disposition scores between grade of students. The results showed a statistically significant relationship between critical thinking disposition and satisfaction with interpersonal relationship and major. Multivariate analysis of variance(MANOVA) revealed that all subscales for three groups according to satisfaction with interpersonal relationship were significantly different(Pillai's trace=0.075, F(14,1782)=4.979, p<0.001) and all subscales for three groups according to satisfaction with major were significantly different(Pillai's trace=0.035, F(14,1728)=2.257, p=0.005).