• Title/Summary/Keyword: Clinical decision making

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Concept Analysis of Well-dying in Korean Society (한국사회의 웰다잉 개념분석)

  • Kim, Gahye;Park, Yeon-Hwan
    • Journal of muscle and joint health
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    • v.27 no.3
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    • pp.229-237
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    • 2020
  • Purpose: This paper aims to clarify the concept of well-dying in the sociocultural context of Korea. Methods: Walker and Avant's method was chosen for the concept analysis. Through a literature review of 36 papers, the attributes and definition of well-dying were derived. Results: The literature revealed that in Korean society, well-dying is defined as the process of actively preparing for death throughout life. The attributes of the concept are a reflection on death, death acceptance, searching for meaning, transcendence, advance decision-making, and sharing values with family. The motivation for thinking about death, the hope of dying with dignity, and the Korean cultural view of death precede the concept, followed by dying with dignity, personal and family happiness, and improved quality of life and death. Conclusion: This study may lead to the unification of concept use based on mutual understanding, thus enabling effective communication in research, education, and clinical settings. This can be the rationale for the development of tools and educational programs as well as establishing policies related to well-dying in Korea.

Comparative Effects and Ranks of Repositioning for Pressure Ulcer Prevention in Adults: A Network Meta-analysis (욕창예방을 위한 체위변경 중재 효과의 비교순위: 네트워크 메타분석)

  • Ko, Ji Woon
    • Journal of muscle and joint health
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    • v.29 no.1
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    • pp.18-27
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    • 2022
  • Purpose: A network meta-analysis was conducted to assess the comparative effects and ranks of repositioning for pressure ulcer prevention in adults. Methods: A network meta-analysis was performed in a frequency method, using the "netmeta" package of R software version 4.1. The effects of repositioning intervention were confirmed by the odds ratio. The comparative ranking of the repositioning effects was confirmed using the cumulative probability (P-score). Results: Seven intervention studies were included in this study. Based on the P-score, the use of the repositioning system was ranked as the most effective among all interventions (P-score 78.7%). Next was 3~4-hour repositioning combined with memory foam mattress use (P-score 77.2%), use of wearable sensor (P-Score 61.4%), 2-hour repositioning combined with memory foam mattress use (P-score 59.1%), 2-hour repositioning combined with powered air pressure redistribution mattress use (P-score 18.0%), and 4-hour repositioning combined with powered air pressure redistribution mattress use (P-score 18.0%). Conclusion: This study provides information on the relative comparative value of various repositioning interventions to prevent pressure ulcers using network meta-analysis. This is expected to be useful for nurses' decision-making when applying repositioning interventions in clinical practice

Emergency Nurses' Critical Thinking Disposition, Problem Solving Ability, and Triage Competency (중증도 분류간호사의 비판적 사고성향, 문제해결능력과 중증도 분류역량)

  • Park, Jae Hyung;Bae, Sun Hyoung
    • Journal of muscle and joint health
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    • v.29 no.2
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    • pp.124-132
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    • 2022
  • Purpose: The purpose of this study was to investigate the relationships among critical thinking disposition, problem solving ability, and triage competency in nurses working in Emergency Rooms (ERs). Methods: This cross-sectional study, conducted in August and September 2021, involved 118 ER nurses from three hospitals in the Gyeonggi-do metropolitan area. The data were analyzed using t-test, ANOVA, Scheffé test, Pearson correlation coefficients, and multiple linear regression analysis using SPSS for Windows version 25.0. Results: The mean score of triage competency among ER nurses was 87.63±15.65. In the regression model, age, ER experience, triage experience, critical thinking disposition, and problem solving ability predicted 52% of the triage competency. Both critical thinking disposition and problem-solving ability were noted to be significant (β=.32, p<.001; β=.36, p<.001, respectively). Conclusion: Critical thinking disposition and problem solving ability of ER nurses were identified as major factors in triage competency. To improve ER nurses' triage competency and enhance critical thinking disposition and problem solving ability, a systematic and ongoing program should be developed and implemented.

Prediction of Survival in Patients with Advanced Cancer: A Narrative Review and Future Research Priorities

  • Yusuke Hiratsuka;Jun Hamano;Masanori Mori;Isseki Maeda;Tatsuya Morita;Sang-Yeon Suh
    • Journal of Hospice and Palliative Care
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    • v.26 no.1
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    • pp.1-6
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    • 2023
  • This paper aimed to summarize the current situation of prognostication for patients with an expected survival of weeks or months, and to clarify future research priorities. Prognostic information is essential for patients, their families, and medical professionals to make end-of-life decisions. The clinician's prediction of survival is often used, but this may be inaccurate and optimistic. Many prognostic tools, such as the Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and Prognosis in Palliative Care Study, have been developed and validated to reduce the inaccuracy of the clinician's prediction of survival. To date, there is no consensus on the most appropriate method of comparing tools that use different formats to predict survival. Therefore, the feasibility of using prognostic scales in clinical practice and the information wanted by the end users can determine the appropriate prognostic tool to use. We propose four major themes for further prognostication research: (1) functional prognosis, (2) outcomes of prognostic communication, (3) artificial intelligence, and (4) education for clinicians.

Recovery Outcomes Following Laparoscopic Surgery in Overweight Rectal Cancer Patients (과체중 직장암 환자의 복강경 수술 회복성과)

  • Woo, Sang Jun;Lee, Eun Sook;Kim, Hyeong Rok
    • Journal of Korean Clinical Nursing Research
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    • v.15 no.3
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    • pp.17-26
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    • 2009
  • Purpose: The purpose of this study was to compare the recovery outcomes between a normal weight group (BMI<25) and an overweight group ($$BMI{\geq_-}25$$), who received laparoscopic surgery for rectal cancer, to provide information for effective decision making. Methods: Data from 76 patients who received laparoscopic surgery for rectal cancer in a university hospital were reviewed retrospectively from September 2004 to March 2007. Collected data were analyzed using Win SPSS 12.0. The recovery outcomes related to the operation were the length of the operation, the amount of bleeding during the operation, the length of stay in the recovery room, first bowel movement, the length of hospital stay, and complications. Results: There was no statistical difference between the two groups with regard to the recovery outcomes. Conclusion: From the above results, nursing information can be offered to help make effective decisions before the operation for overweight patients with rectal cancer who prefer laparoscopic surgery.

A Study on Diabetes Management System Based on Logistic Regression and Random Forest

  • ByungJoo Kim
    • International journal of advanced smart convergence
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    • v.13 no.2
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    • pp.61-68
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    • 2024
  • In the quest for advancing diabetes diagnosis, this study introduces a novel two-step machine learning approach that synergizes the probabilistic predictions of Logistic Regression with the classification prowess of Random Forest. Diabetes, a pervasive chronic disease impacting millions globally, necessitates precise and early detection to mitigate long-term complications. Traditional diagnostic methods, while effective, often entail invasive testing and may not fully leverage the patterns hidden in patient data. Addressing this gap, our research harnesses the predictive capability of Logistic Regression to estimate the likelihood of diabetes presence, followed by employing Random Forest to classify individuals into diabetic, pre-diabetic or nondiabetic categories based on the computed probabilities. This methodology not only capitalizes on the strengths of both algorithms-Logistic Regression's proficiency in estimating nuanced probabilities and Random Forest's robustness in classification-but also introduces a refined mechanism to enhance diagnostic accuracy. Through the application of this model to a comprehensive diabetes dataset, we demonstrate a marked improvement in diagnostic precision, as evidenced by superior performance metrics when compared to other machine learning approaches. Our findings underscore the potential of integrating diverse machine learning models to improve clinical decision-making processes, offering a promising avenue for the early and accurate diagnosis of diabetes and potentially other complex diseases.

Demand-supply of Advanced Practice Nurse (APN) and Alternative Benefit Strategies in the National Health Insurance (전문간호사의 수급 현황과 건강보험 급여화 방안)

  • Kim, Jin-Hyun
    • Perspectives in Nursing Science
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    • v.7 no.1
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    • pp.23-35
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    • 2010
  • Purpose: The purpose of this paper is to analyze the demand and supply of advanced practice nurses and suggest alternative benefit strategies in the Korean national health insurance. Methods: A revised demand & supply model was used to estimate the excess supply of APNs, and policy making process and key actors in the Korean health insurance were considered to develop a political approach to the APN issue. Results: The social demand for APNs is currently estimated to be less than 50% of its supply and the APN education program fell into difficulties in recruits. No reimbursement mechanism for APN's services in the national health insurance has given no economic incentive to hospital managers who have monopsony power in nursing labor market, which has caused the demand shortage of APNs in hospital industry. Payment for APN's services recognized as one of the most significant strategies to booster the social demand for APN's services should be carefully designed and implemented in the national health insurance. In line with this, key actors in health insurance policy decision-making include government, national assembly, labor unions, NGOs, civic groups, medical associations, and academia. Conclusion: The basic researches for APN's activities and cost-effectiveness analysis in clinical settings are required to support the strategies aforementioned. Constructing a policy network among key actors is able to make the payment strategy feasible, which will increase the socal demand for APNs.

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The Study about Personal Color System with Hair color and Make-up - Centering around the Autumn type - (개인(個人) 색채(色彩) 진단(診斷)에 따른 모발(毛髮)과 메이크업 색상(色相)의 변화(變化) - 가을 타입의 모델을 중심(中心)으로 -)

  • Na, Hae-Yun;Cho, Koh-Mi;Lee, Su-Hee
    • Journal of Fashion Business
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    • v.9 no.2
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    • pp.20-27
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    • 2005
  • To find suitable color for an individual is very important in personal image-making. In recent years, the importance and role of personal image is also more emphasized. This study deals with the necessity d personal color system and the proposal of color which looks nice on a person as a result d personal color system. It also includes the method of making personal image by balancing between and using both favorite color and unfavorite color. Besides, I study how does the color image affect the personal appearance image in this paper. From clinical experiments, I concluded as follow. First, Each person has his suitable color. When the color is used, the color, pimples, flows and so on are covered and defects of his face are made up for. Second, By changing the factors of his own original color-group and decision factors - color d skin, hair, eye, etc -, I can change personal color-group. Third, The image of color affects the personal appearance image, when it used in make-up and hair-color. Considering above results, If one uses one's suitable color, one will complement defects done's face and improve merits of one's. Besides, One will be more confident and active by using one's suitable color.

A multi-dimensional approach to disaster mental health and the roles and contributions of social work field (재난 정신건강서비스에서 사회복지분야의 역할과 개입전략 : 다차원적 접근 모델)

  • Kim, Yeunhee
    • Korean Journal of Social Welfare Studies
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    • v.42 no.4
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    • pp.5-34
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    • 2011
  • There have been increasing incidents of natural and social disasters that claimed many lives and caused financial calamities worldwide, which call for an attention to mental health issues affecting disaster victims. This study reviewed the findings of the empirical research on the effects of disaster on the victims, the prevalence and determinants of the mental health problems. The disaster tends to disproportionately affect the socio-economically disadvantaged population and their mental health problems and recovery seemed to be heavily influenced by post-disaster experiences such as restoration of physical environment, prospect of economic recovery and resumption of normalcy in their lives, opportunities for participation in decision-making that affect their lives. Such findings suggest that the disaster mental health should shift from its traditional approach that focuses on short-term clinical interventions to alleviate acute mental distress for the victims to a public health approach that involve medical, social and economic interventions as well as community empowerment to prevent chronicity of the mental health problems and to improve the general quality of life of the individuals and the community adversely affected by the disaster. Implications for the social work research, policy making, education and practice were discussed.

Prognostic Factor Analysis of Overall Survival in Gastric Cancer from Two Phase III Studies of Second-line Ramucirumab (REGARD and RAINBOW) Using Pooled Patient Data

  • Fuchs, Charles S.;Muro, Kei;Tomasek, Jiri;Van Cutsem, Eric;Cho, Jae Yong;Oh, Sang-Cheul;Safran, Howard;Bodoky, Gyorgy;Chau, Ian;Shimada, Yasuhiro;Al-Batran, Salah-Eddin;Passalacqua, Rodolfo;Ohtsu, Atsushi;Emig, Michael;Ferry, David;Chandrawansa, Kumari;Hsu, Yanzhi;Sashegyi, Andreas;Liepa, Astra M.;Wilke, Hansjochen
    • Journal of Gastric Cancer
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    • v.17 no.2
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    • pp.132-144
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    • 2017
  • Purpose: To identify baseline prognostic factors for survival in patients with disease progression, during or after chemotherapy for the treatment of advanced gastric or gastroesophageal junction (GEJ) cancer. Materials and Methods: We pooled data from patients randomized between 2009 and 2012 in 2 phase III, global double-blind studies of ramucirumab for the treatment of advanced gastric or GEJ adenocarcinoma following disease progression on first-line platinum- and/or fluoropyrimidine-containing therapy (REGARD and RAINBOW). Forty-one key baseline clinical and laboratory factors common in both studies were examined. Model building started with covariate screening using univariate Cox models (significance level=0.05). A stepwise multivariable Cox model identified the final prognostic factors (entry+exit significance level=0.01). Cox models were stratified by treatment and geographic region. The process was repeated to identify baseline prognostic quality of life (QoL) parameters. Results: Of 1,020 randomized patients, 953 (93%) patients without any missing covariates were included in the analysis. We identified 12 independent prognostic factors of poor survival: 1) peritoneal metastases; 2) Eastern Cooperative Oncology Group (ECOG) performance score 1; 3) the presence of a primary tumor; 4) time to progression since prior therapy <6 months; 5) poor/unknown tumor differentiation; abnormally low blood levels of 6) albumin, 7) sodium, and/or 8) lymphocytes; and abnormally high blood levels of 9) neutrophils, 10) aspartate aminotransferase (AST), 11) alkaline phosphatase (ALP), and/or 12) lactate dehydrogenase (LDH). Factors were used to devise a 4-tier prognostic index (median overall survival [OS] by risk [months]: high=3.4, moderate=6.4, medium=9.9, and low=14.5; Harrell's C-index=0.66; 95% confidence interval [CI], 0.64-0.68). Addition of QoL to the model identified patient-reported appetite loss as an independent prognostic factor. Conclusions: The identified prognostic factors and the reported prognostic index may help clinical decision-making, patient stratification, and planning of future clinical studies.