• Quality Improvement in Health Care
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• v.7 no.2
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• pp.156-167
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• 2000

Background: Emphasis in healthcare during the 1990s has been to provide both optimal wellness and function with quality in a Cost-effective manner. Critical pathway was developed to meet the need to guide clients along the continunm of care and to achieve continuity of care. The purpose of this study is to review and analyze articles related to the critical pathway that had developed and applied in Korea and abroad from 1995 to 1999. Methods: Total 39 studies were analyzed in terms of group of application, need of development, horizontal axis: time frame, vertical axis : items of care, task force team, identification of preliminary critical pathway, validation of preliminary critical pathway, types of final critical pathway, a person who coordinates and effects on critical pathway. Results: In the aspect of group of application, there were various diseases in the overseas than in Korea. In domestic and overseas, the horizontal axis included mainly the time from the start of hospitalization to discharge and vertical axis of the critical pathway included commonly the following nine items : tests, diet, medications, consultations, activity, assessments, treatments, education, discharge planning. Preliminary critical pathway was mainly drawn up through chart review in both. Types of final critical pathway were mostly for medical team use in Korea and were for medical team and patient use in abroad. A person who coordinates critical pathway was mostly nurse in abroad. There was positive effects on critical pathway in both. Conclusion: Staff education and information about critical pathway are needed to use it effectively.

• Women's Health Nursing
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• v.6 no.2
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• pp.234-257
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• 2000

At present in the medical care, the study and effort for producing health service to consider efficiency, effectiveness, and quality are urgently called for because of the difficulty in the keen competition according to the inter- nationalization and opening, the operation in the medical institution service testing system, the change in the medical policy of KDRGs, and the lack of the health care cost increasing rate. As an alternative, the case management for the new management system is introduced in the U.S., and the Critical Pathway that is the method designing the contents of activity and its result has been developed and applied in order to anticipate and manage the patient-outcome for the realization of the cost-effective case-management. Thus, this study intended to analyze the effectiveness to obtain by developing the Critical Pathway presented as the method to improve the quality-betterment and cost effectiveness through the continuous and consistent patient management for the hysterectomy patient and applying it to the real practice. As a study method, this author formed a conceptual framework through considering five Critical Pathway used in the current U.S. and three Critical Pathway presented in the literature to develop the Critical Pathway for the hysterectomy patient, and made out the preliminary Critical Pathway through reviewing the old chart. This author made the verified the validity of the expert group about the developed Critical Pathway, and to confirm the possibility of practice application, completed and settled the final Critical Pathway after using the Critical Pathway to the hysterectomy patient from March 1st to 15th, 1997. Finally, to analyze the application-effect of the developed Critical Pathway, this author offered health care service applying the Critical Pathway to the hysterectomy patient from April 15th to August 31th, 1997. The guide for the Critical Pathway was carried out in advance by outpatient setting nurse for outpatient setting visit before the operation, and after hospitalization the primary nurse monitored the execution degree on the every duty. After discharge this author surveyed the complication through phone visiting, and one month after discharge surveyed the patient's reaction about the offered service when outpatient setting visit and analyzed the result. The source for health care cost was obtained by the statistics about the hospital charge which was offered by the General Business Department. The results were as follows. 1. It was decided that the vertical line of the Critical Pathway was made up of eight items such as monitoring/assessment, treatment, line/drains, activity, medication, lab test, diet, patient teaching, and the horizontal line of the Critical Pathway was made up of from hospitalization to discharge. 2. After the analysis of service contents through reviewing the old chart, it was decided that the horizontal line of the preliminary Critical Pathway was made up of from hopitalization to fourth postoperative day, and the vertical line of it was divided into eight items which were the contents to occur with the time frame of the horizontal line. 3. After the verifying the validity of the expert group about the preliminary Critical Pathway, the horizontal line was amended from hopitalization to third postoperative day, and taking their consensus, some contents of the horizontal line was amended and deleted. 4. From March 1st to 15th, 1997, to confirm the clinical suitability, this author offered eight hysterectomy patients the medical service through the Critical Pathway. The result was that three of them could be discharged at the expected discharge day, and the others later than that day. Supplementing the preliminary Critical Pathway through analyzing the cause of that delay- case, this author developed the final Critical Pathway. 5. There were no significant differences between the experimental and the control group in the incidence of complication(P > 0.05). 6. The 92.4% of experimental group was satisfied with the Critical Pathway service. 7. The length of hospital stay of the experimental group offered with the Critical Pathway service was 4.6 days and there was a significant difference that it was 1.3 days shorter than that of the control group(t=-29.514, P=0.000). 8. There wsa a significant difference that the mean medical charge per one patient of the experimental group offered the Critical Pathway service was cheaper \124,150 than that of the control group(t=-9.826, P=0.000). 9. The result that the author assumed and analyzed hospital income with the rate of turning bed was assumed that the increase of hospital income was \63,245,072 for that study, and the income increase was expected with \68,704,864 for a year. The result that this author applied the Critical Pathway to the hysterectomy patient have no differences in the incidence of complication, high satisfaction with that service, and the length of hospital stay decreased in the experimental group, and the mean hospital charge per one patient decreased, but hospital income increased. Suggestions for further study and nursing practice are as follows. 1. The study to apply the Critical Pathway for a year, verify the validity, and measure the effect repeatedly is needed. 2. To apply and manage the Critical Pathway effectively, the study to computerize it is needed. 3. The study to develop hospital-based Critical Pathway about other diseases or procedure, and measure the effect is needed.

• Genomics & Informatics
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• v.18 no.1
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• pp.11.1-11.3
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• 2020

In genome-wide association studies, pathway-based analysis has been widely performed to enhance interpretation of single-nucleotide polymorphism association results. We proposed a novel method of hierarchical structural component model (HisCoM) for pathway analysis of common variants (HisCoM for pathway analysis of common variants [HisCoM-PCA]) which was used to identify pathways associated with traits. HisCoM-PCA is based on principal component analysis (PCA) for dimensional reduction of single nucleotide polymorphisms in each gene, and the HisCoM for pathway analysis. In this study, we developed a HisCoM-PCA software for the hierarchical pathway analysis of common variants. HisCoM-PCA software has several features. Various principle component scores selection criteria in PCA step can be specified by users who want to summarize common variants at each gene-level by different threshold values. In addition, multiple public pathway databases and customized pathway information can be used to perform pathway analysis. We expect that HisCoM-PCA software will be useful for users to perform powerful pathway analysis.

• Journal of Korean Academy of Nursing Administration
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• v.8 no.4
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• pp.669-689
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• 2002

Purpose : The purpose of the present study is to develop a clinical pathway applied with activity-based management methodology for efficient clinical management to cope with rapid changing medical environments. Method : After making a preliminary pathway based on which a conceptual frame of reference was established to develop a clinical pathway, the final one was confirmed by verifying experts validity and clinical validity. The ultimate activity-based clinical pathway was restructured after clarifying, schematizing and analyzing the whole activities of clinical pathway in accordance with the conducting process of activity-based management. Result : A clinical pathway for total hip replacement was developed, in which the vertical axis consisted of assessment, examination, consultation, medication, treatment, diet, activity, and education, and the horizontal axis was composed of six days of hospitalization. Then, on the basis of the development, the clinical pathway including the improved contents and information was restructured after making the reform measure by analyzing each of activities in the pathway. And the list of contents related to the clinical management activity was made, which was described its main contents and the pre-activities that ought to be completed before conducting each of activities in the pathway. Conclusion : The clinical pathway applied with activity-based management may be used as a standard guidance for providing continuous and consistent patient care. It will provide the information for nursing activities to nurses and the management information about hospital and nursing activities to the hospital administrators. It will also be used as a tool for communication between medical staff. Besides, it will contribute to creating profits for the hospital by shortening the length of stay in patients.

• Women's Health Nursing
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• v.12 no.4
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• pp.316-325
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• 2006

Purpose: The purpose of this study was to develop a Critical Pathway for Uterine Artery Embolization patients. Method: There were 6 steps that were taken. Step 1 was selecting a diagnosis, and Step 2 was organizing a development team consisting of 7 experts. Step 3 analyzed the medical records, and Step 4 drew up a preliminary Critical Pathway. Step 5 tested the clinical validity of the preliminary Critical Pathway, and Step 6 developed the final Critical Pathway. Result: The contents of the medical practices observed in the medical records were investigated in seven areas: monitoring/assessment, treatment, medication, diet, activity, consults, and education/discharge plan; and a total of 73 items was identified. The validity of the 73 items was examined by a group of specialists. 68 items were adopted, 4 items revised, 1 item removed, and 1 item was added. Using the results, a preliminary Critical Pathway was drawn up. According to the results from examining the clinical validity of the preliminary Critical Pathway with five patients for five weeks, 3 items which showed discrepancy were revised and another 3 items were added. Then, the final Critical Pathway was completed. Conclusion: This Critical Pathway needs to be clinically applied and continuously to measure its effects in terms of the length of stay, cost.effectiveness, and the patients' and staffs' satisfaction.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1998.11a
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• pp.158-158
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• 1998

The non-mevalonate pathway is a newly discovered isoprenoid biosynthetic pathway in some bacteria, cyanobacteria, algae and plants. Because isoprenoid metabolites (ubiquinone, menaquinone, undecaprenol) are essential for bacterial growth, this pathway may represent a novel target for antibacterial agents. Antibiotics with a unique mechanism of action are needed to combat the risk of antibiotic resistance that is a current worldwide problem. In order to study this pathway as viable target, it was necessary to verify use of the pathway in our model system, the bacterium Bacillus subtilis. Incubation experiments with [6,6-$^2$H$_2$]-D-glucose and [l-$^2$H$_3$]-deoxy-D-xylulose were conducted to provide labeled menaquinone-7 (MK -7), the most abundant isoprenoid in B. subtilis. $^2$H-NMR analysis of the MK-7 revealed labeling patterns that strongly support utilization of the non-mevalonate pathway. Another approach to study the pathway is by structure activity relationships of proposed inhibitors of the pathway. Fosmidomycin is a phosphonic acid with antibacterial activity known to inhibit isoprenoid biosynthesis in susceptible bacteria and may act by inhibiting the non-mevalonate pathway. Fosmidomycin and an N-methyl analog were synthesized and tested for antibacterial activity. Fosmidomycin was active against Escherichia coli and B. subtilis, while N-formyl-N-methyl-3-amino-propylphosphonic acid was inactive.

• BMB Reports
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• v.51 no.3
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• pp.106-118
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• 2018

How the organ size is adjusted to the proper size during development and how organs know that they reach the original size during regeneration remain long-standing questions. Based on studies using multiple model organisms and approaches for over 20 years, a consensus has been established that the Hippo pathway plays crucial roles in controlling organ size and maintaining tissue homeostasis. Given the significance of these processes, the dysregulation of the Hippo pathway has also implicated various diseases, such as tissue degeneration and cancer. By regulating the downstream transcriptional coactivators YAP and TAZ, the Hippo pathway coordinates cell proliferation and apoptosis in response to a variety of signals including cell contact inhibition, polarity, mechanical sensation and soluble factors. Since the core components and their functions of the Hippo pathway are evolutionarily conserved, this pathway serves as a global regulator of organ size control. Therefore, further investigation of the regulatory mechanisms will provide physiological insights to better understand tissue homeostasis. In this review, the historical developments and current understandings of the regulatory mechanism of Hippo signaling pathway are discussed.

• Communications for Statistical Applications and Methods
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• v.26 no.4
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• pp.411-430
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• 2019

Tumor development is driven by complex combinations of biological elements. Recent advances suggest that molecularly distinct subtypes of breast cancers may respond differently to pathway-targeted therapies. Thus, it is important to dissect pathway disturbances by integrating multiple molecular profiles, such as genetic, genomic and epigenomic data. However, missing data are often present in the -omic profiles of interest. Motivated by genomic data integration and imputation, we present a new statistical framework for pathway significance analysis. Specifically, we develop a new strategy for imputation of missing data in large-scale genomic studies, which adapts low-rank, structured matrix completion. Our iterative strategy enables us to impute missing data in complex configurations across multiple data platforms. In turn, we perform large-scale pathway analysis integrating gene expression, copy number, and methylation data. The advantages of the proposed statistical framework are demonstrated through simulations and real applications to breast cancer subtypes. We demonstrate superior power to identify pathway disturbances, compared with other imputation strategies. We also identify differential pathway activity across different breast tumor subtypes.

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

• Asian Oncology Nursing
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• v.4 no.2
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• pp.110-123
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• 2004

The purpose of this study was to develop a clinical pathway for the allogeneic bone marrow transplantation donor. For this study, a conceptual framework was developed through a review of the literature including six steps which are using in Jones Hopkins Hospital. USA. The researcher reviewed 129 medical re-cords of donor who had bone marrow donation between January 2002 to January 2004, to identify the overall service contents required by these patients and to make a preliminary clinical pathway. A content validity test was done for the preliminary clinical pathway, a professional group screened 51 medical re-cords and adopted with 3 hospitalization days as the clinical pathway framework. In the fifth step, clinical pathway test was also done to 7 donors from April 28th to July, 2004. After these processes the final clinical pathway was developed. The results of this study are as follows: 1. The vertical axis of the clinical pathway Includes the following 9 items: vital signs, nursing assessment, activity, diet, intervention, medication, test, consultation and patient teaching. The duration of the horizontal axis was 3days from admission to discharge 2. Analysis of the 129 medical records indicated that the average length of stay was 3 4 days. The medical performance according to the vertical axis in the preliminary clinical pathway consisted of 51 items After clinical validity test, it steel consisted of 51 items in the final form. 3. Clinical Validity test was done to 7 bone marrow donors. During these process, The first patient was deleted because he was out of the criteria the investigate set and 6 patients were used, finally The result of this study indicated all of 7 donors were discharged on expected day. 4. Clinical pathway enables to improve the quality of care, multidisciplinary team work It also helps nursing bone marrow donor, effective education to donor or medical member. The results of this study suggest that clinical pathway may be able to improve the quality of nursing care for bone marrow transplantation donors.