• Title/Summary/Keyword: Score ratio

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Pain Passport as a tool to improve analgesic use in children with suspected fractures in emergency departments

  • Hwang, Soyun;Choi, Yoo Jin;Jung, Jae Yun;Choi, Yeongho;Ham, Eun Mi;Park, Joong Wan;Kwon, Hyuksool;Kim, Do Kyun;Kwak, Young Ho
    • The Korean Journal of Pain
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    • v.33 no.4
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    • pp.386-394
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    • 2020
  • Background: In the emergency department (ED), adequate pain control is essential for managing patients; however, children with pain are known to receive less analgesia than adults with pain. We introduce the Pain Passport to improve pain management in paediatric patients with suspected fractures in the ED. Methods: This was a before-and-after study. We reviewed the medical records of paediatric patients who were primarily diagnosed with fractures from May to August 2015. After the introduction of the Pain Passport, eligible children were enrolled from May to August 2016. Demographics, analgesic administration rates, time intervals between ED arrival and analgesic administration, and satisfaction scores were obtained. We compared the analgesic prescription rate between the two periods using multiple logistic regression. Results: A total of 58 patients were analysed. The baseline characteristics of subjects during the two periods were not significantly different. Before the introduction of the Pain Passport, 9 children (31.0%) were given analgesics, while after the introduction of the Pain Passport, a significantly higher percentage of patients (24/29, 82.8%) were treated with analgesics (P < 0.001). The median administration times were 112 (interquartile range [IQR], 64-150) minutes in the pre-intervention period and 24 (IQR, 20-74) minutes in the post-intervention period. The median satisfaction score for the post-intervention period was 4 (IQR, 3-5). The adjusted odds ratio for providing analgesics in the post-intervention period was 25.91 (95% confidence interval, 4.36-154.02). Conclusions: Patient-centred pain scoring with the Pain Passport improved pain management in patients with suspected fractures in the paediatric ED.

Preoperative Therapy Regimen Influences the Incidence and Implication of Nodal Downstaging in Patients with Gastric Cancer

  • Stark, Alexander P.;Blum, Mariela M.;Chiang, Yi-Ju;Das, Prajnan;Minsky, Bruce D.;Estrella, Jeannelyn S.;Ajani, Jaffer A.;Badgwell, Brian D.;Mansfield, Paul;Ikoma, Naruhiko
    • Journal of Gastric Cancer
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    • v.20 no.3
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    • pp.313-327
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    • 2020
  • Purpose: Nodal downstaging after preoperative therapy for gastric cancer has been shown to impart excellent prognosis, but this has not been validated in a national cohort. The role of neoadjuvant chemoradiation (NACR) in nodal downstaging remains unclear when compared with that of neoadjuvant chemotherapy alone (NAC). Furthermore, it is unknown whether the prognostic implications of nodal downstaging differ by preoperative regimen. Materials and Methods: Using the National Cancer Database, overall survival (OS) duration was compared among natural N0 (cN0/ypN0), downstaged N0 (cN+/ypN0), and nodepositive (ypN+) gastric cancer patients treated with NACR or NAC. Factors associated with nodal downstaging were examined in a propensity score-matched cohort of cN+ patients, matched 1:1 by receipt of NACR or NAC. Results: Of 7,426 patients (natural N0 [n=1,858, 25.4%], downstaged N0 [n=1,813, 24.4%], node-positive [n=3,755, 50.4%]), 58.2% received NACR, and 41.9% received NAC. The median OS durations of downstaged N0 (5.1 years) and natural N0 (5.6 years) patients were similar to one another and longer than that of node-positive patients (2.1 years) (P<0.001). In the matched cohort of cN+ patients, more recent diagnosis (2010-2015 vs. 2004-2009) (odds ratio [OR], 2.57; P<0.001) and NACR (OR, 2.02; P<0.001) were independently associated with nodal downstaging. The 5-year OS rate of downstaged N0 patients was significantly lower after NACR (46.4%) than after NAC (57.7%) (P=0.003). Conclusions: Downstaged N0 patients have the same prognosis as natural N0 patients. Nodal downstaging occurred more frequently after NACR; however, the survival benefit of nodal downstaging after NACR may be less than that when such is achieved by NAC.

A COMPARATIVE STUDY ON CRONIN TRIANGULAR FLAP AND ROTATION-ADVANCEMENT REPAIR IN UNILATERAL COMPLETE CLEFT LIP (편측성 완전구순열에서 Cronin 삼각피판법과 회전신전법에 의한 수복의 비교)

  • Ryu, Sun-Youl;Yun, Cheon-Ju
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.23 no.5
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    • pp.415-421
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    • 2001
  • The present study was carried out to compare the postoperative results of Cronin triangular flap and Millard rotation-advancement repair techniques in repairing the unilateral complete cleft lip. Thirteen patients with unilateral complete cleft lip underwent 6 Cronin triangular flap and 7 Millard rotation-advancement repairs at the Department of Oral and Maxillofacial Surgery of Chonnam University Hospital over a period of 6 years (January 1994 to December 1999). The surgical results following the operation were assessed on the basis of scoring, vertical lip length and scar hypertrophy. The mean score was better in Cronin triangular flap group($74.77{\pm}0.86$) than in Millard rotation-advancement group($66.50{\pm}1.14$) for both lip and nose segments. Scar hypertrophy developed in the Millard rotation-advancement repair group with 28.6% incidence but not in the Cronin triangular flap group. No significant difference was found in the ratio of lip length between Millard rotation-advancement repair and Cronin triangular flap groups($0.73{\pm}0.10$ and $0.80{\pm}0.96$). These results suggest that Cronin triangular flap shows better results than Millard rotation-advancement repair in repairing the unilateral complete cleft lip.

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A Pilot Study of Rural Women Leader's Psychological Trap for Getting Some Informations to Reinvent One's Life (여성농업인 리더의 생애경험을 통한 심리적 장애요인에 관한 소고)

  • Kim, Gyung-Mee;Lee, Jin-Young;Choi, Yoon-Ji
    • Journal of Agricultural Extension & Community Development
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    • v.13 no.1
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    • pp.149-171
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    • 2006
  • This is a pilot study on rural women's psychological trap to define some obstacles to self directed learning. During few decades, according to major crop of each farm household has shifted from rice to other crops like as vegetables, fruits, horticultures, livestock, etc., women's role or labor sharing of women in farming has been also increased. Although women are important human resources, till now, there is no a research or an approach to rural woman on the view of individual human being. Therefore this study will contribute to understand woman's behavior or attitudes based on psychological description at each person's experiences. For this study, the data was collected from 23 women leaders who participated in a training course in 2005, through the scale of Jeffrey E. Young & Janet S. Klosko which was developed to improvement of one's repetitious behavior based on cognitive psychological care. It was categorized into 11types of psychological trap of one person, named as follows; (1) trap of being deserted by someone (2) trap of disbelief and being ill-treated (3) trap of weakness (4) trap of dependence (5) trap of emotional deprivation (6) trap of feelings of alienation among society (7) trap of deficiency (8) trap of anxiety to failure (9) trap of subordination (10) trap of the merciless standard by self-estimation (11) trap of the sense of privilege. From the data, the average age of subjects was 52.8years old, and the educational back of subjects was higher than general rural women. In both of the trap of weakness and the trap of the merciless standard by self-estimation, the ratio of over and 4 point score of 6 points was 71.4% and 76.2%. It means most of subjects have experienced fear of unexpected calamity(trap of weakness), and mental press hard for efforts to meet one's ideal standard(trap of the merciless standard by self-estimation). Especially the trap of the merciless standard by self-estimation may have relation with rural women's over burden from farming and local society activities.

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Bayesian Network Analysis for the Dynamic Prediction of Financial Performance Using Corporate Social Responsibility Activities (베이지안 네트워크를 이용한 기업의 사회적 책임활동과 재무성과)

  • Sun, Eun-Jung
    • Management & Information Systems Review
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    • v.34 no.5
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    • pp.71-92
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    • 2015
  • This study analyzes the impact of Corporate Social Responsibility (CSR) activities on financial performances using Bayesian Network. The research tries to overcome the issues of the uniform assumption of a linear function between financial performance and CSR activities in multiple regression analysis widely used in previous studies. It is required to infer a causal relationship between activities of CSR which have an impact on the financial performances. Identifying the relationship would empower the firms to improve their financial performance by informing the decision makers about the different CSR activities that influence the financial performance of the firms. This research proposes General Bayesian Network (GBN) and presents Markov Blanket induced from GBN. It is empirically demonstrated that all the proposals presented in this study are statistically significant by the results of the research conducted by Korean Economic Justice Institute (KEJI) under Citizen's Coalition for Economic Justice (CCEJ) which investigated approximately 200 companies in Korea based on Korean Economic Justice Institute Index (KEJI index) from 2005 to 2011. The Bayesian Network to effectively infer the properties affecting financial performances through the probabilistic causal relationship. Moreover, I found that there is a causal relationship among CSR activities variable; that is Environment protection is related to Customer protection, Employee satisfaction, and firm size; Soundness is related to Total CSR Evaluation Score, Debt-Assets Ratio. Though the what-if analysis, I suggest to the sensitive factor among the explanatory variables.

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Calculation of Human Resources for Medical Technologist in Diagnostic Testing (진단검사분야의 임상병리사 인력산정에 관한 연구)

  • Yang, Byoung Seon;Lim, Yong;Kim, Yoon Sik;Oh, Yeon Suk;Bae, Do Hee;Choi, Se Mook
    • Korean Journal of Clinical Laboratory Science
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    • v.52 no.2
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    • pp.158-163
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    • 2020
  • This study examines and presents reasonable improvement measures for the operation and revision of the relative value scoring system, and the basis for performance of a medical technologist. Seven hospitals were enrolled in the study, and included 5 resident laboratory medicine specialists and 53 medical technologists, giving a ratio of 10.6 technologists per laboratory medicine specialist. The average of professional manpower scores was 18, and the average of each medical institution's total score was 78. Ratings and additional rates were in the range 2~3%, and quality-added ratios were 2~3%, with no significance. Excluding pathological testing and assessing physiological functions, the average number of diagnostic tests for health insurance claims were 9,618,062, including 4,378,146 points for 5% of the total relative value scores. According to the DEA, the appropriate number of medical technologist is one person per 49,974 points of relative value. In conclusion, our study results indicate that it would be desirable to set the appropriate workforce for medical technologist to one person per 50,000 points of relative value. Our data could be used as a basis for enhancing productivity of the workforce and balancing health care resources.

Studies for Reestabilishment of Approval Toxin Amount in Paralytic Shellfish Poison-Infested Shellfish 5. Comparison of Toxicity and Toxin Composition of Paralytic Shellfish Poison between Blue mussel, Mytilus edulis and Oyster, Crassostrea gigas

  • Shin, Il-Shik;Kim, Young-Man
    • Journal of Food Hygiene and Safety
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    • v.15 no.4
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    • pp.287-292
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    • 2000
  • The toxicity and toxin composition between blue mussel, Mytilus edulis and oyster, Crassostrea gigas collected at Woepori in Ko je island in South Coast of Korea in 1996 and 1997 were compared. The highest toxicity score was about 10 times higher in blue mussel than oyster (blue mussel, 8,670 $\mu\textrm{g}$; oyster, 860$\mu\textrm{g}$ in 1996, blue mussel, 5,657 $\mu\textrm{g}$/100g in 1997). The blue mussel also retained its toxicity for slightly longer period than oyster. In the both shellfish, PSP was composed almost exclusively of C toxicity (Cl and C2, 20~65%) and gonyautoxins (GTXl, 2, 3, and 4, 38~78%). In the early period of toxin accumulation, the ratio of 11$\beta$-epimer toxins (C2, GTX4) whose amount was 25~56 mole% (5th March to 12th April in 1996) and 25~80 mole% (18th March to 7th April in 1997), were higher than that of 11-epimer toxins (Cl, GTX2) whose amount was 41~57 mol%(27th May to 3rd June in 1996) and 25~56 mole% (29th April to 12th May in 1997), became higher than that of 11-epimer toxins. The toxin compositions in the both samples changed on a daily basis, presumably owing to metabolism of the toxin in the bivalves.

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Household Types and Changes of Work-Family Time Allocation - Adapting Fuzzy-set Ideal Type Analysis - (일-가족 시간배분에 따른 가구유형과 변화 - 퍼지셋 이상형 분석의 적용 -)

  • Kim, Jin-Wook;Choi, Young-Jun
    • Korean Journal of Social Welfare
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    • v.64 no.2
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    • pp.31-54
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    • 2012
  • Along with increasing mothers' employment, work-family reconciliation has been recognised as a key policy agenda in contemporary welfare states. Although various policy instruments have been introduced and expanded in recent years, the problem of time allocation within couples still remains as a fundamental issue, which has been largely underresearched at a micro perspective. In this context, this study aims to identify dominant types of work-family time allocation within married couple, and to apply these types to the Korean case using the fuzzy-set ideal type analysis. Further, a series of multiple regression analyses will be implemented to find factors affecting each ideal type of work-family time allocation. The 1999 and 2009 Korea Time Use Survey datasets will be adopted for the analyses. Married couples are selected as samples only when men work 40 hours or more per week and they have at least one pre-school child. Empirical analyses cover three parts. First of all, four ideal types on work-family time allocation are classified by intersecting two core variables - the ratio of men's (paid) working and family (caring time plus domestic work) time to total working and family time. In this research, the four types will be labelled the traditional male breadwinner model (TM, high working and low family time), the dual burden model (DB, shared working but low family time), the family-friendly male breadwinner model (FM, high working but shared family time), and the adaptive partnership model (AP, shared working and shared family time). By comparing the composition of the four ideal types in 1999 and 2009, it will examine the trend of work-family time allocation in Korea. In addition, multiple regressions will be useful for investigating which characteristics contribute to the different degree of each fuzzy ideal score in the four models. Finally, policy implications and further research agenda will be discussed.

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The Prognostic Value of the Charlson's Comorbidity Index in Patients with Prolonged Acute Mechanical Ventilation: A Single Center Experience

  • Song, Seung Eon;Lee, Sang Hee;Jo, Eun-Jung;Eom, Jung Seop;Mok, Jeong Ha;Kim, Mi-Hyun;Kim, Ki Uk;Lee, Min Ki;Lee, Kwangha
    • Tuberculosis and Respiratory Diseases
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    • v.79 no.4
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    • pp.289-294
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    • 2016
  • Background: The aim of our study was to evaluate the prognostic value of Charlson's weighted index of comorbidities (WIC) in patients with prolonged acute mechanical ventilation (PAMV, ventilator care ${\geq}96$ hours). Methods: We retrospectively enrolled 299 Korean PAMV patients who were admitted in a medical intensive care unit (ICU) of a university-affiliated tertiary care hospital between 2008 and 2013. Survivors were defined as patients who survived for 60 days after ICU admission. Results: The patients' mean age was $65.1{\pm}14.1$ years and 70.6% were male. The mean ICU and hospital length of stay was $21.9{\pm}19.7$ and $39.4{\pm}39.1$ days, respectively. In addition, the 60-day mortality rate after ICU admission was 35.5%. The mean WIC was $2.3{\pm}1.8$, with significant differences between nonsurvivors and survivors ($2.7{\pm}2.1$ vs. $2.1{\pm}1.7$, p<0.05). The area under the curve of receiver-operating-characteristics curve for WIC was 0.593 (95% confidence interval [CI], 0.523-0.661; p<0.05). Based on Kaplan-Meier curves of 60-day survival, WIC ${\geq}5$ had statistically lower survival than WIC <5 (logrank test, p<0.05). In a multivariate Cox proportional hazard model, WIC ${\geq}5$ was associated with poor prognosis (hazard ratio, 1.901; 95% CI, 1.140-3.171; p<0.05). The mortality rate of patients with WIC ${\geq}5$ was 54.2%. Conclusion: Our study showed a WIC score ${\geq}5$ might be helpful in predicting 60-day mortality in PAMV patients.

Increased Cellular NAD+ Level through NQO1 Enzymatic Action Has Protective Effects on Bleomycin-Induced Lung Fibrosis in Mice

  • Oh, Gi-Su;Lee, Su-Bin;Karna, Anjani;Kim, Hyung-Jin;Shen, AiHua;Pandit, Arpana;Lee, SeungHoon;Yang, Sei-Hoon;So, Hong-Seob
    • Tuberculosis and Respiratory Diseases
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    • v.79 no.4
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    • pp.257-266
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    • 2016
  • Background: Idiopathic pulmonary fibrosis is a common interstitial lung disease; it is a chronic, progressive, and fatal lung disease of unknown etiology. Over the last two decades, knowledge about the underlying mechanisms of pulmonary fibrosis has improved markedly and facilitated the identification of potential targets for novel therapies. However, despite the large number of antifibrotic drugs being described in experimental pre-clinical studies, the translation of these findings into clinical practices has not been accomplished yet. NADH:quinone oxidoreductase 1 (NQO1) is a homodimeric enzyme that catalyzes the oxidation of NADH to $NAD^+$ by various quinones and thereby elevates the intracellular $NAD^+$ levels. In this study, we examined the effect of increase in cellular $NAD^+$ levels on bleomycin-induced lung fibrosis in mice. Methods: C57BL/6 mice were treated with intratracheal instillation of bleomycin. The mice were orally administered with ${\beta}$-lapachone from 3 days before exposure to bleomycin to 1-3 weeks after exposure to bleomycin. Bronchoalveolar lavage fluid (BALF) was collected for analyzing the infiltration of immune cells. In vitro, A549 cells were treated with transforming growth factor ${\beta}1$ (TGF-${\beta}1$) and ${\beta}$-lapachone to analyze the extracellular matrix (ECM) and epithelial-mesenchymal transition (EMT). Results: ${\beta}$-Lapachone strongly attenuated bleomycin-induced lung inflammation and fibrosis, characterized by histological staining, infiltrated immune cells in BALF, inflammatory cytokines, fibrotic score, and TGF-${\beta}1$, ${\alpha}$-smooth muscle actin accumulation. In addition, ${\beta}$-lapachone showed a protective role in TGF-${\beta}1$-induced ECM expression and EMT in A549 cells. Conclusion: Our results suggest that ${\beta}$-lapachone can protect against bleomycin-induced lung inflammation and fibrosis in mice and TGF-${\beta}1$-induced EMT in vitro, by elevating the $NAD^+$/NADH ratio through NQO1 activation.