• Title/Summary/Keyword: levels of evidence

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Using Kirkpatrick's Evaluation Model in a Multimedia-based Blended Learning Environment

  • Embi, Zarina Che;Neo, Tse-Kian;Neo, Mai
    • Journal of Multimedia Information System
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    • v.4 no.3
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    • pp.115-122
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    • 2017
  • Over the years, there has been much research in blended learning. However, research regarding its use and evaluation is inconsistent, not following any specific evaluation method, and may not be applicable to local students. In this research, a case study was conducted to evaluate the environment based on three levels of Kirkpatrick's model. Methodological triangulation was the principle of data collection used in which multiple sources of evidence were triangulated to provide insights into this study. Instruments used include surveys, interviews, questionnaires and pre- and post-tests that are guided by Kirkpatrick's model. The results revealed that students were positive with the learning environment. Students enjoyed learning with multimedia and motivated to learn as well as engaged in the environment. The tests showed significant difference in their learning. Students also perceived that they have transferred their learning from face-to-face lecture into problem-based learning and learning outcome. This research contributes to the field by providing deeper insights into assessments in multimedia-based blended learning environment and empirical evidence on views, attitudes, learning and knowledge transfer of students in higher education.

Neurobehavioral Deficits and Parkinsonism in Occupations with Manganese Exposure: A Review of Methodological Issues in the Epidemiological Literature

  • Park, Robert M.
    • Safety and Health at Work
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    • v.4 no.3
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    • pp.123-135
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    • 2013
  • Exposure to manganese (Mn) is associated with neurobehavioral effects. There is disagreement on whether commonly occurring exposures in welding, ferroalloy, and other industrial processes produce neurologically significant neurobehavioral changes representing parkinsonism. A reviewof methodological issues in the human epidemiological literature onMnidentified: (1) studies focused on idiopathic Parkinson disease without considering manganism, a parkinsonian syndrome; (2) studies with healthy worker effect bias; (3) studies with problematic statistical modeling; and (4) studies arising from case series derived from litigation. Investigations with adequate study design and exposure assessment revealed consistent neurobehavioral effects and attributable subclinical and clinical signs and symptoms of impairment. Twenty-eight studies show an exposure-response relationship between Mn and neurobehavioral effects, including 11 with continuous exposure metrics and six with three or four levels of contrasted exposure. The effects of sustained low-concentration exposures to Mn are consistent with the manifestations of early manganism, i.e., consistent with parkinsonism. This is compelling evidence thatMnis a neurotoxic chemical and there is good evidence that Mn exposures far below the current US standard of $5.0mg/m^3$ are causing impairment.

The Effects of Foreign Direct Investment on Innovation: Based on 61 Industries in Korea (해외직접투자가 혁신에 미치는 영향: 한국의 61개 산업을 중심으로)

  • Yim, Jeong-Dae;Lee, Seung-A;Jung, Se-Jin
    • Korea Trade Review
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    • v.44 no.5
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    • pp.143-159
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    • 2019
  • This study explores the relationship between outward foreign direct investment (FDI) and innovation in 61 industries of Korea between 1999 and 2016. In order to mitigate the endogeneity problem due to potential reverse causality between FDI and innovation, we use the GMM (generalized method of moments). Our results are as follows. First, FDI has a positive effect on innovation. A possible explanation is that through FDI, multinational companies may assimilate host countries' technologies and knowledge by learning, and then recreating new technologies. Furthermore, this positive effect appears greater, as industrial competition becomes fiercer. This result provides empirical evidence that by recreating technology and knowledge learned through FDI with their own intangible assets, such as patents, they may gain a competitive edge over competitors. Second, this study confirms the greater positive effects of FDI in developed countries, as well as countries with higher technology levels. Finally, strategic asset seeking FDI has the greatest positive impact on innovation in Korean industries. In summary, our findings provide empirical evidence that Korean multinationals can learn technology and knowledge of host countries through FDI to secure a competitive edge in the Korean market.

Updates of Nursing Practice Guideline for Enteral Nutrition (경장영양 간호실무지침 개정)

  • Cho, Yong Ae;Gu, Mee Ok;Eun, Young;Yu, Mi;Kim, Jung Yeon;Lee, Hyun Hee;Min, Ja Kyung;Song, Jung Mi
    • Journal of Korean Clinical Nursing Research
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    • v.26 no.1
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    • pp.10-25
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    • 2020
  • Purpose: The purpose of this study was to update the previously developed nursing practice guideline for enteral nutrition (EN). Methods: The guideline update was done in 22 steps using standardized methodology for nursing practice guidelines. Results: The updated EN guideline consisted of 16 domains and 228 recommendations. The domains and number of recommendations in each domain were for IDSA (Infectious Diseases Society of America): 8 on general instruction, 9 on general instruction for special nutrition, 9 on general instruction for EN, 3 on assessment of EN, 10 on access to EN, 18 on EN device insertion, 16 on selection and preparation of nutritional supplements, 46 on administration and stopping EN, 22 on maintenance and management of EN, 9 on monitoring EN, 16 on prevention and management of complications of EN, 18 on medication administration, 20 on EN in various situations, 20 on prevention of errors, 1 on nursing education, and 3 on nursing documentation. For the levels of evidence, there were 9.7% for level I, 13.1% for level II, 62.5% for level III and 1.1% for GRADE (Grading of Recommendations Assessment, Development and Evaluation): 3.3% for low, 0.8% for moderate, 9.3% for very low. A total of 133 recommendations were newly developed and 10 previous recommendations were modified. Conclusion: This updated EN nursing practice guideline can be used to enhance evidence-based practice in fundamentals of nursing practice and it should be disseminated to nurses nationwide in order to improve the efficiency of EN practice.

Use of Integrative Medicine among primary care patients in Western counties - Its implication for traditional Korean medicine in primary care system - (선진국의 일차의료부문의 통합의료 - 일차보건의료체계에서의 한의학에 주는 함의 -)

  • Han, Dong-Woon
    • Journal of Society of Preventive Korean Medicine
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    • v.16 no.1
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    • pp.1-13
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    • 2012
  • The objective of this study is to discuss the role of integrative medicine (IM) in contemporary health care settings, and how and which factors affect and facilitate the success of IM in terms of the integration of complementary and alternative medicine (CAM) and conventional medicine in primary health care (PHC). IM is meant to provide the best possible health care, for both patient and physician. The way of IM use in the developed countries presents various ways that IM can be provided, and it appears that strategies have been successfully developed to facilitate integration. Although few of the barriers to the integration of CAM and conventional medicine have been resolved, concerns over the legitimacy of CAM in health care (e.g., safety, biomedical evidence, and efficacy) are being overcome by the use of evidence-based practice in IM delivery. There are dominant models of IM that have been developed. The model types signify different levels of equity between CAM and conventional medicine in regard to the power, autonomy, and control held by each. However, the factors common to all IM models, whether describing CAM as supplementary or complementary to conventional medicine, is the concept of a health care model that aspires to be client-centred and holistic, with focus on health rather than disease as well as mutual respect among peer practitioners. Finally, this study concluded that the growth and viability of traditional Korean medicine(TKM) depend on evidence-based practices and identifying the successful influences on the integration of TKM and conventional medicine for recognition of its inherent value in PHC. Some recommendations for the integration of TKM and conventional medicine were suggested.

Using of the "Consolidated Standards of Reporting Trials:CONSORT" to heighten quality of Medical Education study (의학교육연구의 질을 향상시키기 위한 '연구보고의 표준' 의 활용)

  • Yoo, Ji-Soo
    • Korean Medical Education Review
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    • v.10 no.2
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    • pp.25-44
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    • 2008
  • Objectives: Through using of the strong research method like a Randomized Controlled Trial: RCT, we have to heighten quality of Medical Education study. I'd like to introduce "CONSORT", which stands for Consolidated Standards of Reporting Trials. Contents: Preventive Service Task Force(200l) in USA proposed Levels of evidence for enlarging evidence-based Practice: EBP. And the CONSORT was introduced, which encompasses various initiatives developed by the CONSORT Group to alleviate the problems arising from inadequate reporting of randomized controlled trials (RCTs). the CONSORT has 13 guides like these: 1. How participants were allocated to interventions 2. Scientific background and explanation of rationale 3. Eligibility criteria for participants. The settings and locations where the data were collected. 4. Precise details of the interventions intended for each group and how and when they were actually administered 5. Specific objectives and hypotheses 6. Clearly defined primary and secondary outcome measures, When applicable. any methods to enhance the quality of measurements (e.g., multiple observations, training of assessors) 7. How sample size was determined. When applicable, explanation of any interim analyses and stopping rules 8. Method used to generate the random allocation sequence, Details of any restriction [of randomization] 9. Method used to implement the random allocation sequence 10. Who generated the allocation sequence, who enrolled participants. and who assigned participants to their groups 11. Whether or not participants, those administering the interventions, and those assessing the outcomes were blinded to group assignment. If done, how the success of blinding was evaluated 12. Statistical methods used to compare groups for primary outcome(s), Methods for additional analyses, such as subgroup analyses and adjusted analyses 13. Flow of participants through each stage (a diagram is strongly recommended) Specifically, for each group report the numbers of participants randomly assigned. receiving intended treatment, completing the study protocol. and analyzed for the primary outcome. Results and Conclusion: Randomized Controlled Trial: RCT guided of CONSORT will contribute to do stronger evidence-based medical studies.

Dietary Reference Intakes of sodium for Koreans: focusing on a new DRI component for chronic disease risk reduction

  • Kim, Hyun Ja;Lee, Yeon-Kyung;Koo, Hoseok;Shin, Min-Jeong
    • Nutrition Research and Practice
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    • v.16 no.sup1
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    • pp.70-88
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    • 2022
  • Sodium is a physiologically essential nutrient, but excessive intake is linked to the increased risk of various chronic diseases, particularly cardiovascular. It is, therefore, necessary to accomplish an evidence-based approach and establish the Korean Dietary Reference Intakes (KDRIs) index, to identify both the nutritional adequacy and health effects of sodium. This review presents the rationale for and the process of revising the KDRIs for sodium and, more importantly, establishing the sodium Chronic Disease Risk Reduction Intake (CDRR) level, which is a new specific set of values for chronic disease risk reduction. To establish the 2020 KDRIs for dietary sodium, the committee conducted a systematic literature review of the intake-response relationships between the selected indicators for sodium levels and human chronic diseases. In this review, 43 studies published from January 2014 to December 2018, using databases of PubMed and Web of Science, were finally included for evaluating the risk of bias and strength of evidence (SoE). We determined that SoE of the relationship between dietary sodium and cardiovascular diseases, cerebrovascular disease, and hypertension, was moderate to strong. However, due to insufficient scientific evidence, we were unable to establish the estimated average requirement and the recommended nutrient intake for dietary sodium. Therefore, the adequate intake of sodium for adults was established to be 1,500 mg/day, whereas the CDRR for dietary sodium was established at 2,300 mg/day for adults. Intake goal for dietary sodium established in the 2015 KDRIs instead of the tolerable upper intake level was not presented in the 2020 KDRIs. For the next revision of the KDRIs, there is a requirement to pursue further studies on nutritional adequacy and toxicity of dietary sodium, and their associations with chronic disease endpoint in the Korean population.

Occupational Exposure to Trichloroethylene and Non-hodgkin Lymphoma Risk (직업적 트리클로로에틸렌 노출과 비호지킨림프종의 연관성)

  • Chun, Jae-Buhm;Han, So-Hee;Yoon, Hyung-Suk;Lee, Eun-Jung;Lee, Kyoung-Mu
    • Journal of Environmental Health Sciences
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    • v.37 no.5
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    • pp.358-368
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    • 2011
  • Objectives: In order to evaluate the association between occupational exposure to chloroethylene (TCE) and risk of non-Hodgkin lymphoma (NHL), we conducted a meta-analysis of retrospective cohort studies and casecontrol studies and attempted to summarize the evidence of the association from molecular-epidemiological studies and experiments with human cells. Methods: In the meta-analysis, we restricted the analysis to those studies with data for chlorinated solvents, degreasers, or TCE. Studies involving dry cleaners or launderers were excluded from the analysis because use of TCE as a dry cleaning fluid has been rare since the 1960s. The data were combined using a random-effects model to estimate the summary risks (OR and RR) and 95% confidence intervals (CIs). Molecular evidence of the effect of TCE on human immune system were also reviewed and summarized. Results: Occupational exposure to TCE was strongly associated with NHL among cohort studies (number of studies=13, summary RR=1.33, 95% CI=1.04-1.70) whereas the association was not statistically significant among case-control studies (number of studies=15, summary OR=1.10, 0.98-1.23). When exposure level was considered, it became statistically significant for the highest exposure level (number of studies=5, summary OR=1.70, 1.25-2.32). Molecular evidences showed that TCE exposure in human or cultured human cells may cause a significant decrease immune cell subsets and changes in hormone levels related to immune response. Conclusions: Our results from meta-analysis and additional molecular evidence suggest that occupational exposure to TCE may cause NHL. However, unmeasured potential confounding and unclear dose-response relationships warrant further study on the role of TCE exposure in NHL carcinogenesis.

The Evidence of Coastal Flooding Within the Coastal Depositsin Hasa-ri, Yeonggwang (영광 하사리 해안 퇴적층 내의 연안 범람 증거)

  • Shin, Won Jeong;Yang, Dong Yoon;Kim, Jong Yeon;Choi, Jeong-Heon
    • Journal of The Geomorphological Association of Korea
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    • v.24 no.3
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    • pp.83-103
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    • 2017
  • Sand deposit with shell units is exposed in Hasa-ri, Yeonggwang-gun, Jeonnam province. We investigated the characteristics of sand sediment topography in the Yeonggwang coastal area to collect evidence of the paleo-environmental change. We performed analysis on particle characteristics, chemical composition, and the age of deposition of sediments. The deposit comprise moderately well sorted medium and fine sand ($1.00{\sim}2.19{\varphi}$). Various sedimentary structures can be observed. Geochemical characteristics change by depth and the degree of variation with depth is small. The results obtained from OSL dating show that sand layers below shell units are deposited 0.32-0.43 ka. As the elevation of the shell unit far mean high water levels or highest high water level, the extensive shell layers could only have been deposited during storm surge conditions. Aeolian processes are discounted due to the size of clasts and the location at which they occur. Results of age dating of the surrounding deposits indicate shell deposits formed after around 300 years age. There is a distinct difference between sedimentary layers including dark brown-black layer. The sedimentary characters such as particle size and geochemistry show difference with depth. It is presumed that depositional environmental in Hasa-ri has changed several times before. This study is expected to contribute to finding an evidence about occurrence of storm surges.

Nurses' Evidence-Based Practice Beliefs and Competencies, and Organizational Supports (일개 대학병원 임상간호사의 근거기반 간호실무 신념, 역량, 조직의 지원에 관한 조사)

  • Kim, Sun Kyung;Lee, Hyun Hee;Park, Gwang Hee;Kim, Hyun Jeong;Choi, Jong Hee;Park, Kyong Gjin;Lee, Min Ji;Lee, Eun Jeong
    • Journal of Korean Clinical Nursing Research
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    • v.24 no.2
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    • pp.245-254
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    • 2018
  • Purpose: The aim of this study was to assess nurses' evidence-based practice (EBP) beliefs and competencies, and organizational supports to develop EBP. Methods: A descriptive study was conducted using a survey of clinical nurses at a tertiary hospital in South Korea. Results: The survey was distributed to a total of 1,413 nurses and was completed by 1,318 nurses. There were significant differences in the EBP beliefs and competencies, and the perception of organizational supports among nurses at different educational levels. The EBP beliefs, EBP competencies, and organizational supports had a positive correlation with each other. EBP competencies were the highest in nurses with less than 3-years of clinical experience, and the perception of organization supports were the highest in nurses with more than 10-years of clinical experience. Conclusion: The findings suggest that educational programs, training, and organizational supports are recommended for facilitating successful EBP among nurses.