• Title/Summary/Keyword: levels of evidence

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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.

Role of n-3 long-chain polyunsaturated fatty acids in human nutrition and health: review of recent studies and recommendations

  • Dael, Peter Van
    • Nutrition Research and Practice
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    • v.15 no.2
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    • pp.137-159
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    • 2021
  • Long-chain (LC) n-3 polyunsaturated fatty acids (n-3 PUFAs), in particular docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), are nutrients involved in many metabolic and physiological processes, and are referred to as n-3 LCPUFA. They have been extensively studied for their effects in human nutrition and health. This paper provides an overview on metabolism, sources, dietary intake, and status of n-3 LCPUFA. A summary of the dietary recommendations for n-3 LCPUFAs for different age groups as well as specific physiological conditions is provided. Evidence for n-3 LCPUFA in cardiovascular diseases, including new studies, is reviewed. Expert recommendations generally support a beneficial effect of n-3 LCPUFA on cardiovascular health and recommend a daily intake of 500 mg as DHA and EPA, or 1-2 servings of fish per week. The role of n-3 LCPUFA on brain health, in particular neurodegenerative disorders and depression, is reviewed. The evidence for beneficial effects of n-3 LCPUFA on neurodegenerative disorders is non-conclusive despite mechanistic support and observational data. Hence, no definite n-3 LCPUFA expert recommendations are made. Data for the beneficial effect of n-3 LCPUFA on depression are generally compelling. Expert recommendations have been established: 200-300 mg/day for depression; up to 1-2 g/day for major depressive disorder. Recent studies support a beneficial role of n-3 LCPUFAs in reducing the risk for premature birth, with a daily intake of 600-800 mg of DHA during pregnancy. Finally, international experts recently reviewed the scientific evidence on DHA and arachidonic acid (ARA) in infant nutrition and concluded that the totality of data support that infant and follow-on formulas should provide both DHA and ARA at levels similar to those in breast milk. In conclusion, the available scientific data support that dietary recommendations for n-3 LCPUFA should be established for the general population and for subjects with specific physiological conditions.

Clinical Practice Guideline for Assessment and Prevention of Falls in Adult People (낙상위험요인 평가 및 낙상예방활동 임상진료지침)

  • Chun, Ja-Hae;Kim, Hyun-Ah;Kwak, Mi-Jeong;Kim, Hyuo-Sun;Park, Sun-Kyung;Kim, Moon-Sook;Choi, Ae-Lee;Hwang, Jee-In;Kim, Yoon-Sook
    • Quality Improvement in Health Care
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    • v.24 no.2
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    • pp.41-61
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    • 2018
  • Purpose: Falls are one of the most frequent health events in medical institutions, however, they can be predicted and prevented. The Quality Improvement Nurse Society clinical practice guideline Steering Committee developed the Clinical Practice Guideline for the assessment and prevention of falls in adult people. The purpose of this study was to assess the risk factors for falls in adults aged 19 years and older, to present an evidence for preventing falls, formulate a recommendations, and indicators for applying the recommendations. Methods: This clinical practice guideline was developed using a 23-step adaptation method according to the Handbook for clinical practice guideline developer (version 1.0) by National Evidence-based Healthcare Collaborating Agency. Evidence levels and recommendation ratings were established in accordance to SIGN 2011 (The Scottish Intercollegiate Guidelines Network). Results: The final 15 recommendations from four domains were derived from experts' advice; 1) assessment of risk factor for falls in adult 2) preventing falls and reducing the risks of falls or falls-related injury 3) management and reassessment after a person falls 4) leadership and culture. Conclusion: This clinical practice guideline can be used as a basis for evaluation and prevention of fall risk factors for adults, to formulate recommendations for fall risk assessment and fall prevention, and to present monitoring indicators for applying the recommendations.

Psychosocial support interventions for women with gestational diabetes mellitus: a systematic review

  • Jung, Seulgi;Kim, Yoojin;Park, Jeongok;Choi, Miyoung;Kim, Sue
    • Women's Health Nursing
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    • v.27 no.2
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    • pp.75-92
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    • 2021
  • Purpose: This study aimed to analyze the content and effectiveness of psychosocial support interventions for women with gestational diabetes mellitus (GDM). Methods: The following databases were searched with no limitation of the time period: Ovid-MEDLINE, Cochrane Library, Ovid-Embase, CINAHL, PsycINFO, NDSL, KoreaMed, RISS, and KISS. Two investigators independently reviewed and selected articles according to the predefined inclusion/exclusion criteria. ROB 2.0 and the RoBANS 2.0 checklist were used to evaluate study quality. Results: Based on the 14 selected studies, psychosocial support interventions were provided for the purpose of (1) informational support (including GDM and diabetes mellitus information; how to manage diet, exercise, stress, blood glucose, and weight; postpartum management; and prevention of type 2 diabetes mellitus); (2) self-management motivation (setting goals for diet and exercise management, glucose monitoring, and enhancing positive health behaviors); (3) relaxation (practicing breathing and/or meditation); and (4) emotional support (sharing opinions and support). Psychosocial supportive interventions to women with GDM lead to behavioral change, mostly in the form of self-care behavior; they also reduce depression, anxiety and stress, and have an impact on improving self-efficacy. These interventions contribute to lowering physiological parameters such as fasting plasma glucose, glycated hemoglobin, and 2-hour postprandial glucose levels. Conclusion: Psychosocial supportive interventions can indeed positively affect self-care behaviors, lifestyle changes, and physiological parameters in women with GDM. Nurses can play a pivotal role in integrative management and can streamline the care for women with GDM during pregnancy and following birth, especially through psychosocial support interventions.

Clinical Practice Guideline on Acupuncture for Post-stroke Spasticity (뇌졸중후 경직에 대한 침치료 임상진료지침)

  • Kim, Je-Shin;Shin, Seung-Won;Lee, Eui-Ju;Shin, Byung-Cheul;Lee, Myeong-Soo;Lim, Sung-Min;Nam, Dong-Woo;Moon, Sang-Kwan
    • The Journal of Korean Medicine
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    • v.36 no.1
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    • pp.1-8
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    • 2015
  • Objectives: This study is aimed to develop a Clinical Practice Guideline (CPG) on acupuncture treatment for the patients with post-stroke spasticity. Methods: Experts committee, consisting of stroke or methodology specialists, searched Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and 19 Korean medicine journals. The search terms were selected to screen the randomized controlled trials (RCTs) or systematic reviews for the effectiveness of acupuncture on post-stroke spasticity, compared with placebo or conventional group. Levels of evidence and grades of recommendations were appraised based on Recommendations for Development of Clinical Practice Guideline in Korean Medicine. Results & Conclusions: One systematic review and 7 RCT were included to build the CPG. There was a strong evidence to support the effectiveness of electroacupuncture treatment for post-stroke spasticity. However, it did not show any sufficient evidence to treat the patients with post-stroke spasticity with the sole acupuncture. The moderate evidence was presented that over 3 times of the electroacupuncture treatments with 1-100 Hz frequency should be performed every week on the acupoints, such as LI11, LI10, TE5, LI4, ST36, GB34, ST40, or LR3, for 20-30 minutes. It was also suggested that the procedure should begin at the acute stage just after the vital signs of the patients are stabilized. Finally, there was a moderate evidence to support safety of acupuncture treatment for post-stroke spasticity.

Change of Pre-Service Elementary Teachers' Professional Visions through Video-Based Reflection on Science Classroom (과학 수업 비디오에 기초한 반성 활동을 통한 초등 예비교사의 전문적 시각의 변화)

  • Yoon, Hye-Gyoung;Song, Youngjin
    • Journal of The Korean Association For Science Education
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    • v.37 no.4
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    • pp.553-564
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    • 2017
  • This study investigated the change of pre-service elementary teachers' professional visions through video-based reflection on science teaching with focus on their attention and pedagogical reasoning about student learning. Specifically, we compared two reflection cycles before and after pre-service elementary teachers went through the collaborative video-based reflection process in a professional learning community. The primary data were collected from eight pre-service elementary teachers and included their science lesson plans, videotaped lessons, video-reflection papers, and transcripts from the interviews. Pre-service elementary teachers' attention was categorized in five aspects: classroom management & control, teacher's instruction, students' thinking & learning, subject knowledge, and assessment. The level of their pedagogical reasoning about student thinking and learning was determined with six levels based on the number of evidence, evidence area, and evidence type. The findings revealed that 1) individual reflection is not enough - collaborative reflection is essential to change their attention toward students learning and thinking 2) pedagogical reasoning levels increase gradually throughout the individual and collaborative video-based reflection processes. The participants not only attributed student learning solely to the characteristics of students but also connected it with their own instruction or science content knowledge and used different types of evidences as they went through two reflection cycles. Implications for using video in the teacher education program were discussed.

Investigation of the differential effect of juice or water extract from Puerariae Radix on hair growth related-genes in dermal papilla cells (갈근(葛根)의 착즙 및 열수 추출에 따른 모유두 세포의 모발 성장 관련 mRNA 발현에 미치는 영향)

  • Jeon, Haili;Cho, Namjoon;Kim, Keekwang;Han, Hyosang
    • The Korea Journal of Herbology
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    • v.33 no.1
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    • pp.1-7
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    • 2018
  • Objectives : Puerariae Radix extracts are a rich source of isoflavones that affect the activity of hepatic antioxidant enzymes. However, the effect of these extracts on hair growth in human dermal papilla (DP) cells is unknown. The purpose of this study is to compare the effects between juice and water extracts of Puerariae Radix on the mRNA expression levels of hair growth-related genes in dermal papilla (DP) cells. Methods : The antioxidant activity of juice and water extracts of Puerariae Radix was analyzed using an ABTS assay. The cytotoxicity was analyzed using the MTS assay in DP cells. mRNA expression levels of hair growth-related genes in dermal papilla (DP) cells were analyzed using quantitative RT-PCR analysis. Results : Juice and water extracts of Puerariae Radix showed strong antioxidant activity. The cytotoxicity was confirmed to be higher in the juice extract than the water extract, using the MTS assay on DP cells. The mRNA expression levels of CTNNB1, FGF7, and BMP6 were significantly increased after treatment with water extract, whereas the juice extract did not affect the expression of hair growth-related genes. Conclusions : Our study provides evidence that water extract of Puerariae Radix is effective at inducing hair growth, by promoting the mRNA expression levels of hair growth-related genes. Also in the future, studies should be conducted to investigate the effects of Puerariae radix extracts on the various hair growth mechanisms of dermal papilla cells.

Role of interleukin-6 in orthodontically induced inflammatory root resorption in humans

  • Kunii, Ryuichi;Yamaguchi, Masaru;Tanimoto, Yasuhiro;Asano, Masaki;Yamada, Kunihiko;Goseki, Takemi;Kasai, Kazutaka
    • The korean journal of orthodontics
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    • v.43 no.6
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    • pp.294-301
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    • 2013
  • Objective: To determine the interleukin (IL)-6 levels in gingival crevicular fluid (GCF) of patients with severe root resorption after orthodontic treatment and investigate the effects of different static compressive forces (CFs) on IL-6 production by human periodontal ligament (hPDL) cells and the influence of IL-6 on osteoclastic activation from human osteoclastic precursor (hOCP) cells in vitro. Methods: IL-6 levels in GCF samples collected from 20 patients (15 and 5 subjects without and with radiographic evidence of severe root resorption, respectively) who had undergone orthodontic treatment were measured by ELISA. The levels of IL-6 mRNA in hPDL cells and IL-6 protein in conditioned medium after the application of different uniform CFs (0, 1.0, 2.0, or 4.0 $g/cm^2$ for up to 72 h) were measured by real-time PCR and ELISA, respectively. Finally, the influence of IL-6 on mature osteoclasts was investigated by using hOCP cells on dentin slices in a pit-formation assay. Results: Clinically, the IL-6 levels were significantly higher in the resorption group than in the control group. In vitro, IL-6 mRNA expression significantly increased with increasing CF. IL-6 protein secretion also increased in a time- and magnitude-dependent manner. Resorbed areas on dentin slices were significantly greater in the recombinant human IL-6-treated group and group cultured in hPDL cell-conditioned medium with CF application (4.0 $g/cm^2$) than in the group cultured in hPDL cell-conditioned medium without CF application. Conclusions: IL-6 may play an important role in inducing or facilitating orthodontically induced inflammatory root resorption.

Comparison of heavy metal concentrations in hairs of a small sample of Korean patients taking traditional herbal medicine

  • Park, Yeong-Chul;Kim, Myung-Dong;Park, Sung-Kyun;Kim, Hyun-Do;Lee, Sun-Dong
    • Advances in Traditional Medicine
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    • v.10 no.3
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    • pp.141-149
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    • 2010
  • A concern of safety issue for traditional herbal medicine is the possibility of some herbs containing heavy metals responsible for several cases of metal poisoning. In our previous study, the physiological levels of heavy metals, such as Cd, Cu, Hg and Pb, were examined to evaluate a potential risk in patients taking herbal medicine. In this study, the levels of 12 heavy metals, including non-metallic element, Se, were analyzed in hair and compared to the results from the previous study. In the previous study, the levels of Cd, Cu, Hg and Pb in hair showed a significantly lower odds ratio than 1. In this study, however, all metals did not show any significant odds ratio higher or lower than 1 even if 5 of 12 metals showed lower odds ratio than 1. In addition, the levels of metal concentrations, especially for Cu, Fe, Pb and Zn, exceeding the WHO reference values were observed in hair. However, any evidence for metal accumulation in hair caused by taking herbal medicines for long duration was not observed in analysis of multiple regression and odds ratio from case-control study. This result would show another possibility for a role of herbs as a non-enzymatic chelator inhibiting the gastrointestinal absorption of heavy metals.

Estimation of Safe Maximum Levels of Vitamins and Minerals to Foods (비타민 무기질 임의영양강화 최대허용수준 추정)

  • Chung, Hae-Rang;Oh, Se-Young
    • Journal of Nutrition and Health
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    • v.39 no.7
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    • pp.692-698
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    • 2006
  • The voluntary addition of vitamins and minerals to the appropriate foods may help reduce the risks associated with low intakes of these micronutrients, yet the potential of excessive intake, particularly for persons consuming very large amount of foods needs to be addressed. Using the Flynn's model to estimate the level of each vitamins and minerals that can be added safely to foods, maximum levels of fortification to conventional foods per 100 kcal portion were estimated. Critical factors in the Flynn's model included tolerable upper intake level (UL), each micronutrient intake at the $95^{th}$ percentile, the proportion of fortified foods in the diets of individuals, the proportion of foods to which micronutrients could be practically added, and a range of estimates for fractions of foods which might be actually fortified in each nutrient. Food vehicles included all foods except for fresh foods and alcoholic beverages, in general. With fortification of 50% of all potentially fortifiable foods, micrornutrients could be added safely to foods at levels per 100 kcal 1) > 100% Recommended Intake (RI) for vitamin $B_12$, 2) 1,200% RI for vitamin $B_1$ and niacin, 3) 1,000% $B_1$ for vitamins $B_2$ and $B_6$, 4) 400% RI for vitamin E, 5) 30% RI for calcium, 6) 20% RI for folic acid, iron and zinc, 7) 10% RI for manganese, 8) no fortification for magnesium, phosphorous and vitamin A, and 8) further consideration of vitamin D, copper and selenium due to insufficient evidence. Results of this study suggests a wide range of vitamins and minerals that can be added safely to foods in current diets of Koreans.