• The korean journal of orthodontics
• /
• v.54 no.2
• /
• pp.89-107
• /
• 2024

Objective: This systematic review aimed to provide a comparative analysis of the treatment outcomes, including hard and soft tissues, postoperative stability, temporomandibular disorders (TMD), and quality of life (QoL), in patients with facial asymmetry who underwent orthognathic surgery. Methods: The primary objective was to address the question, "How do different factors related to surgery affect the outcomes and stability of orthognathic surgery in the correction of facial asymmetry?" A meta-analysis was conducted on the outcome parameters, such as skeletal, dental, and soft tissue symmetry, TMD, QoL, and relapse, using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Subgroup analyses were conducted considering surgery-related factors such as surgical techniques (one-jaw vs. two-jaw), use of the surgery-first approach, utilization of computer simulation, and analytical methods employed to evaluate asymmetry (2D vs. 3D). Results: Forty-nine articles met the inclusion criteria. The metaanalysis demonstrated a significant improvement in the symmetry of hard and soft tissues. The subgroup analysis indicated that the treatment outcomes showed significant improvement, regardless of the factors related to surgery. Changes in TMD signs and symptoms varied according to the surgical technique used. Quality of life improved in the facial, oral, and social domains. Skeletal relapse was observed during the follow-up. Conclusions: Our findings support the positive outcomes of orthognathic surgery in the treatment of facial asymmetry in terms of skeletal and soft tissue improvements, stability, relief of TMD symptoms, and enhancement of QoL. However, most of the included studies showed a low certainty of evidence and high heterogeneity.

• Quality Improvement in Health Care
• /
• v.5 no.1
• /
• pp.152-165
• /
• 1998

Background : In this paper patient outcomes research is going to be reviewed and described, to be compared with relevant studies, and to consider the application in Korea. Methods : We compiled and reviewed the articles and materials related to patient outcomes research especially by PORT(Patient Outcomes Research Team) and rearranged them for seeking the main point and comparing with relevant studies. Results : Patient outcomes research emphasizes patient outcomes as well as conventional clinical outcomes. It is prospective study observing effectiveness in real situation instead of efficacy in ideal condition. Patient outcomes research comprises of 6 fields ; literature review and meta-analysis, use of claims data, decision modeling, outcomes assessment, cost of care, dissemination of research findings. SAA(small-area variations analysis), appropriateness study and clinical practice guideline are connected with patient outcomes research. Conclusion : In view of the fact that current medical policy in Korea is shifting its focus from accessibility to the improvement in quality and cost containment, and is stressing patient-based research, patient outcomes research is one direction for which the medicine is accountable and assessable. Considering that the number of patient receiving medical treatment in Korea is higher than the West, patient outcomes research has competitive power as against the West.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.24 no.4
• /
• pp.227-243
• /
• 2024

This study aimed to evaluate pain assessment strategies and factors associated with outcomes after microvascular decompression for the treatment of primary trigeminal neuralgia in adults. We conducted a systematic review and meta-analysis of English, Spanish, and French literature. We searched three databases, PubMed, Ovid, and EBSCO, from 2010 to 2022 and selected studies including patients with primary trigeminal neuralgia, clear pain assessment, and pain outcomes. Population means and standard deviations were calculated. Studies that included factors associated with postoperative outcomes were included in the meta-analysis. A total of 995 studies involving 5673 patients with primary trigeminal neuralgia following microvascular decompression were included. Patients with arteries compressing the trigeminal nerve demonstrated optimal outcomes following microvascular decompression (odds ratio [OR]= 0.39; 95% confidence interval [CI] = 0.19-0.80; X² = 46.31; Dof = 15; I² = 68%; P = < 0.0001). Conversely, when comparing arterial vs venous compression of the trigeminal nerve (OR = 2.72; 95% CI = 1.16-6.38; X² = 23.23; Dof = 10; I² = 57%; P = 0.01), venous compression demonstrated poor outcomes after microvascular decompression. Additionally, when comparing single-vessel vs multiple-vessel compression (OR = 2.72; 95% CI = 1.18-6.25; X² = 21.17; Dof = 9; I² = 57%; P = 0.01), patients demonstrated unfavorable outcomes after microvascular decompression. This systematic review and meta-analysis evaluated factors associated with outcomes following microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Although MVD is an optimal treatment strategy for PTN, a gap exists in interpreting the results when considering the lack of evidence for most pain assessment strategies.

• Journal of Yeungnam Medical Science
• /
• v.37 no.4
• /
• pp.277-285
• /
• 2020

Tuberculosis (TB) is still a major health problem worldwide. Especially, multidrug-resistant TB (MDR-TB), which is defined as TB that shows resistance to both isoniazid and rifampicin, is a barrier in the treatment of TB. Globally, approximately 3.4% of new TB patients and 20% of the patients with a history of previous treatment for TB were diagnosed with MDR-TB. The treatment of MDR-TB requires medications for a long duration (up to 20-24 months) with less effective and toxic second-line drugs and has unfavorable outcomes. However, treatment outcomes are expected to improve due to the introduction of a new agent (bedaquiline), repurposed drugs (linezolid, clofazimine, and cycloserine), and technological advancement in rapid drug sensitivity testing. The World Health Organization (WHO) released a rapid communication in 2018, followed by consolidated guidelines for the treatment of MDR-TB in 2019 based on clinical trials and an individual patient data meta-analysis. In these guidelines, the WHO suggested reclassification of second-line anti-TB drugs and recommended oral treatment regimens that included the new and repurposed agents. The aims of this article are to review the treatment strategies of MDR-TB based on the 2019 WHO guidelines regarding the management of MDR-TB and the diagnostic techniques for detecting resistance, including phenotypic and molecular drug sensitivity tests.

• Clinics in Shoulder and Elbow
• /
• v.19 no.3
• /
• pp.179-185
• /
• 2016

Rheumatoid arthritis (RA) is a systemic disease with medication as the treatment of choice. However, surgical treatment is recommended when no improvement is noted despite aggressive conservative treatment. Synovectomy provides desirable outcomes for RA patients in the early stage with a glenohumeral joint of Larsen grade II or less; conversely, arthroplasty is recommended for patients with a glenohumeral joint of grade III or higher. RA patients often have attenuation and dysfunction of the rotator cuff, and reverse shoulder arthroplasty has been proven to provide favorable outcomes in some patients. RA is often complicated with osteoporosis and bony deformity; therefore, close attention is necessary to prevent fractures during shoulder arthroplasty.

• Korean Journal of Head & Neck Oncology
• /
• v.39 no.2
• /
• pp.1-6
• /
• 2023

The aging population, particularly those aged 65 and above, is on the rise, with projections indicating a substantial increase in the elderly demographic. This demographic shift brings challenges in managing age-related diseases, including head and neck cancers (HNCs). Frailty, often characterized by physiological decline and vulnerability to stressors, is a crucial factor affecting treatment outcomes of elderly cancer patients. Accordingly, the significance of assessing frailty in elderly HNC patients before their treatment should be emphasized, but current frailty assessment tools may not fully capture the unique challenges faced by HNC patients. Specific indicators, including respiratory and swallowing functions, are proposed for a more tailored assessment. This comprehensive review explores the impact of frailty on various treatment modalities, including surgery, radiation, and chemotherapy, highlighting the need for personalized interventions. Furthermore, it suggests avenues for future research to enhance frailty assessment tools and investigate interventions aimed at improving treatment outcomes in elderly HNC patients.

• The Journal of Information Systems
• /
• v.27 no.1
• /
• pp.153-169
• /
• 2018

Purpose Since human brains catch images faster than texts or numbers, infographics has been widely used in business in the form of "information dashboard" to enhance the efficiency of decision-making. Groupware, however, has neglected the adoption and use of infographics, in particular, in the idea generation process. Given that an overall performance of groupware-based idea generation is no better than that of the (paper-and-pencil-based) Nominal Group Technique, Jung et al. (2010) adopted the notion of infographics in the form of performance feedback to solve the productivity paradox. With the consistent results, which demonstrate beneficial effects of infographics on performance enhancement, an interesting observation that groups with the bar chart treatment performed better than groups with the dot chart treatment was made. The main purpose of this study was to find if there were a performance consistency between the outcomes from the previous study and the outcomes from the current study. Design/methodology/approach In experiment 1, we employed the same system used in the previous study (i.e., Jung et al., 2010). As individuals' contributions accumulated, the mechanism visually displayed individuals' performances two-dimensionally in the form of a bar chart or a dot chart. Then, we compared the performance outcomes from this study to the outcomes from previous study (i.e., Jung et al., 2010). In experiment 2, we modified the performance graph to test the effect of "playfulness" on performance by converting dots to car images. Then, we compared the performance outcome from experiment 2 to the outcomes from experiment 1. Findings Just like our interesting (and unexpected) finding in Jung et al.'s study (2010), the outcome confirmed a consistent superior performance of a bar chart. This implies that a bar chart is a better choice when stimulating performance with a visual aid in the context of groupware-based idea generation. Although a bar chart was criticized in a way that errors of length-area judgments are 40 ~ 250% greater than those of positional judgments along a common scale, such illusion turned out to be facilitating upward performance comparison better. Regarding Experiment 2, the outcome showed that the revised-dot graph is as good as the bar graph in terms of quantity and quality score of ideas. We attribute the performance enhancement of the resized-dot to the interaction between the motivational characteristic and the situational characteristic of playfulness because individuals in the revised-dot graph treatment performed better than individuals in the dot graph treatment. Given the order of performance (Bar >= Revised Dot > Dot) that the revised-dot treatment performed the same as (or lower than) the bar treatment, an additional research is warranted to reach to a consistent outcome.

• Korean Journal of Clinical Pharmacy
• /
• v.23 no.2
• /
• pp.89-96
• /
• 2013

This article aimed to introduce 'risk sharing' schemes for pharmaceuticals between drug manufacturers and healthcare payer. Published literature review was undertaken to summarize risk sharing concepts and collect information on existing scheme examples in other countries focusing on new anticancer drugs. Risk sharing schemes could be categorized into health outcomes-based and non-outcomes (financial) based ones. Outcome-based schemes could be broken down into performance-linked reimbursement and conditional coverage. Performance-linked reimbursement can be further broken into outcomes guarantee and pattern or process of care and conditional coverage included coverage with evidence development and conditional treatment continuation schemes. Non-outcome based schemes included market share and price volume at population level, and utilization caps and manufacturer funded treatment initiation at patient level. We reviewed the fifteen examples for anticancer drugs that risk sharing agreements in response to the inherent uncertainties and increased costs of eleven anticancer drugs. Of them, eight cases were coverage with evidence development schemes. The anticancer drugs except bevacizumab and cetuximab were all listed on the national health insurance formulary in Korea, with reimbursement criteria defined on the basis of approved indications and administrations. Risk sharing approach may be a useful tool to ensure values for drug expenditure, but there are a number of concerns such as high administration costs, lack of transparency and conflicts of interest, especially for performance-based health outcomes reimbursement schemes.

• Journal of Oral Medicine and Pain
• /
• v.46 no.4
• /
• pp.143-149
• /
• 2021

Purpose: Oromandibular dystonia is a neurological disorder that affects the jaw and lower face muscles, often resulting in abnormal repetitive movement of the jaw and perioral structures. The purpose of this study was to assess the effectiveness of surface electromyography (EMG) in evaluating the treatment outcome of oromandibular dystonia. Methods: Based on a retrospective review of medical records, we analyzed the data of four patients who received medication or botulinum toxin injection, as well as surface EMG of the jaw muscles before and after treatment. We assessed the patients' clinical characteristics and the results of surface EMG before and after treatment. Results: The case series included one female and three males, and the age range was 65-78 years. Based on the clinical features, two subjects were classified as jaw deviation and the remaining two were as jaw closing. Dystonic patterns revealed by surface EMG varied, including phasic, tonic, and mixed contraction patterns. EMG amplitude after treatment was lower than pre-treatment value in all four subjects, suggesting improved clinical signs and symptoms. One subject who received clonazepam and another who received botulinum toxin injection showed a remarkable reduction in EMG amplitude within a normal range. Conclusions: Surface EMG can be used to effective evaluate treatment outcomes in patients with oromandibular dystonia. It could be considered as an adjunctive diagnostic tool in managing patients with dystonia.

• Journal of Korean Academy of Nursing
• /
• v.50 no.3
• /
• pp.333-348
• /
• 2020

Purpose: The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Korea by assessing National Health Insurance claims data. Methods: The dataset included 70,136 patients aged 19 years who were inpatients in psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia, schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registered nurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomes included length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint, and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and system characteristics using multilevel modeling. Results: Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatients per registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission. More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnotics use but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injected psycholeptics for chemical restraint. Conclusion: Lower nurse staffing levels are associated with negative health outcomes of psychiatric inpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatric inpatients in Korea.