Development of Items for Transitional Care Service and Outcome Indicators of Discharged Patients for Improvement in Quality of Care

Background@#In this study, with the aim of improving the quality of transitional care service for discharged patients, the Health Care Quality and Outcomes Indicators of the Organization for Economic Co-operation and Development and National Health Service Outcomes Framework of the UK were applied to derive service items for provision and develop evaluation indicators under categories of effectiveness, safety, and patient-centeredness.Method: A scoping review was conducted to derive core concepts and evidence materials/data for transitional care service. For the derived items of transitional care service and evaluation indicators, a three-round Delphi study was conducted with experts in the fields of healthcare/ medicineursing/social welfare. @*Results@#First, as a result of the scoping review, components of transitional care service (assessment of need by period of transitional care service, multi-professional team, connection to community resources, etc.) and themes for outcome indicators (effectiveness, patient safety, patient-centeredness) were derived. Second, by classifying the items for assessment according to the hospitalization and transition period and conducting a Delphi study to derive service items for transitional care service, during the hospitalization period, presence/absence of a caregiver and need for a caregiver, activities of daily living, and necessity for home-based care services were identified as items of high priority. Regarding patient safety, risk of falls and fractures during hospitalization, and necessity for medication reconciliation were identified as the items of high importance. For the transition period, provision of education regarding adequate responses and handling of emergencies, provision of information and guidance on application of services for basic livelihood security program beneficiaries, and education for patient skills in self-management of health were derived as items of high priority. Third, for the derivation of outcome indicators for transitional care service, in the “effectiveness” category, the experts rated a reduction in the 30-day readmission rate as an item of high importance along with a decrease in emergency department visits, reduction in preventable admissions as indicators of high relevance. In terms of “patient safety,” a decrease in drug adverse reactions, and reduction in the incidence of falls and pressure ulcers were identified as indicators of high priority. Finally, for the category of “patient-centeredness,” patient experience assessment, level of service satisfaction reported by patients and their caregivers, and reducing burden on caregivers were identified as indicators of high priority. @*Conclusion@#This study suggest practical implications for the service with high relevance and necessity for transitional period. It also presented outcome indicators of transitional care service to contribute toward an improvement in the quality of care.

Bioactive characteristics of an implant surface coated with a pH buffering agent: an in vitro study

PURPOSE: The purpose of this study was to evaluate the effectiveness of conventional sandblasted, large-grit, acid-etched (SLA) surface coated with a pH buffering solution based on surface wettability, blood protein adhesion, osteoblast affinity, and platelet adhesion and activation.METHODS: Titanium discs and implants with conventional SLA surface (SA), SLA surface in an aqueous calcium chloride solution (CA), and SLA surface with a pH buffering agent (SOI) were prepared. The wetting velocity was measured by the number of threads wetted by blood over an interval of time. Serum albumin adsorption was tested using the bicinchoninic acid assay and by measuring fluorescence intensity. Osteoblast activity assays (osteoblast adhesion, proliferation, differentiation, mineralization, and migration) were also performed, and platelet adhesion and activation assays were conducted.RESULTS: In both the wetting velocity test and the serum albumin adsorption assay, the SOI surface displayed a significantly higher wetting velocity than the SA surface (P=0.000 and P=0.000, respectively). In the osteoblast adhesion, proliferation, differentiation, and mineralization tests, the mean values for SOI were all higher than those for SA and CA. On the osteoblast migration, platelet adhesion, and activation tests, SOI also showed significantly higher values than SA (P=0.040, P=0.000, and P=0.000, respectively).CONCLUSIONS: SOI exhibited higher hydrophilicity and affinity for proteins, cells, and platelets than SA. Within the limits of this study, it may be concluded that coating an implant with a pH buffering agent can induce the attachment of platelets, proteins, and cells to the implant surface. Further studies should be conducted to directly compare SOI with other conventional surfaces with regard to its safety and effectiveness in clinical settings.

Influence of Implant Surface Coated with pH Buffering Agent on Early Osseointegration

PURPOSE: Surface treatment with pH buffering agent has been developed to achieve higher and faster osseointegration. The aim of this study was to evaluate its influence by measuring removal torque and analyzing histological characteristics. MATERIALS AND METHODS: Titanium implants with following surfaces were used in this study: sand-blasted acid-etched (SA) surface (SA group as control I group), SA surface in calcium chloride aqueous solution (CA group as control II group) and SA surface coated with pH buffering agent (pH group as test group). Removal torque test after 2 weeks and bone-to-implant contact and bone area analyses at 2 and 4 weeks were performed. RESULT: The rotational torque values at 2 weeks were significantly higher in pH group (107.5±6.2 Ncm, P < 0.05). The mean values of bone-to-implant contact at 2 and 4 weeks were both higher in pH group (93.0%±6.4% at 2 weeks, 88.6%±5.5% at 4 weeks) than in SA group (49.7%±9.7% at 2 weeks, 47.3%±20.1% at 4 weeks) and CA group (73.7%±12.4% at 2 weeks, 72.5%±10.9% at 4 weeks) with significances (P < 0.05). The means of bone area showed significantly higher numbers in pH group (39.5%±11.3% at 2 weeks, 71.9%±10.9% at 4 weeks, P < 0.05). CONCLUSION: Our findings demonstrated that surface modification with pH buffering agent improved early osseointegration with superior biomechanical property.

Effect of implant surface microtopography by hydroxyapatite grit-blasting on adhesion, proliferation, and differentiation of osteoblast-like cell line, MG-63

OBJECTIVE: This study examined the potential of the in vitro osteogenesis of microtopographically modified surfaces, RBM (resorbable blasting media) surfaces, which generate hydroxyapatite grit-blasting. METHODS: RBM surfaces were modified hydroxyapatite grit-blasting to produce microtopographically modified surfaces and the surface morphology, roughness or elements were examined. To investigate the potential of the in vitro osteogenesis, the osteoblastic cell adhesion, proliferation, and differentiation were examined using the human osteoblast-like cell line, MG-63 cells. Osteoblastic cell proliferation was examined as a function of time. In addition, osteoblastic cell differentiation was verified using four different methods of an ALP activity assay, a mineralization assay using alizarin red-s staining, and gene expression of osteoblastic differentiation marker using RT-PCR or ELISA. RESULTS: Osteoblastic cell adhesion, proliferation and ALP activity was elevated on the RBM surfaces compared to the machined group. The cells exhibited a high level of gene expression of the osteoblastic differentiation makers (osteonectin, type I collagen, Runx-2, osterix). imilar data was represented in the ELISA produced similar results in that the RBM surface increased the level of osteocalcin, osteopontin, TGF-beta1 and PGE2 secretion, which was known to stimulate the osteogenesis. Moreover, alizarin red-s staining revealed significantly more mineralized nodules on the RBM surfaces than the machined discs. CONCLUSION: RBM surfaces modified with hydroxyapatite grit-blasting stimulate the in vitro osteogenesis of MG-63 cells and may accelerate bone formation and increase bone-implant contact.

Endocrine response to step-up microdose GnRH agonist / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the endocrine response to step-up microdose GnRH agonist. METHODS: Administration of triptorelin acetate was initiated from 2 mg and gradually increased to 50 mg during 6-day period to five normal menstruating women. Serum FSH, LH, and estradiol levels were serially measured for 6 days. The same set of experiment was duplicated after taking oral contraceptive for 3 weeks. Serum testosterone and progesterone levels were measured on day 1 and day 5 of experiment. RESULTS: The flare of gonadotropin continued for 6 days. When subjects were pretreated with oral contraceptive, serum FSH levels 4 hrs after GnRH agonist injection were 17.35+/-7.88 mIU/mL, 11.26+/-4.81 mIU/mL, and 9.60+/-4.08 mIU/mL for day 1, 2, and 3 respectively. The FSH levels were not statistically different when pretreatment with oral contraceptive was not applied. The level of serum LH was significantly lower in the cycle, which was pretreated by oral contraceptive (32.13+/-9.61 mIU/mL vs. 14.12+/-5.63 mIU/mL for day 1, 28.95+/-3.09 mIU/mL vs. 15.76+/-9.92 mIU/mL for day 2, and 24.45+/-2.52 mIU/mL vs. 16.86+/-8.56 mIU/mL for day 3). The sign of corpus luteum rescue was found in 2 out of 5 subjects only in non-treated cycle. CONCLUSION: Step-up microdose GnRH agonist protocol could induce persistent gonadotropin flare for 6 days and this regimen could be applied in controlled ovarian hyperstimulation especially for poor responders. The pretreatment with oral contraceptive is necessary to prevent supraphysiologic LH elevation and corpus luteum rescue.

A Case of Miliary Tuberculosis During Pregnancy / 대한주산의학회잡지

Although miliary tuberculosis is uncommon during pregnancy. it is often associated with a maternal history of intravenous drug abuse, malignancy, alcoholism, or human immunodeficiency virus infection, and it is difficult to diagnose when associated with pregnancy. There is no solid evidence that pregnancy has an adverse effect on tuberculosis, thus routine therapeutic abortion is not indicated. If the early diagnosis and promptly adequate chemotherapy was done, the outcome of pregnancy in a women with miliary tuberculosis is likely to be good. Recently we have experienced a case of miliary tuberculosis at 20 weeks gestation without any risk factors of tuberculosis. So we report this case with a brief review of literature.

A Case Diagnosed to Cushing's Syndrome Caused by Adrenal Cortical Adenoma during Pregnancy after Ovulation Induction / 대한산부인과학회잡지

This woman was a secondary infertile patient with amenorrhea, hirsutism, and hyperprolactinemia due to excessive secretion of androgen. We had an impression that her disease was polycystic ovary syndrome, and she became pregnant after ovulation induction. Complications arised, such as hypertension, diabetes and pulmonary edema at 23rd week of pregnancy and physical findings of Cushing's syndrome were observed. Cushing's syndrome caused by adrenal cortical adenoma was diagnosed through endocrine and radiologic examination. We let her keep pregnancy through adjusting hypercorticolism with metyrapone to restrain abnormal steroidogenesis during pregnancy. After delivery, we carried out adrenalectomy through laparoscopic surgery and then can't find out any problem to be appeared to the mother and her neonate. We report this case with brief discussion.

Cytolagic Diagnosis of Colon Cancer by Colon Cleansing Solution / 대한소화기내시경학회지

Colorectal cancer consists of 8.2 percent of all malignancy in korea, and shows more increaing tendency. Despite the advances in the detection of calorectal cancer no single screening technique has achieved both high degree of diagnostic accuracy and minimal patient morbidity. We studied 24 patients, who underwent colonoscopy, with clinical suspicious colon cancer at Presbyterian Medical Center between Jan and Sep.1995, and evaluated the diagnostic feasibility of colon lavage cytology using oral cleansing solution.(continue...)

Cytolagic Diagnosis of Colon Cancer by Colon Cleansing Solution / 대한소화기내시경학회지

Colorectal cancer consists of 8.2 percent of all malignancy in korea, and shows more increaing tendency. Despite the advances in the detection of calorectal cancer no single screening technique has achieved both high degree of diagnostic accuracy and minimal patient morbidity. We studied 24 patients, who underwent colonoscopy, with clinical suspicious colon cancer at Presbyterian Medical Center between Jan and Sep.1995, and evaluated the diagnostic feasibility of colon lavage cytology using oral cleansing solution.(continue...)