National hospital quality measures for surgical site infections in South Korea: a survey among 20 expert physicians.

BACKGROUND: Surgical site infection (SSI) is recognized as an important quality indicator for patient safety. In Korea, the use of prophylactic antibiotics for surgery is conducted as a national quality measures related to SSI prevention. The objective of the present study was to investigate physicians' perceptions of hospital quality measures for SSI as well as identify obstacles that might hinder its implementation in South Korea. METHOD: Online-based questionnaires were administered twice. Twenty physician experts who were members of the Healthcare Review and Assessment Committee that was constituted for the "Assessment of prophylactic use of antibiotics for surgery" participated in the study. The first survey comprised open-ended questions that were designed to elicit the physician who could hinder the implementation of SSI indicators. The second survey, which was developed on the basis of the initial survey's results, consisted of 10 closed-ended questions about the feasibility of objective perception and the need for subjectivity, with regard to SSI. RESULTS: From among the 20 physicians, we collected data from 16 respondents in the first survey (response rate of 80%) and 15 respondents in the second survey (response rate of 75%).Thirty-one percent of the respondents supported hospital SSI evaluations, and 69% expressed objections. The obstacles that were perceived as being able to hinder hospital SSI evaluations pertained to difficulties in collecting data, unavailability of information, possibility of underreporting, and redundancy of the inquiry undertaken by the Korean National Healthcare-associated Infections Surveillance System-SSI. Physician experts provide significantly higher ratings for the clinical indicator, rate of readmission due to SSI, both in terms of feasibility and need, when evaluating the results of SSI prevention in hospitals. CONCLUSION: The results of this study show that physicians perceive the need for QI development of hospital SSI measurements to prevent nation-wide SSIs in Korea. However, the feasibility of hospital SSI measurements is low. To develop QIs of hospital SSIs using health insurance claims data, it is necessary to develop a methodology for claims data-based surveillance systems and a data collection system in order to increase the sensitivity and validity of post-operative SSI detection.

Development of p-Coumaric Acid Analysis in Human Plasma and Its Clinical Application to PK/PD Study.

It has been recognized that p-Coumaric acid (p-CA) has protective effects as an antioxidant, anti-inflammatory agent. A sensitive and efficient Liquid Chromatography-Mass Spectrometry (LC-MS) method for maximum determination of p-CA in human plasma has been established using Ultra-performance liquid Chromatography-tandem mass Spectrometry (UPLC-MS/MS). This study provides the developed analysis of p-CA extracted from Bambusae Caulis in Taeniam (BC) to examine the improvement of the treatment p-CA, IGF-1 and Osteocalcin level in human children which are important factors on the growth of children's height through Pharmacokinetics/Pharmacodynamics (PK/PD) model. p-CA and internal standard in a plasma sample were detected by the Multiple Reaction Monitoring (MRM) scan mode with positive ion detection. The sample participating in the study was made of 34 subjects (placebo = 18, treatment = 16). The subjects were enrolled to be randomized to the control group and BC group. Randomized subjects took tested treatment twice a day, three capsules with oral administration (258 mg/capsule) each time after a meal. Standard calibration curves (reproducibility) were constructed and the lower limit of quantitation (LLOQ) for p-CA was found to be 0.2 ng/mL on injection of the sample into the UPLC-MS/MS system. Accuracy and precision were evaluated and the intra-accuracy was 99.2-103.8% with precision of 1.0-5.6% and inter-accuracy was 99.6-108.4% and precision of 1.3-6.4% for p-CA. The method has been successfully applied to PK/PD studies of p-CA in human plasma. The p-CA, BC in Taeniam extract increased the level of IGF-1 and Osteocalcin, and changed the height from baseline, which suggested that the p-CA could play an important role in longitudinal bone growth. Therefore, the p-CA extracted from BC in Taeniam might be a good alternative medicine to growth hormone (GH) therapy.

Measurement reliability of automated oscillometric blood pressure monitor in the elderly with atrial fibrillation: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to identify whether automated oscillometric blood pressure monitor (AOBPM) is a reliable blood pressure (BP) measurement tool in geriatric patients with atrial fibrillation (AF) with high variability in BP and to evaluate whether it can be applied in practice. METHODS: Electronic searches were performed in databases including MEDLINE, EMBASE, the Cochrane Library, and CINAHL by using the following keywords: 'atrial fibrillation,' 'atrial flutter, 'blood pressure monitor', 'sphygmomanometer.' The QUADAS-2 was applied to assess the internal validity of selected studies. Meta-analysis was performed using RevMan 5.3 program. DESIGN: Systematic review. RESULTS: We identified 10 studies, including 938 geriatric patients with AF. We compared with the previously used BP measurement method (mainly office) and AOBPM, and the patients with AF were divided into the AF-AF (atrial fibrillation rhythm continued) and AF-SR groups (sinus rhythm recovered). The difference in the systolic BP was -3.0 mmHg [95% confidence interval (CI): -6.58 to 0.59] and -1.62 (95% CI: -6.08 to 2.84) mmHg in the AF-AF and AF-SR groups, respectively. The difference in the diastolic BP was 0.17 (95% CI: -2.90 to 3.25) mmHg and -0.23 (95% CI: -5.11 to 4.65) mmHg, respectively. CONCLUSION: This review showed that the BP difference from AOBPM compared with the auscultatory BP method was less than 5 mmHg in the elderly with AF. This difference is acceptable in clinical practice. However, AOBPM compared with invasive arterial BP in the diastolic BP was a difference of 5 mmHg or more, and so its accuracy cannot be assured.

Predictive validity of automated oscillometric blood pressure monitors for screening atrial fibrillation: a systematic review and meta-analysis.

Background: This study was conducted to verify if automated oscillometric blood pressure monitors (AOBPMs) have sufficiently high predictive validity to screen patients with atrial fibrillation (AF). Methods: Electronic searches were performed to identify all studies published between 1946 and 14 July 2018, from indexed in Ovid-Medline, Embase, the Cochrane Library, and CINAHL by using the following keywords: 'atrial fibrillation,' 'atrial flutter,' 'blood pressure monitor,' and 'sphygmomanometer.' Results: Thirteen diagnostic accuracy studies, including a total of 9,380 elderly, were included in our meta-analysis. The meta-analysis showed that the pooled sensitivity was 0.91 (95% CI, 0.89 to 0.93), and the heterogeneity between studies was as high as 88.4% (X2 = 120.55, p < 0.001). The pooled specificity was 0.96 (95% CI, 0.96 to 0.97), and the heterogeneity between studies was 95.3% (X2 = 299.26, p < .001). The area under the curve (AUC) of the summary receiver operating characteristic (sROC) curve was 0.98 (SE = 0.005), and the Q-value was 0.94 (SE = 0.010). Conclusion: The AOBPM is an appropriate screening tool that may be applied to elderly to verify the presence of AF conveniently. The AOBPM has high applicability in practice, since it may prevent potentially fatal complications such as stroke.

Effect of Mobile Health on Obese Adults: A Systematic Review and Meta-Analysis.

OBJECTIVES: This study was conducted to examine the effects of mobile health (mHealth), using mobile phones as an intervention for weight loss in obese adults. METHODS: An electronic search was carried out using multiple databases. A meta-analysis of selected studies was performed. The effects of mHealth were analyzed using changes in body weight and body mass index (BMI). RESULTS: We identified 20 randomized controlled trials (RCTs) involving 2,318 participants who fit our inclusion criteria. The meta-analysis showed that body weight was reduced with a weighted mean difference (WMD) of -2.35 kg (95% confidence interval [CI], -2.84 to -1.87). An examination of the impact of duration of intervention showed that weight loss was greater after 6 months of mHealth (WMD = -2.66 kg) than between three and four months (WMD = -2.25 kg); it was maintained for up to 9 months (WMD = -2.62 kg). At 12 months, weight loss was reduced to a WMD of -1.23 kg. BMI decreased with a WMD of -0.77 kg/m2 (95% CI, -1.01 to -0.52). BMI changes were not statistically significant at 3 months (WMD = -1.10 kg/m2), but they were statistically significant at 6 months (WMD = -0.67 kg/m2). CONCLUSIONS: The use of mHealth for obese adults showed a modest short-term effect on body weight and BMI. Although the weight loss associated with mHealth did not meet the recommendation of the Scottish Intercollegiate Guideline Network, which considers a reduction of approximately 5 to 10 kg of the initial body weight as a successful intervention. Well-designed RCTs are needed to reveal the effects of mHealth interventions.

Predictive validity of the Braden Scale for pressure ulcer risk in hospitalized patients.

PURPOSE: Although the Braden Scale has been used as a basic tool to assess pressure ulcer risk, the validity of its effectiveness and accuracy was insufficient. Therefore, this study developed the groundwork for the predictive validity of the Braden Scale through a meta-analysis of prospective diagnosis assessment research. METHODS: Articles published between 1966 and 2013 from periodicals indexed in the Ovid Medline, Embase, CINAHL, KoreaMed, NDSL and other databases were selected, using the keyword 'pressure ulcer'. QUADAS-II was applied to assess the internal validity of the diagnostic studies. Selected studies were analyzed using meta-analysis with MetaDiSc 1.4. RESULTS: Twenty-one diagnostic studies with high methodological quality, involving 6070 patients, were included. The meta-analysis revealed that the pooled sensitivity was 0.72 (95% CI 0.68, 0.75); pooled specificity was 0.81 (95% CI 0.80, 0.82), and the sROC AUC was 0.84 (SE = 0.02). A detail analysis confirmed that age and reference standards were the factors that affected the diagnostic accuracy of the Braden Scale. CONCLUSION: The results suggest that the Braden Scale has a moderate predictive validity. This research also revealed the possibility that the predictive validity of the Braden Scale could be enhanced if it was applied differently according to the attributes of the study subjects.

Novel and simple route to fabricate fully biocompatible plasmonic mushroom arrays adhered on silk biopolymer.

A fully biocompatible plasmonic quasi-3D nanostructure is demonstrated by a simple and reliable fabrication method using strong adhesion between gold and silk fibroin. The quasi-3D nature gives rise to complex photonic responses in reflectance that are prospectively useful in bio/chemical sensing applications. Laser interference lithography is utilized to fabricate large-area plasmonic nanostructures.

A fully biocompatible single-mode distributed feedback laser.

A fully biocompatible laser would be attractive in many aspects of biomedical research. Here we report a single-mode biocompatible distributed feedback laser consisting of silk, riboflavin and silver in the form of a freestanding film. The distributed feedback structure has a large surface area and flexibility. The fabricated laser exhibited single-mode lasing at a wavelength of 495 nm.

Enhanced fluorescence from CdSe/ZnS quantum dot nanophosphors embedded in a one-dimensional photonic crystal backbone structure.

A nano-engineered phosphor structure that produces enhanced fluorescence is reported. Two kinds of polymer materials with different refractive indices are spin-coated alternately to realize a one-dimensional (1D) photonic crystal (PC) phosphor platform, in which CdSe/ZnS core-shell quantum dots (QDs) were embedded as a fluorescence agent. The 1D PC phosphor structure is designed to match the pump photon energy with one of the photonic band-edges (PBEs), where the photon group velocity becomes zero, and thus the interaction between pump photons and fluorescent centres strengthened. A reference phosphor structure is also designed and fabricated; however, it has no PBE and exhibited bulk-like photonic properties. The fluorescence intensity from the 1D PC phosphors is examined during the pump photon energy scanning across the PBE. It is found that fluorescence from the 1D PC phosphor reaches its maximum when the pump photon energy coincides with the PBE, which is consistent with the theoretical prediction. In comparison with the reference phosphor, the fluorescence from the 1D PC phosphor is measured to be enhanced by a factor of 1.36.

Model calculations for enhanced fluorescence in photonic crystal phosphor.

We propose a novel photonic structure, based on the photonic crystal (PC) effect, which simulations show results in an improved fluorescence efficiency from embedded phosphor. To be specific, the phosphor pumping efficiency can be significantly improved by tuning the pump photon energy to a photonic band-edge (PBE) of the PC phosphor. We have confirmed this theoretically by calculating optical properties of one-dimensional PC phosphor structures using the transfer-matrix method and plane-wave expansion method. For a particular model structure based on a quantum dot phosphor, the fluorescence enhancement factor was estimated to be as high as 6.9 for a monochromatic pump source and 2.2 for a broad bandwidth (20 nm) pump source.

A comparative study on the validity of fall risk assessment scales in korean hospitals.

PURPOSE: The purpose of this study was to compare the validity of three fall risk assessment scales including the Morse Fall Scale (MFS), the Bobath Memorial Hospital Fall Risk Assessment Scale (BMFRAS), and the Johns Hopkins Hospital Fall Risk Assessment Tool (JHFRAT). METHODS: This study was a prospective validation cohort study in five acute care hospitals in Seoul and Gyeonggi-Do, Korea. In total, 356 patients over the age of 18 years admitted from December 2009 to February 2010 participated. The three fall risk assessment scales listed above were tested for sensitivity, specificity, positive predictive and negative predictive values. A receiver-operating characteristic (ROC) curve was generated to show sensitivities and specificities for predicting falls based on different threshold scores for considering patients at high risk. RESULTS: Based on the mean scores of each scale for falls, the MFS at a cut-off score of 50 had a sensitivity of 78.9%, specificity of 55.8%, positive predictive value of 30.8%, and negative predictive value of 91.4%, which were the highest values among the three fall assessment scales. Areas under the curve of the ROC curves were .761 for the MFS, .715 for the BMFRAS, and .708 for the JHFRAT. CONCLUSIONS: Accordingly, of the three fall risk assessment scales, the highest predictive validity for identifying patients at high risk for falls was achieved by the MFS.