OBJECTIVE: To compare the lumbar vertebral bone marrow fat-signal fractions obtained from six-echo modified Dixon sequence (6-echo m-Dixon) with those from single-voxel magnetic resonance spectroscopy (MRS) in patients with low back pain. MATERIALS AND METHODS: Vertebral bone marrow fat-signal fractions were quantified by 6-echo m-Dixon (repetition time [TR] = 7.2 ms, echo time (TE) = 1.21 ms, echo spacing = 1.1 ms, total imaging time = 50 seconds) and single-voxel MRS measurements in 25 targets (23 normal bone marrows, two focal lesions) from 24 patients. The point-resolved spectroscopy sequence was used for localized single-voxel MRS (TR = 3000 ms, TE = 35 ms, total scan time = 1 minute 42 seconds). A 2 × 2 × 1.5 cm³ voxel was placed within the normal L2 or L3 vertebral body, or other lesions including a compression fracture or metastasis. The bone marrow fat spectrum was characterized on the basis of the magnitude of measurable fat peaks and a priori knowledge of the chemical structure of triglycerides. The imaging-based fat-signal fraction results were then compared to the MRS-based results. RESULTS: There was a strong correlation between m-Dixon and MRS-based fat-signal fractions (slope = 0.86, R² = 0.88, p < 0.001). In Bland-Altman analysis, 92.0% (23/25) of the data points were within the limits of agreement. Bland-Altman plots revealed a slight but systematic error in the m-Dixon based fat-signal fraction, which showed a prevailing overestimation of small fat-signal fractions (< 20%) and underestimation of high fat-signal fractions (> 20%). CONCLUSION: Given its excellent agreement with single-voxel-MRS, 6-echo m-Dixon can be used for visual and quantitative evaluation of vertebral bone marrow fat in daily practice.
Bone Marrow ; Evaluation Studies as Topic ; Fractures, Compression ; Humans ; Low Back Pain ; Magnetic Resonance Spectroscopy* ; Neoplasm Metastasis ; Spectrum Analysis ; Spine ; Triglycerides

PURPOSE: This study focuses on investigating the effectiveness of simulation education on emergency management using a low-fidelity simulator as related to clinical skill performance, self-confidence, knowledge, learning satisfaction, and critical thinking disposition in new nurses. METHODS: A pre-post test experimental design of nonequivalent control group was applied. Fifty-five new nurses were recruited, 28 nurses for the experimental group and 27 nurses for the control group. A simulation education for emergency management comprising knowledge lecture, team learning, skill education, team simulation, and debriefing was developed and implemented from Feb. 14 to 27, 2015. Data were analyzed with percentage, average, and standard deviation, chi-square, and t-test using SPSS. RESULTS: The experimental group showed significantly higher knowledge (t=5.81, p<.001), clinical skill performance (t=10.08, p<.001), self-confidence (t=-6.24, p<.001), critical thinking disposition (t=2.42, p=.019), and learning satisfaction (t=4.21, p<.001) for emergency management compared with the control group who had traditional lecture education. CONCLUSION: The results indicate that a simulation education using a low-fidelity simulator is an efficient teaching method for new nurses to deepen their clinical skill performance, self-confidence, knowledge, learning satisfaction, and critical thinking disposition in learning emergency management.
Clinical Competence ; Education ; Emergencies ; Emergency Nursing ; Evaluation Studies as Topic ; Learning ; Patient Simulation ; Research Design ; Teaching ; Thinking

PURPOSE: The purpose of this study was to estimate the effects of a video low intensity exercise program provided during hemodialysis on fatigue, activity of daily living, positive psychological capital and blood pressure of patients being treated. METHODS: A non-equivalent control group pre-post test design was used. Participants were 85 hemodialysis patients assigned to either the experimental group (n=41) or the control group (n=44). The experimental group exercised for about 25 minutes 3 times a week for 8 weeks. Data analyses involved descriptive statistics, χ2 test, t-test, multiple regression and repeated measure ANOVA using SPSS/WIN 23.0. RESULTS: The exercise intervention significantly reduced post hemodialysis fatigue and significantly increased positive psychological capital. There was a significant interaction effect on time by group in blood pressure. Systolic blood pressure changes in the experimental group were stable but, changes in the control group tended to increase gradually. CONCLUSION: To reduce fatigue and increase positive psychological capital for hemodialysis patients, providing exercise during hemodialysis is recommended. Furthermore individualized exercise in terms of intensity, time, duration, etc should be developed and tested. Also, to reduce drastic blood pressure changes during hemodialysis, exercise should be provided.
Blood Pressure ; Evaluation Studies as Topic ; Fatigue ; Humans ; Renal Dialysis ; Statistics as Topic

PURPOSE: The aim of this study was to examine the effects of aroma hand massage on stress, fatigue, and sleep in sophomore nursing students. METHODS: This study was a quasi-experimental design with a nonequivalent control group and a pre-post test was used. Thirty-seven sophomore nursing students were recruited. The experimental group (n=18) underwent 40 minutes aroma hand massage which was provided by the research assistant. The research assistant was trained with a video clip for aroma hand massage that was developed by Korea Aroma Association. Aroma oil contained lavender essential oil and sweet orange oil mixed with a jojoba oil base. The control group (n=19) did not receive any other treatments related aroma and massage. RESULTS: Significant improvements were exhibited in scores for stress (t=−2.61, p=.013) and fatigue in the experimental group (t=−2.05, p=.047) compared to the control group. However, differences in sleep between two groups were not statistically significant (t=1.23, p=.277) between two groups. CONCLUSION: The results of this study suggest that aroma hand massage could be useful to decrease stress and fatigue levels for sophomore nursing students. Therefore, results of this study can be used as a basis of health care programs for reducing stress of nursing students.
Aromatherapy ; Citrus sinensis ; Delivery of Health Care ; Evaluation Studies as Topic ; Fatigue ; Hand ; Humans ; Korea ; Lavandula ; Massage ; Nursing ; Students, Nursing

BACKGROUND: Seoul National University College of Medicine has provided a new educational curriculum on basis of the competency-based curriculum since 2016. The new curriculum included the medical humanities course (MHC) to potentiate humanities of medical students. The present study applied the context, input, process and product (CIPP) evaluation model to the MHC in order to confirm the feasibility of the CIPP model and to improve the MHC by questionnaire survey and analysis of teaching materials. METHODS: This study analyzed the MHC provided to the freshmen in 2016 and to the freshmen and sophomores in 2017 by the CIPP model. Firstly, evaluation criteria and indicators were developed according to the CIPP classification. The materials collected from the course were analyzed by quantitative and qualitative analysis according to the evaluation criteria. In the quantitative analysis, an independent sample t-test was performed to verify the difference in the responses between the students (n = 522) and the professors (n = 22). In addition, content analysis was conducted for qualitative evaluation. RESULTS: There were significant differences in perceptions of MHC between students and professors about the results of almost all objective survey questions through the t-test, such as score 3.64 in students and 4.48 in professors in response to the item of ‘provision of appropriate feedback.’ As a result of the content analysis, 7 categories and 20 subcategories were derived. There were the most responses to various instructional methods (students, 20%; professors, 21.5%). CONCLUSION: The CIPP evaluation model was acceptable for the MHC analysis. The first task is to raise students' awareness of the MHC in order to improve the MHC quality.
Classification ; Curriculum ; Evaluation Studies as Topic ; Humanities ; Humans ; Seoul ; Students, Medical ; Teaching Materials

OBJECTIVES: The outcomes of the treatment of unilateral cleft lip can vary considerably due to variations in repair techniques. The aim of this study was to evaluate and compare treatment outcomes of surgical repair of unilateral cleft lip using either the Tennison–Randall or Millard technique based on (qualitative) parent/subject and professional assessments. MATERIALS AND METHODS: This was a prospective, randomized, controlled study conducted at Lagos University Teaching Hospital between January 2013 and July 2014. A total of 56 subjects with unilateral cleft lip presenting for primary surgery who satisfied the inclusion criteria were recruited for the study. Subjects were randomly allocated to surgical groups A or B through balloting. Group A underwent cleft repair with the Tennison–Randall technique, while group B underwent cleft repair with the Millard rotation advancement technique. Surgical outcome was assessed using qualitative evaluation by the guardian/subject and independent assessors based on a modified form of the criteria described by Christofides and colleagues. RESULTS: Of the 56 subjects enrolled in this study, 32 were male, with a male to female ratio of 1.3:1. Fifteen of the guardians/subjects in the Tennison–Randall group were most bothered about the lower part of the residual lip scar, while 12 guardians/subjects in the in the Millard group were most bothered about the upper part of the scar. More noses were judged to be flattened in the Millard group than in the Tennison–Randall group. Assessors observed a striking disparity in scar transgression of the philtral ridges between the two groups. CONCLUSION: Essentially, there were no major difference in the overall results between Millard rotation-advancement and Tennison–Randall repairs. Both Millard and Tennison–Randall's techniques require significant improvements to improve the appearance of the scar on the upper part and lower part of the lip, respectively.
Cicatrix ; Cleft Lip ; Evaluation Studies as Topic ; Female ; Hospitals, Teaching ; Humans ; Lip ; Male ; Nose ; Prospective Studies ; Strikes, Employee ; Treatment Outcome

PURPOSE: The purpose of this study was to evaluate the morphology of the mandibular cortex in cases of medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis or bone metastases using a computer programme.MATERIALS AND METHODS: Fifty-four patients with MRONJ (35 with osteoporosis and 19 with bone metastases) were examined using panoramic radiography. The morphology of the mandibular cortex was evaluated using a computer programme that scanned the mandibular inferior cortex and automatically assessed the mandibular cortical index (MCI) according to the thickness and roughness of the mandibular cortex, as follows: normal (class 1), mildly to moderately eroded (class 2), or severely eroded (class 3). The MCI classifications of MRONJ patients with osteoporosis or bone metastases were evaluated with the Pearson chi-square test. In these analyses, a 5% significance level was used.RESULTS: The MCI of MRONJ patients with osteoporosis (class 1: 6, class 2: 15, class 3: 14) tended to be higher than that of patients with bone metastases (class 1: 14, class 2: 5, class 3: 0) (P=0.000).CONCLUSION: The use of a computer programme to assess mandibular cortex morphology may be an effective technique for the objective and quantitative evaluation of the MCI in MRONJ patients with osteoporosis or bone metastases.
Bisphosphonate-Associated Osteonecrosis of the Jaw ; Classification ; Cytochrome P-450 CYP1A1 ; Evaluation Studies as Topic ; Humans ; Image Processing, Computer-Assisted ; Jaw ; Neoplasm Metastasis ; Osteonecrosis ; Osteoporosis ; Radiography, Panoramic

PURPOSE: The purpose of this study was to examine the effects of an aging management program on the resilience and successful aging of middle-aged women.METHODS: A quasi-experimental study with a non-equivalent control and pre-post test design was used. The participants were 39 middle-aged women living in urban areas in Korea. The experimental group (n=22) received the aging management program for a total of 10 weeks, 90 minutes to 120 minutes per week. The aging management program consisted of strategies to enhance the behavior, promotion conditions, and habits of the program, including various activities for middle-aged women. The data were analyzed using χ² tests, independent t-tests, and repeated measures analysis of variance with the SPSS/WIN 21.0 program.RESULTS: The resilience score of the experimental group was significantly higher level than the score of the control group in the time-to-group interactions (F=3.70, p=0.029). The successful aging score of the experimental group was significantly higher than the score of the control group in the time-to-group interactions (F=5.86, p=0.004). However, the sub-hypotheses of resilience (self-regulation and interpersonal relationships) and successful aging (physical aging adaptation and psychological age adaptation) were partially accepted.CONCLUSIONS: The aging management program for middle-aged women was identified as an effective intervention for promoting resilience and successful aging in middle-aged women. Therefore, this suggests that the aging care program could be a useful intervention program to improve the mental health of middle-aged women living in communities.
Aging ; Evaluation Studies as Topic ; Female ; Humans ; Korea ; Mental Health ; Middle Aged ; Non-Randomized Controlled Trials as Topic ; Preventive Health Services ; Resilience, Psychological

PURPOSE: Recently, a new Bayesian Penalized Likelihood (BPL) Reconstruction Algorithm was introduced by GE Healthcare, Q.Clear; it promises to provide better PET image resolution compared to the widely used Ordered Subset Expectation Maximization (OSEM). The aimof this study is to compare the performance of these two algorithms on several types of findings, in terms of image quality, lesion detectability, sensitivity, and specificity.METHODS: Between September 6th 2017 and July 31st 2018, 663 whole body 18F-FDG PET/CT scans were performed at the Nuclear Medicine Department of S. Martino Hospital (Belluno, Italy). Based on the availability of clinical/radiological follow-up data, 240 scans were retrospectively reviewed. For each scan, a hypermetabolic finding was selected, reporting both for OSEM and Q.Clear: SUVmax and SUVmean values of the finding, the liver and the background close to the finding; size of the finding; percentage variations of SUVmax and SUVmean. Each finding was subsequently correlated with clinical and radiological follow-up, to define its benign/malignant nature.RESULTS: Overall, Q.Clear improved the SUVvalues in each scan, especially in small findings (< 10mm), high SUVmax values (≥ 10), and medium/low backgrounds. Furthermore, Q.Clear amplifies the signal of hypermetabolic findings without modifying the background signal, which leads to an increase in signal-to-noise ratio, improving overall image quality. Finally, Q.Clear did not affect PET sensitivity or specificity, in terms of number of reported findings and characterization of their nature.CONCLUSIONS: Q.Clear is an iterative algorithm that improves significantly the quality of PET images compared to OSEM, increasing the SUVmax of findings (in particular for small findings) and the signal-to-noise ratio. However, due to the intrinsic characteristics of this algorithm, it will be necessary to adapt and/or modify the current interpretative criteria based of quantitative evaluation, to avoid an overestimation of the disease burden.
Delivery of Health Care ; Evaluation Studies as Topic ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Liver ; Nuclear Medicine ; Positron-Emission Tomography and Computed Tomography ; Retrospective Studies ; Sensitivity and Specificity ; Signal-To-Noise Ratio

Single-photon emission computed tomography/computed tomography (SPECT/CT) is an already established nuclear imaging modality. Co-registration of functional information (SPECT) with anatomical images (CT) paved the way to the wider application of SPECT. Recent advancements in quantitative SPECT/CT have made it possible to incorporate quantitative parameters, such as standardized uptake value (SUV) or %injected dose (%ID), in gamma camera imaging. This is indeed a paradigm shift in gamma camera imaging from qualitative to quantitative evaluation. In fact, such quantitative approaches of nuclear imaging have only been accomplished for positron emission tomography (PET) technology. Attenuation correction, scatter correction, and resolution recovery are the three main features that enabled quantitative SPECT/CT. Further technical improvements are being achieved for partial-volume correction, motion correction, and dead-time correction. The reported clinical applications for quantitative SPECT/CT are mainly related to Tc-99m-labeled radiopharmaceuticals: Tc-99m diphosphonate for bone/joint diseases, Tc-99m pertechnetate for thyroid function, and Tc-99m diethylenetriaminepentaacetic acid for measurement of glomerular filtration rate. Dosimetry before trans-arterial radio-embolization is also a promising application for Tc-99m macro-aggregated albumin. In this review, clinical applications of Tc-99m quantitative SPECT/CT will be discussed.
Evaluation Studies as Topic ; Gamma Cameras ; Glomerular Filtration Rate ; Positron-Emission Tomography ; Radionuclide Imaging ; Radiopharmaceuticals ; Sodium Pertechnetate Tc 99m ; Thyroid Gland ; Tomography, Emission-Computed, Single-Photon