Sie sind auf Seite 1von 5

3URFHHGLQJVRIWKH1XWULWLRQ6RFLHW\   '2,316

7KH$XWKRUV
 1XWULWLRQ6RFLHW\

3161XWULWLRQDQGFOLQLFDOPDQDJHPHQWRIGLVHDVH.&+)HDURQDQG5/XII
&$%,QWHUQDWLRQDO3163URFHHGLQJVRI1XWULWLRQ6RFLHW\  1XWULWLRQ6RFLHW\

7KHQXWULWLRQDOPDQDJHPHQWRIVXUJLFDOSDWLHQWVHQKDQFHGUHFRYHU\
DIWHUVXUJHU\

.HQQHWK&+)HDURQ DQG5DFKHO/XII
'HSDUWPHQWRI&OLQLFDODQG6XUJLFDO6FLHQFHV 6XUJHU\ 6FKRRORI&OLQLFDO6FLHQFHVDQG&RPPXQLW\+HDOWK7KH8QLYHUVLW\RI
(GLQEXUJK5RRP)7KH5R\DO,QILUPDU\RI(GLQEXUJK/LWWOH)UDQFH&UHVFHQW(GLQEXUJK(+$8.
3URIHVVRU.&+)HDURQID[HPDLO.)HDURQ#HGDFXN

0DOQXWULWLRQKDVORQJEHHQUHFRJQLVHGDVDULVNIDFWRUIRUSRVWRSHUDWLYHPRUELGLW\DQGPRUWDOLW\
7UDGLWLRQDO PHWDEROLF DQG QXWULWLRQDO FDUH RI SDWLHQWV XQGHUJRLQJ PDMRU HOHFWLYH VXUJHU\ KDV
HPSKDVLVHG SUHRSHUDWLYH IDVWLQJ DQG UHLQWURGXFWLRQ RI RUDO QXWULWLRQ  G DIWHU VXUJHU\
$WWHPSWVWRDWWHQXDWHWKHFRQVHTXHQWQXWULWLRQDOGHILFLWDQGWRLQIOXHQFHSRVWRSHUDWLYHPRUELGLW\
DQG PRUWDOLW\ KDYH LQFOXGHG SDUHQWHUDO HQWHUDO DQG RUDO VLS IHHGLQJ 5HFHQW VWXGLHV KDYH
HPSKDVLVHGWKDWDQHQKDQFHGUDWHRIUHFRYHU\FDQEHDFKLHYHGE\DPXOWLPRGDODSSURDFKIRFXVHG
RQPRGXODWLQJWKHPHWDEROLFVWDWXVRIWKHSDWLHQWEHIRUH HJFDUERK\GUDWHDQGIOXLGORDGLQJ 
GXULQJ HJ HSLGXUDO DQDHVWKHVLD  DQG DIWHU HJ HDUO\ RUDO IHHGLQJ  VXUJHU\ 8VLQJ VXFK DQ
DSSURDFK SUHOLPLQDU\ UHVXOWV RQ SDWLHQWV XQGHUJRLQJ HOHFWLYH FRORUHFWDO VXUJHU\ LQGLFDWH D
VLJQLILFDQWUHGXFWLRQLQKRVSLWDOVWD\ WUDGLWLRQDOFDUHQPHGLDQVWD\ GYHQKDQFHGUHFRYHU\
SURJUDPPH Q  PHGLDQ VWD\  G 3    FDQ EH DFKLHYHG 6XFK ILQGLQJV HPSKDVLVH WKH
SRWHQWLDOUROHRIPXOWLPRGDOFDUHSURJUDPPHVLQWKHSURPRWLRQRIHDUO\UHFRYHU\IURPPDMRU
VXUJLFDOWUDXPD

3UHRSHUDWLYHIDVWLQJ3RVWRSHUDWLYHQXWULWLRQDOVXSSRUW(QKDQFHGUHFRYHU\DIWHUVXUJHU\

7KH DLP RI WKH SUHVHQW DUWLFOH LV WR UHYLHZ WKH QXWULWLRQDO UHODWLRQVKLS +LOO   IRU H[DPSOH XVHG QHXWURQ
PDQDJHPHQW RI WKH VXUJLFDO SDWLHQW ,Q SDUWLFXODU WKH DFWLYDWLRQ ERG\ FRPSRVLWLRQ DQDO\VLV WR GHWHUPLQH WRWDO
UDWLRQDOHDQGQDWXUHRIQXWULWLRQDOVXSSRUWZLWKLQWKHFRQWH[W ERG\ 1 DQG WKXV GHILQH WKRVH SDWLHQWV ZLWK RU ZLWKRXW D
RIWUDGLWLRQDOSHULRSHUDWLYHFDUHZLOOEHFRPSDUHGZLWKWKDW PDUNHG SURWHLQ GHILFLW 7KH VWXG\ LQYROYHG !  SDWLHQWV
IRUHQKDQFHGUHFRYHU\IROORZLQJVXUJHU\ XQGHUJRLQJJDVWURLQWHVWLQDOWUDFWUHVHFWLRQ7KHUHZDVDOHVV
GUDPDWLFEXWVWLOOPDUNHGLQFUHDVHLQERWKPDMRUFRPSOLFD
WLRQVDQGWKHGXUDWLRQRISRVWRSHUDWLYHVWD\LQWKRVHSDWLHQWV
1XWULWLRQDOVWDWXVDQGVXUJLFDORXWFRPH
ZLWK PDUNHG ZKROHERG\ SURWHLQ GHSOHWLRQ &OHDUO\ LW LV
7KH UHDVRQV ZK\ QXWULWLRQDO VWDWXV LV FRQVLGHUHG WR EH DQ GLIILFXOW WR VHSDUDWH SRVWRSHUDWLYH PRUELGLW\ UHODWHG WR
LPSRUWDQW GHWHUPLQDQW RI VXUJLFDO RXWFRPH FDQ EH WUDFHG PDOQXWULWLRQSHUVHYWKDWUHODWHGSULPDULO\WRWKHSDWLHQWV
EDFN WR WKH V DQG WKH VWXGLHV RI 6WXGOH\   +H XQGHUO\LQJSDWKRORJ\ ZKLFKMXVW KDSSHQV WR KDYHLQGXFHG
GHPRQVWUDWHGLQSDWLHQWVXQGHUJRLQJSDUWLDOJDVWUHFWRP\IRU PDOQXWULWLRQ  1HYHUWKHOHVV VXFK VWXGLHV KDYH IRUPHG WKH
FRPSOLFDWHG SHSWLF XOFHU GLVHDVH WKDW WKRVH ZKR KDG ORVW EDVLV IRU XVLQJ QXWULWLRQDO VXSSRUW WR WU\ WR UHGXFH SRVW
   RI WKHLU SUHLOOQHVV VWDEOH ZHLJKW KDG DQ RSHUDWLYH RSHUDWLYHPRUELGLW\DQGPRUWDOLW\
PRUWDOLW\RIDSSUR[LPDWHO\ZKHUHDVWKRVHZLWK! 
ZHLJKW ORVV KDG DQ RSHUDWLYH PRUWDOLW\ RI DSSUR[LPDWHO\
3DUHQWHUDOQXWULWLRQ
  ,W PLJKW EH DUJXHG WKDW PRUH PRGHUQ VXUJHU\ ZLWK
SURSK\ODFWLFDQWLELRWLFVEHWWHUDQDHVWKHVLDLPSURYHGVXWXUH 8QIRUWXQDWHO\ WKURXJKRXW WKH V DQG LQWR WKH V
PDWHULDOV DQG RSWLPDO SK\VLRWKHUDS\ PLJKW DYRLG VXFK D QXWULWLRQDO VXSSRUW FDPH WR EH UHJDUGHG DV D SDQDFHD IRU
KLJK UDWH RI SRVWRSHUDWLYH FRPSOLFDWLRQV LQ PDOQRXULVKHG DOO VXUJLFDO LOOV ,Q SDUWLFXODU QXPHURXV WULDOV RI SHUL
SDWLHQWV+RZHYHUPRUHUHFHQWVWXGLHVVWLOOVKRZDVLPLODU RSHUDWLYH WRWDO SDUHQWHUDO QXWULWLRQ ZHUH XQGHUWDNHQ LQ

&RUUHVSRQGLQJDXWKRU 3URIHVVRU.&+)HDURQID[HPDLO.)HDURQ#HGDFXN

Downloaded from https:/www.cambridge.org/core. IP address: 115.178.215.1, on 08 Jun 2017 at 06:50:07, subject to the Cambridge Core terms of use, available at
https:/www.cambridge.org/core/terms. https://doi.org/10.1079/PNS2003299
 .&+)HDURQDQG5/XII

FRKRUWVRISDWLHQWVZKRZHUHQRWVSHFLILFDOO\PDOQRXULVKHG LQWHQVLYH FDUH XQLW WKH VLWXDWLRQ LV FRPSOH[ +RZHYHU WKH
+H\ODQG HW DO   KDYH UHFHQWO\ XQGHUWDNHQ D PHWD RYHUDOOFRQVHQVXVLVWKDWDVKLIWIURPSDUHQWHUDOQXWULWLRQWR
DQDO\VLVDQGQRWVXUSULVLQJO\FRQFOXGHGWKDWSHULRSHUDWLYH HQWHUDOQXWULWLRQKDVEHHQRIPDMRUEHQHILWRYHUWKHODVW
SDUHQWHUDO QXWULWLRQ JLYHQ WR SDWLHQWV XQGHUJRLQJ PDLQO\ \HDUV ,Q UHODWLRQ WR WKH URXWLQH SRVWRSHUDWLYH VXUJLFDO
PDMRUXSSHUJDVWURLQWHVWLQDOFDQFHUVXUJHU\KDVQRLQIOXHQFH SDWLHQWLWLVPRUHGLIILFXOWWRDFKLHYHDFRQVHQVXV$UHFHQW
RQSRVWRSHUDWLYHPDMRUFRPSOLFDWLRQVRUPRUWDOLW\ PHWDDQDO\VLVKDVHPSKDVLVHGDSRWHQWLDOUHGXFWLRQLQSRVW
RSHUDWLYHLQIHFWLRXVFRPSOLFDWLRQVLQSDWLHQWVJLYHQHQWHUDO
IHHGLQJ ZLWK DQ LPPXQRPRGXODWRU\ UHJLPHQ +H\V HW DO
(QWHUDOQXWULWLRQ
 +RZHYHULQRQHRIWKHODUJHVWVLQJOHFHQWUHVWXGLHV
'XULQJ WKH V WKHUH ZDV D VKLIW LQ HPSKDVLV IURP +HVOLQ HW DO DE   SDWLHQWV ZLWK RHVRSKDJHDO
SDUHQWHUDOQXWULWLRQ WR HQWHUDO QXWULWLRQSDUWLFXODUO\ IRUWKH JDVWULF SDQFUHDWLF RU ELOH GXFW FDQFHU ZHUH UDQGRPLVHG
FDUH RI WKH FULWLFDOO\ LOO 7KH UDWLRQDOH IRU D FKDQJH LQ WR SRVWRSHUDWLYH HDUO\ HQWHUDO IHHGLQJ ZLWK DQ LPPX
HPSKDVLV LQFOXGHG WKH IDFW WKDW HQWHUDO IHHGLQJ LV PRUH QRPRGXODWRU\ UHJLPHQ YLD D MHMXQRVWRP\ WXEH Y VWDQGDUG
SK\VLRORJLFDOLVDVVRFLDWHGZLWKIHZHUFRPSOLFDWLRQVDQGLV LQWUDYHQRXVIOXLGVEHIRUHFRPPHQFHPHQWRIRUDOGLHW7KHUH
DOVRFKHDSHU+RZHYHUIRUWKHSRVWRSHUDWLYHSDWLHQWZLWKD ZHUHQR GLIIHUHQFHVLQPDMRUFRPSOLFDWLRQV OHQJWKRIVWD\
JDVWURLQWHVWLQDODQDVWRPRVLVWKHUHLVWKHDQ[LHW\WKDWILOOLQJ RU SRVWRSHUDWLYH PRUWDOLW\ 7KXV WKH UROH RI URXWLQH
WKHJDVWURLQWHVWLQDOWUDFWZLWKHQWHUDOIHHGLQWKHHDUO\SRVW SODFHPHQWRIDIHHGLQJMHMXQRVWRP\LQSDWLHQWVXQGHUJRLQJ
RSHUDWLYH SHULRG PLJKW LQFUHDVH DQDVWRPRWLF OHDN UDWH DQG PDMRUXSSHUJDVWURLQWHVWLQDOVXUJHU\LVUHDOO\RQO\MXVWLILHG
PLJKW DOVR EH DVVRFLDWHG ZLWK DQ LQFUHDVHG LQFLGHQFH RI RQWKHEDVLVRIWKHXVHIXOQHVVRIWKLVURXWHIRUWKHIHHGLQJRI
DVSLUDWLRQSQHXPRQLD SDWLHQWV ZKR JR RQ WR GHYHORS LQWUDDEGRPLQDO FRPSOLFD
)ROORZLQJ WUDGLWLRQDO RSHQ DEGRPLQDO VXUJHU\ SDWLHQWV WLRQV UDWKHU WKDQ LQ WKH SUHYHQWLRQ RI FRPSOLFDWLRQV LQ
IUHTXHQWO\ H[SHULHQFH D SHULRG RI JDVWURLQWHVWLQDO SDUDO\VLV WKH ILUVW LQVWDQFH 0RUHRYHU LQ WKH DEVHQFH RI URXWLQH
LOHXV  7KH VPDOO ERZHO LV WKH ILUVW VHFWLRQ RI WKH JDVWUR PHDVXUHVWRLPSURYHJDVWURLQWHVWLQDOIXQFWLRQLQWKHLPPH
LQWHVWLQDOWUDFWWRUHJDLQQRUPDOPRWLOLW\DQGWKLVIDFWRUKDV GLDWH SRVWRSHUDWLYH SHULRG LW KDV EHHQ GHPRQVWUDWHG WKDW
EHHQ WKH UDWLRQDOH IRU WKH XVH RI QDVRMHMXQDO RU QHHGOH HDUO\ SRVWRSHUDWLYH HQWHUDO IHHGLQJ UHVXOWV LQ LPSDLUHG
FDWKHWHU MHMXQRVWRP\ IRU WKH SURYLVLRQ RI HDUO\ HQWHUDO UHVSLUDWRU\PHFKDQLFVDQGGHFUHDVHGPRELOLW\ :DWWHUVHWDO
IHHGLQJ LQ SRVWRSHUDWLYH SDWLHQWV XQGHUJRLQJ PDMRU DE 
DEGRPLQDO VXUJHU\ 7KDW WKLV PHWKRG RI IHHGLQJ FDQ EH ,WLVQRZUHFRJQLVHGWKDWIRUWKHYDVWPDMRULW\RISDWLHQWV
XQGHUWDNHQ LQ D VDIH PDQQHU KDV EHHQ GHPRQVWUDWHG E\ D SRVWRSHUDWLYH FRPSOLFDWLRQV UHODWH PRUH WR SUHRSHUDWLYH
QXPEHU RI GLIIHUHQW UHVHDUFK JURXSV )RU H[DPSOH LQ D PRUELGLW\ DQG WKH WHFKQLFDO DVSHFWV RI VXUJHU\ WKDQ WR
FRQVHFXWLYHVHULHVRISDWLHQWV6DUU  GHPRQVWUDWHG QXWULWLRQDO VWDWXV SHU VH ,Q SDUWLFXODU 3HWWLJUHZ  +LOO
WKDW RQO\ WKUHH SDWLHQWV KDG PDMRU FRPSOLFDWLRQV UHODWHG   GHPRQVWUDWHG LQ D ODUJH FRKRUW RI SDWLHQWV XQGHU
WR WKHLU IHHGLQJ MHMXQRVWRP\ 0RUHRYHU XVLQJ WKH MHMX JRLQJ DEGRPLQDO VXUJHU\ WKDW WKH EHVW SUHGLFWRU RI
QRVWRP\ URXWH !   RI SDWLHQWV DFKLHYHG WKHLU JRDOV IRU SRVWRSHUDWLYH FRPSOLFDWLRQV ZDV WKH SRVWRSHUDWLYH
IXOO HQWHUDO QXWULWLRQDO VXSSRUW DQG IOXLG DQG HOHFWURO\WH DVVHVVPHQW E\ WKH VXUJHRQ RI KRZ ZHOO WKH VXUJHU\ KDG
EDODQFHE\WKHIRXUWKSRVWRSHUDWLYHGD\+RZHYHUDVLQDOO JRQH7KHGHYHORSPHQWRIPRUHPRGHUQDQDHVWKHWLFDJHQWV
PHGLFDO RU VXUJLFDO LQWHUYHQWLRQV LW LV LPSHUDWLYH WR FDUU\ DQGWKHIUHTXHQWXVHRIHSLGXUDODQDHVWKHVLD 5RGJHUVHWDO
WKHVH RXW ZLWK PLQLPXP PRUELGLW\ DQG PRUWDOLW\ 6PLWK   KDYH SUREDEO\ IXUWKHU DWWHQXDWHG WKH LPSRUWDQFH RI
HW DO   UHSRUWHG RQ D VHULHV RI ILIW\ SDWLHQWV XQGHU WKH QXWULWLRQDO VWDWXV RI WKH SDWLHQW LQ UHODWLRQ WR SRVW
JRLQJPDMRUXSSHUJDVWURLQWHVWLQDOUHVHFWLRQIRUFDQFHUZKR RSHUDWLYHPRUELGLW\DQGPRUWDOLW\,QVXPPDU\LQDPRGHUQ
ZHUH UDQGRPLVHG WR SRVWRSHUDWLYH MHMXQRVWRP\ IHHGLQJ RU FRQWH[W LW VHHPV OHVV UHDOLVWLF WR H[SHFW WKDW URXWLQH
FRQYHQWLRQDO LQWUDYHQRXV IOXLGV 0HDQ KRVSLWDO VWD\ ZDV QXWULWLRQDOVXSSRUWPLJKWLQIOXHQFHSRVWRSHUDWLYHRXWFRPH
VLJQLILFDQWO\ 3    SURORQJHG LQ WKH JURXS XQGHUJRLQJ LQWHUPVRIPDMRUPRUELGLW\DQGPRUWDOLW\0RUHSUHFLVHO\
HQWHUDO IHHGLQJ 0RUHRYHU WKHUH ZHUH WZHQW\ FDWKHWHU WKHUH KDV EHHQ D VKLIW LQ HPSKDVLV WRZDUGV WKH XVH RI
UHODWHGFRPSOLFDWLRQVDQGRQHGHDWKGXHWROHDNDJHIURPD QXWULWLRQDO VXSSRUW WR LQIOXHQFH WKH UDWH DQG TXDOLW\ RI
FDWKHWHU LQWR WKH SHULWRQHDO FDYLW\ 6XFK VWXGLHV HPSKDVLVH UHFRYHU\RIWKHSDWLHQW
WKDW DQ\ SRWHQWLDO EHQHILW IURP QXWULWLRQDO VXSSRUW FDQ EH
RYHUZKHOPHG LQ WKH SUHVHQFH RI FRPSOLFDWLRQV UHODWHG WR
7UDGLWLRQDOSRVWRSHUDWLYHFDUH
IDLOXUHVRIWHFKQLTXH
,Q WHUPV RI QXWULWLRQDO VWDWXV SDWLHQWV ZLWK PDMRU EXUQV &RQYHQWLRQDOSRVWRSHUDWLYHFDUHKDVHPSKDVLVHGUHVWLQJWKH
DSSHDUWREHQHILWIURPHDUO\HQWHUDOIHHGLQJEXWWKLVIRUPRI JDVWURLQWHVWLQDOWUDFW XQWLOIXOOUHFRYHU\RI IXQFWLRQRFFXUV
QXWULWLRQDO VXSSRUW LV QRW DVVRFLDWHG ZLWK D UHGXFWLRQ LQ 3DWLHQWV DUH URXWLQHO\ IDVWHG RYHUQLJKW SUHRSHUDWLYHO\ DQG
PRUELGLW\ RU PRUWDOLW\ *RWWVFKOLFK HW DO   :KHQ IUHTXHQWO\ UHFHLYH ERZHO SUHSDUDWLRQ WKDW FDQ FDXVH ERWK
FRPSDUHG ZLWK WRWDO SDUHQWHUDO QXWULWLRQ HDUO\ HQWHUDO GHK\GUDWLRQDQGIOXLGDQGHOHFWURO\WHDEQRUPDOLWLHV5HFHQW
IHHGLQJLQSDWLHQWVZLWKPDMRUDEGRPLQDOWUDXPDUHVXOWVLQ HYLGHQFHKDVVXJJHVWHGLWLVHQWLUHO\VDIHWRDOORZLQWDNHRI
D UHGXFWLRQ LQ VHSWLF PRUELGLW\ .XGVN HW DO DE  FOHDU IOXLGV XS WR  K EHIRUH DQDHVWKHVLD LQ PRVW SDWLHQWV
+RZHYHU LW KDV EHHQ VXJJHVWHG WKDW VXFK DQ DSSDUHQW )DVWLQJHWDO ,WKDVDOVREHHQVXJJHVWHGWKDWURXWLQH
EHQHILWLVUHODWHGPRUHWRWKHDGYHUVHHIIHFWVRIRYHUIHHGLQJ IOXLG DQG FDUERK\GUDWH ORDGLQJ  K EHIRUH VXUJHU\ FDQ
ZLWKWRWDOSDUHQWHUDOQXWULWLRQWKDQWRDQ\WUXHEHQHILWIURP DWWHQXDWH SRVWRSHUDWLYH LQVXOLQ UHVLVWDQFH DQG LPSURYH
HQWHUDOIHHGLQJSHUVH -HHMHHEKR\ )RUSDWLHQWVLQWKH SDWLHQW ZHOOEHLQJ /MXQJTYLVW HW DO   0RUHRYHU

Downloaded from https:/www.cambridge.org/core. IP address: 115.178.215.1, on 08 Jun 2017 at 06:50:07, subject to the Cambridge Core terms of use, available at
https:/www.cambridge.org/core/terms. https://doi.org/10.1079/PNS2003299
1XWULWLRQDQGFOLQLFDOPDQDJHPHQWRIGLVHDVH 

ERZHOSUHSDUDWLRQPD\QRWEHQHFHVVDU\DWDOO 6DQWRVHWDO GD\VE\WKHXVHRIPXOWLPRGDOLQWHUYHQWLRQ )LJ +HKDV


  &RQYHQWLRQDO SUHRSHUDWLYH PHGLFDWLRQ DQG DQDHV IRFXVHG RQ SRVWRSHUDWLYH SDLQ JXW IXQFWLRQ DQG PRELOLW\
WKHVLDFDQRIWHQOHDYHWKHSDWLHQWVHGDWHGIRUVHYHUDOKRXUV 7KHVHDUHDVDUHVHHQDVWKHPDLQGRPDLQVWKDWGHOD\WLPHRI
IROORZLQJ VXUJHU\ DQG WKHUHIRUH XQDEOH WR VLW XS DQG WDNH GLVFKDUJH 3DWLHQWV FDQ UHWXUQ KRPH LI WKHLU SDLQ LV
IOXLGV RU GLHW 2SLDWH DQDOJHVLD LV XVHG IUHTXHQWO\ DQG WKLV DGHTXDWHO\ FRQWUROOHG ZLWK VLPSOH RUDO DQDOJHVLD LI WKH\
SUDFWLFH FDQ FRQWULEXWH WR SRVWRSHUDWLYH VHGDWLRQ DQG DOVR DUH DEOH WR WDNH VXIILFLHQW IOXLGV DQG QXWULWLRQ WR PDLQWDLQ
LQFUHDVH WKH LQFLGHQFH RI SRVWRSHUDWLYH LOHXV QDXVHD DQG KRPHRVWDVLV DQG LI WKH\ DUH PRELOH HQRXJK WR JR WR WKH
YRPLWLQJ 3DWLHQWV IUHTXHQWO\ KDYH D QLO E\ PRXWK VLJQ WRLOHW HWF 7KH LQWHUYHQWLRQV WR DGGUHVV VXFK LVVXHV LQFOXGH
SRVWHG DERYH WKHLU EHG IRU  G LQ WKH SRVWRSHUDWLYH RSWLPLVDWLRQ RI SRVWRSHUDWLYH SDLQ UHOLHI ZLWK HSLGXUDO
SHULRGDQGGXULQJWKLVWLPHWKH\UHFHLYHPDLQWHQDQFHIOXLGV DQDHVWKHVLD7KHODWWHULVFDUULHGRQIRU KDQGDOORZV
YLD WKH LQWUDYHQRXV URXWH 5HFHQW HYLGHQFH KDV VXJJHVWHG SDWLHQWVWREHYLUWXDOO\SDLQIUHHGXULQJWKLVSHULRG(SLGXUDO
WKDW H[FHVV LQWUDYHQRXV IOXLGV DQG LQ SDUWLFXODUVDOLQH  J DQDHVWKHVLD DQG DQDOJHVLD UHGXFH ERWK SRVWRSHUDWLYH LOHXV
1D&OO  PD\ FRQWULEXWH WR SRVWRSHUDWLYH JDVWURLQWHVWLQDO DQG WKH PHWDEROLF UHVSRQVH WR LQMXU\ E\ EORFNLQJ YLVFHUDO
WUDFW G\VIXQFWLRQ SURORQJ SRVWRSHUDWLYH VWD\ /RER HW DO V\PSDWKHWLF DQG SDUDV\PSDWKHWLF SDWKZD\V +ROWH
  DQG DGYHUVHO\ DIIHFW RYHUDOO FOLQLFDO RXWFRPH )URVW .HKOHW   7KH XVH RI HDUO\ RUDO HQWHUDO QXWULWLRQ LV
HW DO   )LQDOO\ SDWLHQWV DOVR XQGHUJR HQIRUFHG EHG IXUWKHU HQFRXUDJHG E\ DYRLGDQFH RI ERWK VHGDWLRQ LQ WKH
UHVWQRWRQO\DVDSDUWRIWUDGLWLRQDOFDUHEXWDOVREHFDXVHRI SRVWRSHUDWLYH SHULRG DQG WKH URXWLQH XVH RI RSLDWH
WKHSUHVHQFHRIGULSVFDWKHWHUVDQGGUDLQV DQDOJHVLD 3DWLHQWV DUH PRELOLVHG HDUO\ RQ WKH EDVLV RI
:LWKLQ WKLV WUDGLWLRQDO SDWWHUQ RI SRVWRSHUDWLYH FDUH DGHTXDWH SDLQ UHOLHI DQG D ZHOOGHILQHG QXUVLQJ FDUH
SDWLHQWV DUH WKXV VXEMHFW WR D SHULRG RI VWDUYDWLRQ DQG SDWKZD\
LPPRELOLVDWLRQWKDW PD\ ODVW  ZHHN ,Q RUGHUWR FRPEDW 7KHVXFFHVV RIWKLVDSSURDFKKDVEHHQ VKRZQLQVWXGLHV
WKHQXWULWLRQDOFRQVHTXHQFHVRIVXFKVWDUYDWLRQRUDOVXSSOH H[DPLQLQJ WKH UHFRYHU\ RI SDWLHQWV IROORZLQJ FRORUHFWDO
PHQWV KDYH EHHQ WHVWHG LQ RUGHU WR WU\ WR HQKDQFH QRUPDO UHVHFWLRQ %DVVHHWDO ,QDFRQVHFXWLYHVHULHVRIVL[W\
IRRG LQWDNH IROORZLQJ UHFRPPHQFHPHQW RI RUDO QXWULWLRQ SDWLHQWV GLVFKDUJH ZDV SODQQHG IRU  K IROORZLQJ VXUJHU\
6XFK VWXGLHV KDYH GHPRQVWUDWHG WKDW RUDO VXSSOHPHQWV FDQ UDWKHU WKDQ WKH PRUH FRQYHQWLRQDO  G  7KH PHGLDQ
DWWHQXDWH SRVWRSHUDWLYH ZHLJKW ORVV %HDWWLH HW DO   DJH RI WKH SDWLHQWV ZDV  \HDUV DQG DW OHDVW RQHWKLUG RI
+RZHYHU UHFRYHU\ WR SUHRSHUDWLYH OHYHOV RI QXWULWLRQDO SDWLHQWV KDG PDUNHG FRPRUELGLW\ 7KLUW\WZR RI WKH VL[W\
VWDWXVPD\WDNHPDQ\ZHHNVRUPRQWKV3UHYHQWLRQLVVXUHO\ SDWLHQWV ZHQW KRPH ZLWKLQ  K LQGLFDWLQJ WKDW ZLWK DQ
WKHEHWWHUSROLF\ DFFHOHUDWHG VWD\ SURJUDPPH LW LV SRVVLEOH WR GLVFKDUJH WKH
PDMRULW\ RI SDWLHQWV XQGHUJRLQJ FRORUHFWDO VXUJHU\ DERYH
WKHSHOYLFEULPZLWKLQDYHU\VKRUWWLPHIUDPH
(QKDQFHGUHFRYHU\SRVWRSHUDWLYHFDUH
$V SDUW RI WKH (QKDQFHG 5HFRYHU\ $IWHU 6XUJHU\ 6WXG\
$ PRUH IXQGDPHQWDO VKLIW LQ WHUPV RI SRVWRSHUDWLYH FDUH *URXS WKH SRVVLELOLW\ RI HVWDEOLVKLQJ VXFK DQ DSSURDFK LQ
KDV EHHQWRFRQVLGHUHQKDQFLQJWKHRYHUDOOUHFRYHU\UDWHRI PXOWLSOHFRXQWULHVWKURXJKRXW(XURSHKDVEHHQH[DPLQHG,Q
SDWLHQWV IROORZLQJ RSHQ DEGRPLQDO VXUJHU\ 7KLV DSSURDFK FRQWUDVW WR WKH QRUPDO SROLF\ RI SUH DQG SRVWRSHUDWLYH
KDV EHHQ SLRQHHUHG E\ +HQULN .HKOHW LQ &RSHQKDJHQ VWDUYDWLRQLWKDVEHHQGHPRQVWUDWHGLQWKH&RORUHFWDO8QLWLQ
'HQPDUN ZKR VXJJHVWHG WKDW WKH QRUPDO GHFOLQH LQ (GLQEXUJK 8. WKDW WKH PDMRULW\ RI SDWLHQWV XQGHUJRLQJ
IXQFWLRQDOVWDWXVWKDWPD\RFFXURYHUDSHULRGRIZHHNVLQ PDMRUSHOYLF DQWHULRUUHVHFWLRQ VXUJHU\DUHDEOHWRWDNHSUH
WKHSRVWRSHUDWLYHSHULRGFRXOGEHVKRUWHQHGWRDPDWWHURI RSHUDWLYH IOXLG DQG FDUERK\GUDWH ORDGLQJ XS WR  K EHIRUH
JRLQJ WR VXUJHU\ DQG WKDW DW OHDVW D SURSRUWLRQ DUH DEOH WR
FRPPHQFH RUDO IOXLGV DQG RUDO IHHGV RQ WKH QLJKW RI
RSHUDWLRQDQGKDYHWKHLULQWUDYHQRXVIOXLGVGLVFRQWLQXHGRQ
WKHLUILUVWRUVHFRQGSRVWRSHUDWLYHGD\ )LJ 0RUHRYHU
KRVSLWDO VWD\ KDV EHHQ UHGXFHG IURP DSSUR[LPDWHO\  G
ZLWK WUDGLWLRQDO FDUH WR  G ZLWK WKH HQKDQFHG UHFRYHU\
SURJUDPPH )LJ &OHDUO\WKLVUHPDUNDEOHFKDQJHLQUDWH
Rate of return of function

RI UHFRYHU\ FDQQRW EH DVFULEHG HQWLUHO\ WR WKH QXWULWLRQDO


FRPSRQHQW RI WKH SURJUDPPH ,W ZLOO WDNH PDQ\ IXWXUH
VWXGLHV WR GHILQH SUHFLVHO\ WKH UROH RI HDFK LQGLYLGXDO
FRPSRQHQWLQUHODWLRQWRSDWLHQWVUDWHRIUHFRYHU\
Enhanced recovery care
&RQFOXVLRQ
$OWKRXJK DUWLILFLDO HQWHUDO RU SDUHQWHUDO QXWULWLRQDO VXSSRUW
Traditional care
LVQRWJHQHUDOO\LQGLFDWHGIRUHOHFWLYHDEGRPLQDOVXUJHU\WKH
WUDGLWLRQDO DSSURDFK RI VWDUYLQJ WKH SDWLHQW XQGHUJRLQJ
Days Weeks PDMRUDEGRPLQDOVXUJHU\LVQRZVWURQJO\XQGHUTXHVWLRQ,W
Post-operative period DSSHDUV WKDW LI D PXOWLPRGDO FDUH SDWKZD\ LV DGRSWHG
PDUNHGRUDOQXWULWLRQDQGIOXLGLQWDNHFDQEHDFKLHYHGLQWKH
)LJ  'LIIHUHQW SDWWHUQV RI UHFRYHU\ IROORZLQJ WUDGLWLRQDO Y LPPHGLDWH SHULRSHUDWLYH SHULRG DQG WKH RYHUDOO UDWH RI
HQKDQFHGUHFRYHU\SRVWRSHUDWLYHFDUH UHFRYHU\FDQEHHQKDQFHG

Downloaded from https:/www.cambridge.org/core. IP address: 115.178.215.1, on 08 Jun 2017 at 06:50:07, subject to the Cambridge Core terms of use, available at
https:/www.cambridge.org/core/terms. https://doi.org/10.1079/PNS2003299
 .&+)HDURQDQG5/XII

80

70
Compliance (% patients)
60

50

40

30

20

10

0 400 ml oral fluids and Day 0: free oral fluids and Day 1: free fluids, 400 ml Day 2: free fluids, 400 ml
carbohdrates 2 h pre-op 200 ml oral supplement oral supplement, no IV oral supplement, no IV

)LJ  1XWULWLRQ DQG IOXLG PDQDJHPHQW LQ SDWLHQWV Q   XQGHUJRLQJ FRORUHFWDO DQWHULRU  UHVHFWLRQ 3DWLHQWV ZHUH VXEMHFW WR D PXOWLPRGDO
FDUH SDWKZD\ WKDW LQFOXGHG URXWLQH SUHRSHUDWLYH SUHRS  DGPLQLVWUDWLRQ RI D  PO RUDO IOXLGV DQG FDUERK\GUDWH GULQN 3UHRS 1XWULFLD
7URZEULGJH:LOWV8. % DQGIUHHRUDOIOXLGVDQG PORIDZKROHSURWHLQRUDOVLSIHHG )RUWLVLS1XWULFLD K IURPWKHGD\RIVXUJHU\
RQZDUGV&RPSOLDQFHLVGRFXPHQWHGRQSRVWRSHUDWLYHGD\ ] DQG , IRUSDWLHQWVZKRZHUHQRWRQO\DEOHWRFRQVXPH PORIWKHVLS
IHHGEXWZKRZHUHDEOHWRWDNHVXIILFLHQWIOXLGVRYHUDOOWRDOORZGLVFRQWLQXDWLRQRILQWUDYHQRXVIOXLGV QR,9  .&+)HDURQDQG5/XIIRQEHKDOIRI
WKH(QKDQFHG5HFRYHU\$IWHU6XUJHU\*URXSXQSXEOLVKHGUHVXOWV 

12 )DVWLQJ66RUHLGH( 5DHGHU-&  &KDQJLQJSUHRSHUDWLYH


IDVWLQJ SROLFLHV ,PSDFW RI D QDWLRQDO FRQVHQVXV $FWD $QDHV
10
WKHVLRORJLFD6FDQGLQDYLFD
)URVW $ :DNHILHOG &+ 6HQJXSWD )  )HDURQ .   5HOD
WLRQVKLSEHWZHHQIOXLGDGPLQLVWUDWLRQVDQGRXWFRPHLQFRORUHFWDO
Length of stay (d)

8
** VXUJHU\3URFHHGLQJVRIWKH1XWULWLRQ6RFLHW\$
*RWWVFKOLFK 00 -HQNLQV 0( 0D\HV 7 .KRXU\ - .DJDQ 5-
6 :DUGHQ *'   $Q HYDOXDWLRQ RI WKH VDIHW\ RI HDUO\ YV
GHOD\HGHQWHUDOVXSSRUWDQGHIIHFWVRQFOLQLFDOQXWULWLRQDODQG
4 HQGRFULQHRXWFRPHVDIWHUVHYHUHEXUQV-RXUQDORI%XUQ&DUHDQG
5HKDELOLWDWLRQ
2 +HVOLQ 0- /DWNDQ\ / /HXQJ ' %URRNV $' +RFKZDOG 61
3LVWHUV 3: 6KLNH 0  %UHQQDQ 0) D  $ SURVSHFWLYH
0 UDQGRPL]HG WULDO RI HDUO\ HQWHUDO IHHGLQJ DIWHU UHVHFWLRQ RI
Traditional Enhanced recovery XSSHU JDVWURLQWHVWLQDO PDOLJQDQF\ $QQDOV RI 6XUJHU\ 
)LJ  /HQJWK RI KRVSLWDO VWD\ LQ D FRQVHFXWLYH VHULHV RI SDWLHQWV

XQGHUJRLQJFRORUHFWDO DQWHULRU UHVHFWLRQDQGIROORZLQJHLWKHUDWUD
+HVOLQ 0- /DWNDQ\ / /HXQJ ' %URRNV $' +RFKZDOG 61
GLWLRQDOSHULRSHUDWLYHFDUHSDWKZD\ Q RUDQHQKDQFHGUHFRYHU\
3LVWHUV 3: 6KLNH 0  %UHQQDQ 0) E  $ SURVSHFWLYH
DIWHUVXUJHU\SDWKZD\ Q 0HGLDQYDOXHVZHUHVLJQLILFDQWO\GLIIHU
UDQGRPL]HGWULDORIHDUO\HQWHUDOIHHGLQJDIWHUUHVHFWLRQRIXSSHU
HQWIURPWKRVHIRUWKHWUDGLWLRQDOWUHDWPHQWJURXS 0DQQ:KLWQH\8
JDVWURLQWHVWLQDOPDOLJQDQF\GLVFXVVLRQ$QQDOVRI6XUJHU\
WHVW  3   .&+)HDURQDQG5/XIIRQEHKDOIRIWKH(QKDQFHG

5HFRYHU\$IWHU6XUJHU\*URXSXQSXEOLVKHGUHVXOWV
+H\ODQG '. 0DF'RQDOG 6 .HHIH /  'URYHU -: 
7RWDO SDUHQWHUDO QXWULWLRQ LQ WKH FULWLFDOO\ LOO SDWLHQW D PHWD
DQDO\VLV -RXUQDO RI WKH $PHULFDQ 0HGLFDO $VVRFLDWLRQ 

+H\V 6' :DONHU /* 6PLWK ,  (UHPLQ 2   (QWHUDO
QXWULWLRQDO VXSSOHPHQWDWLRQ ZLWK NH\ QXWULHQWV LQ SDWLHQWV ZLWK
$FNQRZOHGJHPHQWV FULWLFDO LOOQHVV DQG FDQFHU D PHWDDQDO\VLV RI UDQGRPL]HG
FRQWUROOHGFOLQLFDOWULDOV$QQDOVRI6XUJHU\
7KH(QKDQFHG5HFRYHU\$IWHU6XUJHU\*URXSLVVXSSRUWHG +LOO */   &KDQJHV LQ ERG\ FRPSRVLWLRQ DQG RXWFRPH LQ
E\DVWXG\JUDQWIURP1XWULFLD VXUJLFDOSDWLHQWV&OLQLFDO1XWULWLRQ
+ROWH. .HKOHW+  (SLGXUDODQDHVWKHVLDDQGDQDOJHVLD
5HIHUHQFHV HIIHFWV RQ VXUJLFDO VWUHVV UHVSRQVHV DQG LPSOLFDWLRQV IRU
SRVWRSHUDWLYHQXWULWLRQ&OLQLFDO1XWULWLRQ
%DVVH/+MRUW-DNREVHQ'%LOOHVEROOH3:HUQHU0 .HKOHW+ -HHMHHEKR\ .1   (QWHUDO DQG SDUHQWHUDO QXWULWLRQ
  $ FOLQLFDO SDWKZD\ WR DFFHOHUDWH UHFRYHU\ DIWHU FRORQLF HYLGHQFHEDVHGDSSURDFK3URFHHGLQJVRIWKH1XWULWLRQ6RFLHW\
UHVHFWLRQ$QQDOVRI6XUJHU\ 
%HDWWLH $+ 3UDFK $7 %D[WHU -3  3HQQLQJWRQ &5    $ .XGVN .$ &URFH 0$ )DELDQ 7& 0LQDUG * 7ROOH\ ($ 3RUHW
UDQGRPLVHG FRQWUROOHG WULDO HYDOXDWLQJ WKH XVH RI HQWHUDO QXWUL +$.XKO05 %URZQ52 D (QWHUDOYHUVXVSDUHQWHUDO
WLRQDO VXSSOHPHQWV SRVWRSHUDWLYHO\ LQ PDOQRXULVKHG VXUJLFDO IHHGLQJ(IIHFWVRQVHSWLFPRUELGLW\DIWHUEOXQWDQGSHQHWUDWLQJ
SDWLHQWV*XW DEGRPLQDOWUDXPD$QQDOVRI6XUJHU\

Downloaded from https:/www.cambridge.org/core. IP address: 115.178.215.1, on 08 Jun 2017 at 06:50:07, subject to the Cambridge Core terms of use, available at
https:/www.cambridge.org/core/terms. https://doi.org/10.1079/PNS2003299
1XWULWLRQDQGFOLQLFDOPDQDJHPHQWRIGLVHDVH 

.XGVN .$ &URFH 0$ )DELDQ 7& 0LQDUG * 7ROOH\ ($ SUHSDUDWLRQ LQ SDWLHQWV XQGHUJRLQJ HOHFWLYH FRORUHFWDO VXUJHU\
3RUHW +$ .XKO 05  %URZQ 52 E  (QWHUDO YHUVXV %ULWLVK-RXUQDORI6XUJHU\
SDUHQWHUDO IHHGLQJ (IIHFWV RQ VHSWLF PRUELGLW\ DIWHU EOXQW DQG 6DUU 0*    $SSURSULDWHXVH FRPSOLFDWLRQV DQG DGYDQWDJHV
SHQHWUDWLQJ DEGRPLQDO WUDXPD GLVFXVVLRQ $QQDOV RI 6XUJHU\ GHPRQVWUDWHGLQFRQVHFXWLYHQHHGOHFDWKHWHUMHMXQRVWRPLHV
 %ULWLVK-RXUQDORI6XUJHU\
/MXQJTYLVW21\JUHQ- 7KRUHOO$  0RGXODWLRQRISRVW 6PLWK5&+DUWHPLQN5-+ROOLQVKHDG-: *LOOHWW'-  )LQH
RSHUDWLYH LQVXOLQ UHVLVWDQFH E\ SUHRSHUDWLYH FDUERK\GUDWH ERUHMHMXQRVWRP\IHHGLQJIROORZLQJPDMRUDEGRPLQDOVXUJHU\D
ORDGLQJ3URFHHGLQJVRIWKH1XWULWLRQ6RFLHW\ FRQWUROOHGUDQGRPL]HGFOLQLFDOWULDO%ULWLVK-RXUQDORI6XUJHU\
/RER '1 %RVWRFN .$ 1HDO .5 3HUNLQV $& 5RZODQGV %- 
$OOLVRQ63  (IIHFWRIVDOWDQGZDWHUEDODQFHRQUHFRYHU\RI 6WXGOH\+2  3HUFHQWDJHRIZHLJKWORVV$EDVLFLQGLFDWRURI
JDVWURLQWHVWLQDO IXQFWLRQ DIWHU HOHFWLYH FRORQLF UHVHFWLRQ D VXUJLFDOULVNLQSDWLHQWVZLWKFKURQLFSHSWLFXOFHU-RXUQDORIWKH
UDQGRPLVHGFRQWUROOHGWULDO/DQFHW $PHULFDQ0HGLFDO$VVRFLDWLRQ
3HWWLJUHZ 5$  +LOO */   ,QGLFDWRUV RI VXUJLFDO ULVN DQG :DWWHUV-0.LUNSDWULFN601RUULV6%6KDPML)0 :HOOV*$
FOLQLFDOMXGJHPHQW%ULWLVK-RXUQDORI6XUJHU\ D  ,PPHGLDWH SRVWRSHUDWLYH HQWHUDO IHHGLQJ UHVXOWV LQ
5RGJHUV$:DONHU16FKXJ60F.HH$.HKOHW+YDQ=XQGHUW LPSDLUHGUHVSLUDWRU\PHFKDQLFVDQGGHFUHDVHGPRELOLW\$QQDOV
$6DJH')XWWHU06DYLOOH*&ODUN7 0DF0DKRQ6  RI6XUJHU\
5HGXFWLRQRISRVWRSHUDWLYHPRUWDOLW\DQGPRUELGLW\ZLWKHSLGXUDO :DWWHUV -0 .LUNSDWULFN 60 1RUULV 6% 6KDPML )0  :HOOV
RUVSLQDODQDHVWKHVLDUHVXOWVIURPRYHUYLHZRIUDQGRPLVHGWULDOV *$ E  ,PPHGLDWH SRVWRSHUDWLYH HQWHUDO IHHGLQJ UHVXOWV
%ULWLVK0HGLFDO-RXUQDO LQ LPSDLUHG UHVSLUDWRU\ PHFKDQLFV DQG GHFUHDVHG PRELOLW\
6DQWRV-&-U%DWLVWD-6LULPDUFR07*XLPDUDHV$6 /HY\&( GLVFXVVLRQ$QQDOVRI6XUJHU\
  3URVSHFWLYH UDQGRPL]HG WULDO RI PHFKDQLFDO ERZHO

Downloaded from https:/www.cambridge.org/core. IP address: 115.178.215.1, on 08 Jun 2017 at 06:50:07, subject to the Cambridge Core terms of use, available at
https:/www.cambridge.org/core/terms. https://doi.org/10.1079/PNS2003299

Das könnte Ihnen auch gefallen