• 제목/요약/키워드: Clinical judgment

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AHP 분석을 이용한 음허 설문항목의 중요도 부여 (Study of The Diagnostic Indicators of Yin-Deficiency Pattern Using by AHP)

  • 김기태;고흥;신선미;정진화
    • 대한한의진단학회지
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    • 제18권3호
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    • pp.175-186
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    • 2014
  • The purpose of this study is to give priority in Yin-deficient questionnaire items. if adequate priority is given, clinical judgment and questionnaire of the results is expected to be similar. The AHP is a systematic procedure for analyzing the elements of any problem hierarchically. Based on survey of expertise, as series of pairwise comparison judgements is performed to evaluate the various elements in the hierarchy. We are expected to use the AHP analysis that would apply to oriental doctor's diagnostic process analysis. In this study, korean medical doctors experienced over 5 years was included. Results given the importance to Yin-deficient questionnaire items, Results given the importance to the questionnaire items, the most important item was Irritable fever on the five Hearts, the second was tidal fever.

인지적 의사결정에 근거한 증상별 자기관리프로그램이 만성 심부전 환자의 신체·기능상태, 건강지식 및 삶의 질에 미치는 영향 (Effects of a Symptom Focused Self-Management Program on Symptom and Functional status, Health Perception, and Quality of Life of Patients with Chronic Heart Failure)

  • 김기연
    • 성인간호학회지
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    • 제19권1호
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    • pp.132-143
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    • 2007
  • Purpose: The purpose of this study was to identify effects of a self-management program on symptom and functional status, health perception, and quality of life(QOL) of patients with CHF. Methods: Patients with CHF as defined through clinical judgment using the Framingham criteria and EF<50% were enrolled in the study (experimental: 21, control: 20). The symptom focused self-management program consisted of coping behaviors for symptoms including dyspnea, chest discomfort/pain, dizziness, ankle edema, and basic self-management including medications, diets, activity, lifestyle changes. Experimental group received an educational booklet after survey, and periodic telephone follow-up by a trained nurse. Data were collected the 3rd day after admission and at 1 month, 3 months, and 6 months after discharge using questionnaires. Results: Significant differences were found in the presence of symptoms, health perception, and QOL between groups during follow-up. Although no significant difference was found in functional status, the experimental group reported better functional status than the control group. Conclusion: By facilitating self-management of CHF using tailored interventions including education programs and telephone monitoring, it is expected that patients will be able to monitor their symptoms routinely, adhere to therapeutic regimen, and have a better QOL.

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Developing a Best-Evidence Pre-employment Medical Examination: An Example from the Construction Industry

  • Gouttebarge, Vincent;van der Molen, Henk F.;Frings-Dresen, Monique H.W.;Sluiter, Judith K.
    • Safety and Health at Work
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    • 제5권3호
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    • pp.165-167
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    • 2014
  • The Dutch construction industry has introduced a compulsory preemployment medical examination (PE-ME). Best-evidence contents related to specific job demands are, however, lacking and need to be gathered. After the identification of job demands and health problems in the construction industry (systematic literature search and expert meeting), specific job demands and related requirements were defined and instruments proposed. Finally, a work ability assessment was linked to the instruments' outcomes, resulting in the modular character of the developed PE-ME. Twenty-two specific job demands for all Dutch construction jobs were identified, including kneeling/squatting, working under time pressure, and exposure to hazardous substances. The next step was proposing self-report questions, screening questionnaires, clinical tests, and/or performance-based tests, leading to a work ability judgment. "Lifting/carrying" is described as an example. The new modular PE-ME enables a job-specific assessment of work ability to be made for more than 100 jobs in the Dutch construction industry.

국내 간호학생 대상 윤리관련 연구 동향 (Trends of the researches related to ethical topic in Korean nursing students)

  • 진은주;강현주
    • 한국간호교육학회지
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    • 제26권4호
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    • pp.402-411
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    • 2020
  • Purpose: The purpose of this study is to explore the trends of research related to ethical topics in Korean nursing students. Methods: A total of 131 articles that were published from 2000 to 2020 were analyzed and summarized according to publishing type, research design, subject, data analysis method, main research topic, research variables and instrument. Results: Most studies were journal articles (93.9%) and their most frequent research design was survey (75.7%). The research subjects covered all grades (35.1%) or they were divided between clinical nursing practicum (29.8%) or not (21.4%). The main research topics were biomedical ethics, ethical values, moral judgment and ethics education. Recently, ethical decision making and practical ability in nursing practice were reported. The instruments for measuring variables were limited and the same tools were used several times. Conclusion: Based on the findings of this study, it is suggested that the selection of various research topics and the application of research methods related to ethics for nursing students will continue in response to rapidly changing social phenomena in the future. In particular, it is necessary that research related to ethical and practical ability as well as ethical attitudes and perceptions of nursing students be actively carried out.

사상체질(四象體質)에 따른 질병 및 증상유형(症狀類型)에 관한 임상적(臨床的) 연구(硏究)III (문진표를 중심으로) (A Clinical Study of the Type of Disease and Symptom according to Sasang Constitution Classification)

  • 이영옥;김종원
    • 사상체질의학회지
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    • 제14권3호
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    • pp.74-84
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    • 2002
  • The purpose of study is 584 patients who had been treated in the Oriental Medical Hospital at Dong Eui Medical Center during 1 year from February 2001 to January 2002. We proceeded the judgment of Sasang constitution by 'Questiinaire of Sasang Constitution Classification(I)' and 'Questiinaire of Sasang Constitution Classification II(QSCCII)'. The following conclusion were made in comparison with Sasang Constitution and Questiinaire about disease and style of symptoms. 1. The subject of 'increase of the weight of a body(gain weight), cough, nasal discharge(rhinorrhea), stuffed nose, sweatier, more like fat food, more like salty food', has significant differences in sasang constitution classification. The frequency of Taeum group is more than of Soeum group and Soyang group. 2. The subject of 'the complextion is bad, anorexia, indigestion, nervousness, sonitus', has significant differences in sasang constitution classification. The frequency of Soeum group is more than of Taeum group and Soyang group. 3. The subject of 'urodynia, otic discharge', has significant differences in sasang constitution classification. The frequency of Soyang group is more than of Taeum group and Soeum group.

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INTERPRETING A SINGLE ANTISTREPTOLYSIN O TEST: A COMPARISON OF THE 'UPPER LIMIT OF NORMAL' AND LIKELIHOOD RATIO METHODS

  • Gray Gregory C.;Struewing Jeffery P.;Hyams Kenneth C.;Escamilla Joel;Tupponce Alan K.;Kaplan Edward L.
    • 대한예방의학회:학술대회논문집
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    • 대한예방의학회 1994년도 교수 연수회(역학)
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    • pp.164-168
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    • 1994
  • Single serologic tests may occasionally influence clinicians in making diagnoses. The antistreptolysin O (ASO) test is a frequently used tool for detecting recent Streptococcus pyogenes infection and is helpful in the diagnosis of diseases like rheumatic fever. Using data from a 1989 prospective study of 600 healthy male military recruits, in which 43% experienced S. pyogenes upper respiratory tract infection (2-dilution rise in ASO), this report compared two methods of interpreting a single ASO titer. Using the 'upper limit of normal' (80 percentile) method, recruits with an ASO titer of greater than 400 showed evidence of recent S. pyogenes infection. This method had a sensitivity and specificity of only 65.9 and 81.9% respectively. In contrast to the 'yes-no'. dichotomy of the 'upper limit of normal' method. the likelihood ratio method statistics were ASO value specific, more consistent with clinical judgment, and better emphasized the caution clinicians must use in interpreting a single ASO test.

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Communication at the End of Life

  • Onishi, Hideki
    • Journal of Hospice and Palliative Care
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    • 제24권3호
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    • pp.135-143
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    • 2021
  • End-of-life patients experience physical, mental, social, and existential distress. While medical personnel provide medication and care to alleviate patients' distress, listening to and interacting with patients remains essential for understanding their psychological condition. The most important tool, though difficult to implement in practice, is end-of-life discussion (EOLD). EOLD has been shown to have positive effects on end-of-life treatment choices, achievement of patients' life goals, improvements in the quality of life of patients and their families, and the prevention of depression and complicated grief among bereaved family members. EOLD is not often undertaken in clinical practice, however, due to hesitancy among medical personnel and patients for various reasons. In order to conduct an EOLD, the patient's judgment, psychiatric illnesses such as delirium and depression, and psychological issues such as the side effects of psychotropic drugs, denial, and collusion must be evaluated. Open and honest conversation, treatment goal setting, the doctor's familiarity with the patient's background, and attentiveness when providing information are important elements for any dialogue. Meaning-centered psychotherapy was developed to alleviate the existential distress of cancer patients, and its application may promote EOLD. The future development of meaning-centered psychotherapy in practice and in research is expected to further promote EOLD.

말소리장애 아동의 말명료도와 음향학적 측정치 간 상관관계 (The Correlation between Speech Intelligibility and Acoustic Measurements in Children with Speech Sound Disorders)

  • 강은영
    • 대한통합의학회지
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    • 제6권4호
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    • pp.191-206
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    • 2018
  • Purpose : This study investigated the correlation between speech intelligibility and acoustic measurements of speech sounds produced by the children with speech sound disorders and children without any diagnosed speech sound disorder. Methods : A total of 60 children with and without speech sound disorders were the subjects of this study. Speech samples were obtained by having the subjects? speak meaningful words. Acoustic measurements were analyzed on a spectrogram using the Multi-speech 3700 program. Speech intelligibility was determined according to a listener's perceptual judgment. Results : Children with speech sound disorders had significantly lower speech intelligibility than those without speech sound disorders. The intensity of the vowel /u/, the duration of the vowel /${\omega}$/, and the second formant of the vowel /${\omega}$/ were significantly different between both groups. There was no difference in voice onset time between the groups. There was a correlation between acoustic measurements and speech intelligibility. Conclusion : The results of this study showed that the speech intelligibility of children with speech sound disorders was affected by intensity, word duration, and formant frequency. It is necessary to complement clinical setting results using acoustic measurements in addition to evaluation of speech intelligibility.

Reliability and Validity of the Appropriateness Evaluation Protocol for Public Hospitals in Korea

  • Lee, Clara;Kim, Stella Jung-Hyun;Lee, Changwoo;Shin, Euichul
    • Journal of Preventive Medicine and Public Health
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    • 제52권5호
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    • pp.316-322
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    • 2019
  • Objectives: This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea. Methods: In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared. Results: The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively. Conclusions: Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.

Normative Issues in Next Generation Sequencing Gene Testing

  • Na-Kyoung Kim
    • 한국발생생물학회지:발생과생식
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    • 제27권1호
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    • pp.47-56
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    • 2023
  • Despite the commercialization of Next generation sequencing (NGS) gene testing, only a few studies have addressed the various ethical and legal problems associated with NGS testing in Korea Here, we reviewed the normative issues that emerged at each stage of the wet analysis and bioinformatics analysis of NGS gene testing. In particular, it was in mind to apply various international guidelines and the principles of bioethics to actual clinical practice. Considering the characteristics of NGS testing, wet analysis of additional testing can be justified if presumptive consent is recognized. Furthermore, the medical relationship between diseases needs to be established and it should be clear that the patient would have given consent if the patient had been aware of the correlation between genes. At the stage of bioinformatics analysis, the question of unsolicited findings arises. In case of unsolicited and relevant findings, according to American College of Medical Genetics and Genomics (ACMG), a recognized relationship between genes and diseases needs to be established. In case of unsolicited and not-relevant findings, it is almost impossible to determine whether knowing or not knowing the findings is more beneficial to the patient. However, it seems to be certain that the psychological harm an individual may suffer from such information is likely to be greater if the disease is severe and if there is no cure. The list of genes for which the ACMG guidelines impose reporting obligations is a good reference for judgment.