• Title/Summary/Keyword: Clinical standards

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Development of and Evaluation Tool for the Quality of Patient Care in Musculo-skeletal Disorder (${\cdot}$ 골격장애 환자의 간호질 평가 도구 개발)

  • Choi, Soon-Ook;Kim, Moon-Sil
    • Journal of Korean Academy of Nursing Administration
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    • v.1 no.2
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    • pp.338-348
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    • 1995
  • We need to continuously evaluate for nursing quality and the outcome to reflect nursing, to repair and improve of nursing. The first problem for nursing quality improvement is development of evaluation tool for the quality of nursing care. We need a system for quality assurance evaluation that is, development and framework of evaluation tool for nursing care quality. The purpose of this study was attempted to develop an evaluation tool for the quality of nursing care in musculoskeletal disorder patients. The approach method of nursing quality for the development of the tool in this study was process evaluation framework. The study were devided dvelopment process and reliability, validity verification process. The subjects of development process of this tool are three nursing export groups, and the subject of reliability, validity verification process are 20 samples of two university hospital in seoul, who were within discharge 3 months after admission treatment in musculo-skeletal disorder. Data for this study was collected from March 10 to April 13, 1995. The development process of the tool were as follows : 1. Make preliminary list of the tool by focal group were constituted 12 clinical nurses. 2. Modify and add preliminary list by 4 nursing expert panel. 3. Calculate content validity of the tool by 25 nursing expert panel of judge. 4. Verify reliability and validity of the tool. 5. Finalize an evaluation tool for the quality of the nursing care in musculo-skeletal disorder. The results of this study were as follows : 1) Development an evaluation tool for the quality of nursing care in musculo-skeletal disorder. (1) The evalution tool of this study was developed 5 standards, 33 criterias and 133 indicators. (2) 5 standards were divided according to Nursing Process. from standard 1 to standard 5, involved criterias were each 6(18%), 3(9%), 3(9%), 15(46%), 6(18%). 2) Verify reliability and validity of the tool. (1) Score of adequate degree for content validity of 33 criterias and 133 indicators were every average 2.82. (2) Inter-rater reliabilities(consentaneity score) of the tool by pearson correlation coefficient between three raters were : r=.7506, r=.8934, r=.6695. and Inter-rater reliabilities by single-facet crossed design were : r=.7464. (3) The alpha coefficient relating to internal consistency was .8524 over all 30 items of 33 criterias of developed tool. (4) Score of the quality of nursing care following to generaal characteristics of this study subjects were stastically significant differences according to educational level (F=2.93, p=.029)and diagnosing classification (F=2.50, p=.042). Through this study, I'm sure that the developed tool for the quality of patient care in musculo-skeletal disorder will show the way of more improvement of the quality of nursing care and effective nursing interventions.

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Development of An Evaluation Tool for the Quality of Patient Care Chonic Renal Failure (만성 신부전 환자간호의 질평가 도구개발)

  • Yang, Young-Ock;Kim, Moon-Sil
    • Journal of Korean Academy of Nursing Administration
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    • v.2 no.1
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    • pp.57-72
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    • 1996
  • Provision of better nursing care to patients is a difficult but important task. The first problem for nursing quality improvement is development of evaluation tool for the quality of nursing care. This study tries to develop a patient care tool for patients with chronic renal failure. This study as a procedural evaluation of patient care, tries to show what, how, at what order to provide care to patients with chronic renal failure. This study is divided into process of development of tool, its reliability and validity. Among process of development of tool is focal group, small expert group and expert evaluation group. To develop approprieteness of tool, nurses working is four major hospitals is Seoul were selected. To evaluate the credibility of subjects, 19 patient who were hospitalized and discharged within 3 months were selected. The period for collecting data for reliability and valiability evaluation was between Sept. 20 to Oct. 18, 1995. The development process of this study is as follows ; 1. Make preliminary list of the tool by focal group consisting of 8 clinical nurses. 2. Modify and add preliminary list by 4 expert nursing panel. 3. Calculate content validity of the tool by 23 nursing expert panel of judge. 4. Verity relability and validity of the tool. 5. Finalize an evaluation tool for the quality of nursing care in chronic renal failure patient. The result of this study were as follows ; 1. Development of evaluation tool for the quality of nursing care in chronic renal failure. 1) The evaluation of this study was developed 5 standards, 28 criteria. and 130 indicators 2) Nursing care evaluation scores for chronic renal failure patients were average 68.8. 2. Verity reliability and validity of the tool. 1) 5 standards were divided into 4 point scale and according to 28 creteria, indicators of standard were 3.72 and of criteria were 3.77 2) Inter - rater reliability (consentaneity score) of the tool by pearson correlation coefficient betwwen rates were r= .72, r= .75 and interreliabilities by single - facet crossed design were r= .96. 3) The alpha coeffecient relating to internal consistency was .7259 over 27 items of 28 criterias of developed tool. Through this study, I'm sure that the developed tool for the quality of patient care in chronic-renal failure patient will show the way of more improvement of the quality of nursing care and effective nursing intervention.

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A Study on the Nutritional Assessment of Early Childhood Using Mid-Upper-Arm Circumference (상박위(上膊圍)에 의(依)한 성장기(成長期) 아동(兒童)에 영양상태(營養狀態)의 판정(判定)에 관(關)한 연구(硏究))

  • Tchai, B.S.;Nam, Y.K.;Chung, Y.J.
    • Journal of Nutrition and Health
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    • v.8 no.4
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    • pp.9-14
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    • 1975
  • Growth retardation and a variable degree of body disproportion are recognized features of malnutrition, and mild and moderate protein-calorie malnutrition(PCM). Among the various body measurements suggested to assess the prevalence of all grades of PCM as judged by growth retardation and by body disproportion, the 'mid-upper-arm circumference'-abbreviated to 'arm-circumference' has been suggested as a potential useful simple field index for the assessment of PCM showing that the measurement would give composite information simultaneously on three important effects on PCM-deficit in the muscle protein reservoirs, availability of calorie stores in the form of subcutaneous fat, and growth failure. And this is selected because of its easy accessibility, and less involvement with clinical edema. This study is conducted to make a comparison between the percentage of Korean weight for age standards and the percentage of mid-upper-arm circumference for age standards of 175 preschool children aged $3{\sim}72$ months who are selected among the low-income residents in Seoul. In this study, a comparison is made between the results obtained by expressing the observed weight of the child as a percentage of Korean standard, referred to as 'weight-for-age' and the observed arm-circumference expressed as a percentage of the age-specific arm standard of Jelliffe, referred to as 'arm-for-age'. All the measurements were taken following the techniques described by Jelliffe. The left mid upper arm was measured using a glass-fibre tape and the Fairbanks Morse beam balance was used for weighing. 80% level of weight for age Korean standard and 85% level of arm for are Jelliffe standard were used as an upper borderline limit for PCM. Comparing the 80% weight-for-age and the 85% arm-for-age standard as an upper limit for PCM, for children aged $3{\sim}72$ months, results in 84.6% agreement with the sensitivity of 86.4% and its specificity of 83.5%. If arm circumference alone had been measured and judgement made on this basis, then only 5.1% of the children would have been 'wrongly' classified. And there is a moderately close correlation between arm circumference and weight for age as the data in Table 4 shows. The problem therefore lies in the standard for arm circumference in normal children and in determining what is the lower limit of normal. Once this is clearly difined, one can rely more confidently on arm circumference measurements alone for the nutritional assessment of early childhood.

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The Clinical Study on Spectacle Wearers of Highschool Students (고등학생 안경착용자의 착용상태에 관안 임상적 연구)

  • Kim, Sang-Kyun;Sung, A-Young
    • Journal of Korean Ophthalmic Optics Society
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    • v.9 no.1
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    • pp.19-27
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    • 2004
  • The purpose of this study is to survey spectacle wearers's way of thinking through the questionaire and to investigate their wearing conditions through fitting conditions, the pantascopic angle, vertex distance, the coincidence of vertical and horizontal distance between optical center of the lens and pupillary distance of the eye in random selected 150 ametropic corrective wearers in the age of 17 to 19. The results are as follows : 1. The most popular causes of physical complaints in the ex-wearing spectacle are frame pressure(34.0%), slipping forward(30.0%) and most popular visual complaints are blur vision(30.0%) and asthenopia(20.0%). 2. The most common physical or visual complaints in the present wearing spectacle are slipping forward(30.0%), pressure (50.0%), color(10.0%). 3. Myopic glasses wearers accounted for 56.7% of the subjects, the others were compound myopic astigmatism. In 60% of the subjects' binocular diopter did not coincide. 4. In the pantascopic angle of the both eyes coincide in 66.7% of the subjects. The average of pantascopic angle is $10.07^{\circ}$. 5. In the vertex distance of the both eyes coincided in 65.3% of the subjects. the he average of vertex distance is 13.6 mm. 6. Among 150 eyes with monocular, the vertical distance between optical center of the lens and pupillary distance of the eye is within the RAL-RG 915 that is tolerance of ophthalmic dispensing in German Standards in 82 eyes (54.6%). 7. Among 150 eyes with monocular, the horizontal distance between optical center of the lens and pupillary distance of the eye is within the RAL-RG915 that is tolerance of ophthalmic dispensing in German Standards in 86 eyes(57.3 %).

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A Systematic Review on the Reporting Quality of Acupuncture Treatment for Carpal Tunnel Syndrome (손목터널증후군에 사용된 침 치료 보고의 질 평가)

  • Hyun, Ji-Yoon;Shin, Joo-eun;Im, Chae-Jeong;Park, Ji-Yeun
    • Korean Journal of Acupuncture
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    • v.37 no.3
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    • pp.131-144
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    • 2020
  • Objectives : The aim of this study is to analyze the details of acupuncture treatment methods and the reporting quality of acupuncture on Carpal Tunnel Syndrome (CTS). Methods : Search was conducted in Pubmed, EMBASE, and Cochrane Library for acupuncture studies on CTS. The reporting quality of acupuncture treatment was assessed using the following guidelines: Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) for analyzing the method of acupuncture treatment, Consolidated Standards of Reporting Trials (CONSORT) for analyzing study design and study process, and Risk of Bias (ROB) for analyzing bias. The number of reported items was calculated and evaluated as a proportion. The reported proportion of each study was classified into three grades: Grade A (% score ≥75), Grade B (50≤ % score <75), and Grade C (% score <50). Results : A total of 9 Randomized Controlled Trials (RCTs) were included in this study. All trials reported 12 items (66.67%) on average in STRICTA guidelines. Five studies were conducted with manual acupuncture and 3 studies were conducted with electroacupuncture. PC7 (Daereung) was most frequently used to treat CTS. In STRICTA guideline evaluation, 3 studies were classified as Grade A, 5 studies were classified as Grade B, and 1 study was classified as Grade C. In the CONSORT statement assessment, all trials reported an average of 20.56 items. Of the 9 RCTs, 6 studies were classified as Grade B and 3 studies were classified as Grade C. In ROB assessment, most studies showed a low (63.49%) or unclear (26.98%) risk of bias. The selective reporting bias and the incomplete outcome data bias were found to have the lowest risk of bias, and the allocation concealment of selection bias was found to have the most unclear risk of bias. Conclusions : Recent acupuncture studies on CTS showed moderate reporting quality. However, more detailed reports on acupuncture are still needed to establish more solid evidence of acupuncture treatment.

Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging for Language Mapping in Brain Tumor Surgery: Validation With Direct Cortical Stimulation and Cortico-Cortical Evoked Potential

  • Koung Mi Kang;Kyung Min Kim;In Seong Kim;Joo Hyun Kim;Ho Kang;So Young Ji;Yun-Sik Dho;Hyongmin Oh;Hee-Pyoung Park;Han Gil Seo;Sung-Min Kim;Seung Hong Choi;Chul-Kee Park
    • Korean Journal of Radiology
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    • v.24 no.6
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    • pp.553-563
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    • 2023
  • Objective: Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging-derived tractography (DTI-t) contribute to the localization of language areas, but their accuracy remains controversial. This study aimed to investigate the diagnostic performance of preoperative fMRI and DTI-t obtained with a simultaneous multi-slice technique using intraoperative direct cortical stimulation (DCS) or corticocortical evoked potential (CCEP) as reference standards. Materials and Methods: This prospective study included 26 patients (23-74 years; male:female, 13:13) with tumors in the vicinity of Broca's area who underwent preoperative fMRI and DTI-t. A site-by-site comparison between preoperative (fMRI and DTI-t) and intraoperative language mapping (DCS or CCEP) was performed for 226 cortical sites to calculate the sensitivity and specificity of fMRI and DTI-t for mapping Broca's areas. For sites with positive signals on fMRI or DTI-t, the true-positive rate (TPR) was calculated based on the concordance and discordance between fMRI and DTI-t. Results: Among 226 cortical sites, DCS was performed in 100 sites and CCEP was performed in 166 sites. The specificities of fMRI and DTI-t ranged from 72.4% (63/87) to 96.8% (122/126), respectively. The sensitivities of fMRI (except for verb generation) and DTI-t were 69.2% (9/13) to 92.3% (12/13) with DCS as the reference standard, and 40.0% (16/40) or lower with CCEP as the reference standard. For sites with preoperative fMRI or DTI-t positivity (n = 82), the TPR was high when fMRI and DTI-t were concordant (81.2% and 100% using DCS and CCEP, respectively, as the reference standards) and low when fMRI and DTI-t were discordant (≤ 24.2%). Conclusion: fMRI and DTI-t are sensitive and specific for mapping Broca's area compared with DCS and specific but insensitive compared with CCEP. A site with a positive signal on both fMRI and DTI-t represents a high probability of being an essential language area.

Clinical review of Typhoid Fever Patients (장티브스에 관한 임상적 관찰)

  • 최정신
    • Journal of Korean Academy of Nursing
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    • v.6 no.1
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    • pp.60-71
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    • 1976
  • The author reviewed the medical records of 96 typhoid fever patients who were diagnosed, admitted, and treated at Sea grave Memorial Hospital from January 1 , 1973 through August 31, 1975. Diagnosis was determined by clinical observation, aerology and bacteriology, eighty patients were treated medically, the remaining 16 patients required surgical intervention. The following results were obtained: 1) The age distribution of the patients revealed that 33.3% wert between 10 and 19 years old 21.9% were between 20 and 29, and 19.8% were between 30 and 39. The majority of patients were from these more active age groups. Male to female sex ratio was 1.3 : 1 2) Seasonal distribution was observed. Most illness occurred in the summer and autumn month 5. 3) 84. 3%of the patients came from farm families. 4) Duration between onset and admission averaged 16.0 days. The group without compilations was admitted after an average of 15. 1 days; The group with complications was ad-matted after an average of 19.4 days. 5) Methods of treatment before admission were as follows: 10.4% at medical clinics, 61, 5% at pharmacies (antibiotics 47.9%, other. drugs 13.5%), 7.3% by herb medications, 20.8% had no treatment. 6) Main clinical symptoms were as follows: fever 93.8%, headache 47.9%, abdominal pain 47.9%, chills 38.5%, cough 36.5%, general weakness 26.0%, nausea e vomiting 24.0% and generalized pain 21.9%. 7) Temperature of patients on admission: 22.9% were 39f or more, 67.6% were between 37℃ and 38℃, and 9.4% were 37℃ or less. 8) Occurrence of intensional bleeding after onset of disease averaged 9.3 days; perforation occurred at an average of 19. 1 days. 9) Interval between onset of major complication and surgical intervention averaged 2.8 days. 10) Among the 68 patients who underwent the bacteriological test the positive rate was 44.1% (30). The positive ,ales to, each separate culture method were as follows: 20.4% in the blood culture, 40.4% in the stool culture and 6.7% in the urine culture. Among these bacteriological positive patients 15 patients had a negative results or less than 160 titer of vidal reaction. 11) The initial vidal test of the total group showed a counts of 160 titer or more in 60.4% and less than 160 titer in 39.6%, 12) W. B. C. Counts in the uncomplicated group indicated that 32.5% were 6,000/㎣ or less, 47.5% were between 6,000 and 10,000, arid 20.0% were 10,000/㎣ or more. In the complicated group, 37.6% were 6,000/㎣ or less, 25,0% were 6,000-10,000/㎣ and 37.6% were 10,000/㎣ or more. 13) Duration of hospital stay of the patients averaged 6.4 days in the uncomplicated group and 12.7 days in the complicated group. 14) Subdiaphragmatic free air simple X-ray was found in 91.7% of the perforated cases. 15) Duration of antibiotic therapy until an febrile state was attained averaged 4.8 days in the uncomplicated group and 6.5 days in the complicated group. 16) Operative procedures were as follows: one layer simple closure of their perforation with or without debasement in 56.3%, drainage only in 6.3%, small bowel resection with primary anastomosis in 18.8% , externalization in 6.3%, cholecystectomy in 6.3%, The clinical findings of this study suggest the following recommendations. According to Top's report; 1% of typhoid fever patients treated with chlorarnphenicol and 2% of patients treated with other drugs become chronic carriers. Therefore, importance should be given to the strict control of these carriers. Immunization, improvement of sanitation and living standards are all needed for the prevention and treatment of disease, but a more serious problem is a lack of knowledge on the part of patients and their families. Thus it is most urgent to enlighten the citizens about the transmission and hygiene related to contagious disease. Legal restriction of sale of antibiotics at drug stores without a physician's prescription is an urgent matter for public health administrators. An even more important nursing responsibility is the reemphasis on health education both in the clinical setting and in the home.

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A Systematic Review of Randomized Controlled Trials on Acupuncture Treatment for Neck Pain (경항통에 침치료를 시행한 무작위대조군연구(RCT)들에 대한 계통적 연구)

  • Kim, Hyun-Wook;Kim, Sung-Soo;Kang, Jung-Ah;Nam, Dong-Woo;Kim, Eun-Jung;Hong, Kwon-Eui;Kim, Sung-Chul;Lee, Jae-Dong;Kim, Kap-Sung;Lee, Geon-Mok
    • Journal of Acupuncture Research
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    • v.26 no.2
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    • pp.103-123
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    • 2009
  • Objectives : The aim of this study is to review RCTs of acupuncture treatment for neck pain and to establish standards of acupuncture treatment for neck pain. Methods : We searched articles in Pubmed using ICD 10. Study quality was assessed using the FEAS and Jadad score. Results and Conclusions : Three review studies and nineteen clinical trials were searched and reviewed. Among the nineteen clinical trials reviewed, positive outcome was reported in thirteen studies. Most frequently used meridians were GB, BL, SI, GV and LI, The most frequently used acupuncture points were $GB_{20}$, $GB_{21}$, $LI_4$, $BL_{10}$, $GV_{14}$ and $SI_3$. More than two needles were inserted in the studies and needle retention time was more than 10 minutes. The most frequently used needle length was 40mm, and diameter was 0.25mm and 0.30mm. The mean number of treatment sessions were more than 10 times. Frequency of treatment was more than once a week, And treatment duration was more! than 5 weeks. The total FEAS scores ranged from 3 to 15.5, and the mean value was 9.39. Jadad score ranged from 2 to 5, and the mean value was 3.42. The number of studies scoring over three points on the Jadad scale was sixteen.

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Music for Pediatric Patients in Medical Settings: A Systematic Review of Randomized Controlled Trials (소아환자를 위한 음악: 무작위 임상연구의 체계적인 문헌고찰)

  • Lee, Jin Hyung
    • Journal of Music and Human Behavior
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    • v.10 no.2
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    • pp.1-33
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    • 2013
  • The aim of this study was to systematically review the latest clinical trials in music medicine and medical music therapy for pediatric patients. Thirteen databases were searched to obtain randomized controlled/crossover design studies published between the year 2000 and 2012 in English language. Out of 1012 articles retrieved in the initial search, fifteen studies were identified based on an exclusion criteria. Overall, selected articles involved children 1 month to 18 years, sample size of 11 to 150, and total participants of 987. Studies were classified and compared as music medicine or music therapy studies through a systematic synthesis assessing general characteristics, methodological quality, measured outcomes, types of interventions and the study results. Seven music medicine and eight music therapy studies measured seven dependent variables using thirty-six different measurement tools with a large heterogeneity in the selection, type, and method of music interventions. Evaluation of the methodological quality revealed that many studies did not provide a full report of the research method, and did not meet some or most methodological standards, such as randomization, allocation concealment, double or partial blinding, and intention to treat analysis. Although overall research results were positive if not significant, poor methodological quality and heterogeneity in design and intervention strategies raise the question of research bias and trustworthiness issues. The systematic review concluded that music may have a valuable clinical effect in addressing the physical and psychosocial needs of hospitalized children, although more rigorous, homogeneous and replicable studies are greatly needed.

Clinical Investigation and Follow-up Monitoring of Fatigue Patients Visiting the Oriental Medical Hospital (한방병원 보양클리닉에 내원하는 피로환자의 임상적 분석 및 치료경과 관찰)

  • 이종훈;이지현;박신명;김영철;이장훈;우홍정
    • The Journal of Korean Medicine
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    • v.21 no.4
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    • pp.55-63
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    • 2000
  • Objectives : Fatigue is a common symptom experienced by everyone. Nevertheless, clinicians have a tendency of ignoring it since fatigue itself is not considered a distinct disease. Actually, some limited research about chronic fatigue syndrome has been made within the country, but in reality, the probability of getting this syndrome is still considered very low due to the strict diagnosis standard. Therefore, there are tremendous numbers of patients who do not get enough attention from clinicians for their fatigue symptoms only because technically they do not belong to the syndrome. Therefore, a basic statistical database must be compiled and patient management programs must be developed. To accomplish this, we conducted this study by measuring degree of fatigue, clinical characteristics and processes of Oriental medical treatment of fatigue patients. Methods : The objects of this study were selected from the new patients who entered the tonification Clinic in Kynnghee Oriental Medical Center between August 11, 2000 and October 7, 2000. Their main complaint was fatigue and they did not suffer from any physical or mental problem either historically or at the time of the study. The objects were divided into two groups based on duration of fatigue; fatigue under 6 months is considered as acute fatigue and fatigue for longer than 6 months is chronic fatigue. The prepared survey sheet for measuring fatigue degree was distributed to the patients with their consent. The patients were divided again into three subgroups : the fIrst group went through 1st test and constitution test after tonification clinic; the second one went into constitution test skipping Ist measuring test; the third one went into only tonification clinic with neither 1st measuring test nor constitution test. Results : The total number of object patients was 47 and 80% of them were considered as 'fatigue patients' by the Chalder scale. Among all patients, 29.5% requested treatment for chronic fatigue, which is over 6 months. The average of scale II for all patients was 14.8, which indicates moderate fatigue. The averages of scale II-1, II-2, II-3 were respectively 7.5, 5.9, and 3.7 so the most common complaint was physical fatigue. When compared scale II based on occupations, student group scored 6.9 and office man group scored 8.5 in scale II-1, physical fatigue, but it was not significant. Conclusions : Numerous number of patients have come to Oriental medical centers or hospitals in Korea. Therefore, deeper statistical research and follow-up-monitoring are reqnired in the Oriental medical academic world. In this study, among all patients who entered the tonification Clinic in Kyunghee Oriental Medical Center, 29.5% requested treatment for chronic fatigue, which is over 6 months. This kind of statistical report is the first time trial in the Oriental medical academy world. Through these steps, more objective treatment can be made and standards of prognosis assessment can be established.tablished.

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