• 제목/요약/키워드: clinical reasoning

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뇌졸중 환자의 운전재활 시기 결정을 위한 K-MBI의 임상적 유용성: 예비 연구 (Clinical Usefulness on K-MBI for Decision of Driving Rehabilitation Period in Patients with Stroke: A pilot study)

  • 박명옥
    • 재활복지공학회논문지
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    • 제11권2호
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    • pp.91-98
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    • 2017
  • 연구배경 및 목적: 수정된 바델지수(MBI)는 지역사회 재활세팅 및 재활 병원에서 흔히 사용되어지는 기본적인 일상생활 평가 도구이다. 선행 연구들에 의하면 노인 혹은 뇌졸중 환자들의 운전 능력과 일상생활활동의 수준은 유의미한 상관성이 있음을 보고된 바 있다. 그러나, 뇌졸중 환자의 운전능력을 예측함에 있어 임상에서 흔히 사용되는 일상생활 활동 기본 평가인 수정된 바델지수의 유용성을 밝힌 연구는 미비하다. 본 연구에서는 한국형 수정된 바델 지수(K-MBI)룰 활용하여 뇌졸중 환자의 운전 가능성을 알아봄으로서 운전 수행 능력을 예측함에 있어 한국형 수정된 바델 지수의 임상적 유용성을 알아보고자 하였다. 연구방법: 서울 소재 재활병원에서 재활치료를 받고 있는 뇌졸중 환자 48명이 연구에 참여하였다. 모든 연구 대상자에게 K-MBI 검사를 통해 기본적인 일상생활 활동 수준을 측정하였고 가상현실 운전시뮬레이터를 이용하여 운전 수행능력을 측정하였다. 운전 시뮬레이터상의 운전 수행 검사의 합격/불합격에 따른 K-MBI 점수의 예측 타당도를 ROC curve를 이용하여 검증하였다. 결과: 뇌졸중 이후 운전재활을 권고할 만한 기본적인 일상생활 활동 수준은 K-MBI 점수가 최소 86.5점인 경우가 적절한 것으로 나타났다. 결론: 본 연구는 뇌졸중 환자의 운전 재활을 권고하는 시기를 예측함에 있어 유용한 기초 자료가 될 것으로 판단된다.

의과대학 선택교육과정의 운영절차와 만족도 평가 (Evaluation of Process and Satisfaction for Selective Courses in a Medical School)

  • 김도환;최영휴;한상윤;신좌섭;이승희
    • 의학교육논단
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    • 제19권2호
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    • pp.90-100
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    • 2017
  • The necessity of embracing selective courses in medical curriculum is increasing due to the expansion of medical knowledge and changes in the health care environment. In contrast to the abundant evidence regarding elective or selective courses during the clinical phase, articles focusing on the preclinical period are relatively scarce. This study aims to explore the development, implementation, and evaluation of newly-adopted selective courses in the first-year medical curriculum in a medical school which recently underwent a major curricular revision. First of all, the Curriculum Committee established goals and operating principles of the courses, and then the committee encouraged all participating professors to attend a related faculty development workshop after finalizing the list of courses. A survey was conducted at the end of each course for evaluation. Of the 36 courses opened in 2016, the overall satisfaction of students was $4.98{\pm}1.06$ (out of 6) and showed a strong correlation with students' previous expectations, reasoning- and participation-oriented teaching, and outcome of the courses including increased motivation. In the open-ended responses, students and professors described not only intended outcomes such as acquisition of medical knowledge and increased interest in new topics, but also unintended outcomes including positive impression for selective courses and even high satisfaction and rewarding experiences, especially from the teachers' perspective. Although long-term outcomes remain to be seen, the results of this study show the feasibility and impact of selective courses and will contribute to effective implementation in other medical schools.

노년층의 인지-화용언어 능력 평가 : 평가도구 및 내용타당도 연구 (Cognitive-Pragmatic Language Assessment for Normal Aging : Study of Assessment Tools and Content Validity)

  • 이미숙;김향희
    • 한국콘텐츠학회논문지
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    • 제12권5호
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    • pp.280-292
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    • 2012
  • 인간의 인지-화용언어 능력은 일반적으로 연령이 증가함에 따라 저하된다. 노년층의 인지-화용언어 능력을 평가하는 것은 인지 기능이나 치매 등 관련 질병들에 대한 예측에 도움이 된다. 본 연구에서는 노년층의 인지-화용언어 능력을 평가하기 위한 기존의 도구들을 분석하고, 현재 저자들이 연구 개발 중인 평가영역 및 문항들에 대한 내용타당도(content validity)를 검증하고자 하였다. 이를 위해 17명의 언어치료사 및 임상심리사들이 판단한 척도점수에 근거하여 내용타당도 지수(Content Validity Index, CVI)를 산정하였다. 연구 결과, 주의력, 기억력, 조직화 능력, 추론력, 문제해결력, 집행기능, 화용언어 등 7개 영역 모두 CVI가 .75를 초과하였다. 이에 따라, 현 문항들이 노년층의 인지-화용언어 능력을 평가하기 위한 목적과 적절히 부합하는 내용적 타당성을 지니는 것으로 입증되었다.

『동의수세보원(東醫壽世保元)』의 결흉(結胸) 해석 - 소양인 결흉을 중심으로 - (Interpretation of chest bind(結胸) in Donguisusebowon(東醫壽世保元) based on the chest bind disease of the Soyang pattern)

  • 장우창
    • 대한한의학원전학회지
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    • 제28권4호
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    • pp.99-119
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    • 2015
  • Objectives : This study aims to compare and analyze the contents and logic of Lee Jema's chest bind theory of the Soyang pattern with that of the traditional perspective since Shanghanlun, and to further investigate its underlying meaning and evaluate its value. Methods : Study chest bind related arguments of Lee through historical, demonstrative and positive investigation. First, contrast related texts starting from Shanghanlun, followed by reasoning based on general medical logic. Finally review clinical case studies from texts and papers for verification. Results : According to Lee, the key to diagnosis and treatment in preventing major chest bind which is a severe condition in the exterior cold pattern of the Soyang constitution, is to disperse fluid bind using GanSui(甘遂) in the water counterflow and vomiting(水逆嘔吐) stage prior to the major chest bind symptoms of stiffness and pain in the lower chest(心下硬痛), and reducing phlegm-rheum using DoJeokGangGiTang(導赤降氣湯) in the beginning stages of chest bind. HyeongBangDoJeokSan(荊防導赤散) is the main formula in treating phlegm-rheum, a causal factor to chest bind, modified according to the 'treat the three burners separately(三焦分治)' theory of the DaoChiSan(導赤散) section in WanBingHuiChun (萬病回春) to accomodate the Soyang constitution. Conclusions : If we follow Lee's diagnosis and treatment system on chest bind, it will allow us to diagnose chest bind in the earlier stages and secure safe treatment.

수학교사의 대수식 쓰기 지도를 위한 발달에 핵심적인 이해 (Mathematics teachers' Key Developmental Understandings for teaching equation writing)

  • 최윤형;이수진
    • 한국수학교육학회지시리즈A:수학교육
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    • 제60권3호
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    • pp.297-319
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    • 2021
  • 본 연구는 Gess-Newsome(1999)의 변형적 관점에서 수학교사의 수학적 이해와 잠재적 학생들을 가르치기 위한 지도방법 간의 관계를 면밀히 이해하고자 중등 수학교사 4명을 대상으로 질적 사례 연구를 수행하였다. 구체적으로, 대수식 쓰기 문제해결을 위한 발달에 핵심적인 이해를 조사 후, 연구 참여자들이 이에 주목하여 문제를 해결하는지 분석하였다. 나아가 대수식 쓰기를 지도하기 위한 수업을 예상하는 과정에서 나타나는 교수적 행동과 수학적 이해 사이의 연관성을 분석하였다. 분석 결과 KDU에 주목한 2명은 대수식 쓰기 문제해결에 성공했으나, 다른 2명은 가분수 상황을 그림으로 나타내거나 상호적 추론을 요구하는 문제를 어려워하였다. 또한 교사들이 구상한 대수식 쓰기를 지도하는 방법에서 확인된 교수적 행동은 그들이 문제해결 과정에서 주목했던 수학적 이해가 투영되어 있었다. 본 연구 결과는 특정 수학 내용에 대한 교사의 KDU와 교수 활동을 위한 지식과의 연결 사례를 제시함으로 교사교육 연구에 기여한다.

지역사회 인재 양성을 위한 조선대학교 의과대학 코호트 구축 및 운영 사례 (Establishment of a Cohort at Chosun University College of Medicine for Social Accountability)

  • 최효선;김영전;유효현
    • 의학교육논단
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    • 제25권2호
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    • pp.132-138
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    • 2023
  • Cohorts are established and operated at medical schools as part of efforts to improve the quality of education. Chosun University College of Medicine clarified the purpose of establishing three cohorts in light of its core values and developed criteria and indicators for each purpose. An organization focusing on cohort construction and operation was established as the Cohort Committee under the Quality Improvement Committee, and guidelines were proposed. In addition, a database and system were developed to handle primary data efficiently, and tools for measuring psychological variables were created. The data collected by establishing a cohort, regions, and admission types of graduates were first analyzed for the following projects: (1) an analysis of the educational process and quality improvement to educate medical professionals who contribute to the community after graduation, and (2) an analysis of the educational process and quality improvement to secure excellence in the medical field (e.g., knowledge and clinical reasoning), using information on the academic achievements of students and graduates as primary data. Chosun University College of Medicine is conducting cohorts and longitudinal studies gradually, starting with a simple, practically feasible system to solve the difficulties faced in cohort establishment and operation. Medical educators hope that future data collection and analysis will improve the quality of medical school education and have practical implications.

항정신병약물 치료 후 인지기능 변화 차이 연구 : 장기 지속형 주사제와 경구제 비교의 예비 연구 (Change in Cognitive Function after Antipsychotics Treatment : A Pilot Study of Long-Acting Injectable versus Oral Form)

  • 성기영;김서영;김의태
    • 대한조현병학회지
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    • 제21권2호
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    • pp.74-80
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    • 2018
  • Objectives : This study investigated whether long-acting injectable (LAI) paliperidone is different from its oral form in terms of the effect on cognitive function in schizophrenia spectrum and other psychotic disorders. Methods : We reviewed the medical records of patients in Seoul National University Bundang Hospital who were diagnosed as having schizophrenia and/or other psychotic disorders based on DSM-5 from 2016 to 2017. Seven patients were treated with oral paliperidone and 11 were treated with paliperidone palmitate. All patients underwent clinical and neuropsychological assessment, including the Korean version of the MATRICS Consensus Cognitive Battery (MCCB) at their first visit or within one month of their initial treatment. MCCB was repeated within three to 12 months after the initial assessment. Results : There was no significant difference between the two groups in most cognitive domains including speed of processing, attention and vigilance, working memory, verbal learning, visual learning and reasoning and problem solving domain. However, patients treated with paliperidone palmitate showed better improvement in social cognition domain than those taking oral paliperidone. The standardized values of social cognition domain scores had significantly improved over time in patients under paliperidone palmitate, demonstrating a significant time-by-group interaction. Conclusion : Our results show that long-acting injectable paliperidone could be helpful in some aspects of improving cognitive function in schizophrenia spectrum and other psychotic disorders. Further studies with other antipsychotics are necessary to generalize the results.

서영태(徐靈胎)와 길익동동(吉益東洞)의 학술사상 비교 연구 (I) - 각자의 주요 저서를 중심으로 - (Comparative Study about Academic Thoughts of Xu Lingtai and Yoshimasu Todo (I) - Focus on their Major Books -)

  • 윤철호;황황
    • 대한한방내과학회지
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    • 제31권4호
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    • pp.792-812
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    • 2010
  • In the 18th century, Xu Lingtai (徐靈胎) and Yoshimasu Todo (吉益東洞) were famous doctors advocating ancient medicine, though they lived in different countries, China and Japan. We compared their major books, analyzed their academic thoughts and then took conclusions as below. 1. The first, for instance "Classified Prescriptions of Treatise on Cold Damage Diseases, 傷寒論類方" and "Classified Assemblage of Prescriptions, 類聚方". Based on essential thought that a prescription and a syndrome should correspond, these books arranged and classified the Zhang Zhongjing (張仲景)'s texts."Classified Prescriptions of Treatise on Cold Damage Diseases", based on the thought that principles, methods, formulas and medicinals (理法方藥) were integrated in prescriptions, tried to find out the implicit treatment rules in prescriptions and syndromes through analyzing "Treatise on Cold Damage Diseases, 傷寒論". On the other hand, because Classified Assemblage of Prescriptions focused on the syndromes of ancient prescriptions (古方), it classified and collected the related texts of Treatise on Cold Damage Diseases and "Synopsis of Prescriptions of the Golden Chamber, 금궤요략", and then suggested only simple instructions on how to prescribe medicine. So in this book, the trend of experience was clear. 2. The second, there is "100 Kinds Records from Shennong's Classic of Materia Medica, 神農本草經百種錄" and "Description work of herbal pharmacology comprised of excerpts from Shanhanlun and medical experiences, 藥徵". Though both of these books are professional oriental pharmacology publications that advocate reactionism, there were remarkable differences in writing style between them. "Description work of herbal pharmacology comprised of excerpts from Shanhanlun and medical experiences" was based on "Treat on Cold Damage Diseases" and "Synopsis of Prescriptions of the Golden Chamber", just explained the effects of medications and discussed 'matter of course (所當然)', but not discussed 'the reason why (所以然)'. In explaining style of syndromes, it confirmed through research, and emphasized the inductive method. On the other hand, "100 Kinds Records from Shennong's Classic of Materia Medica based on "Shennong's Classic of Materia Medica, 神農本草經", explained the nature of medications and discussed 'the reason why (所以然)'. In explaining style of syndromes, it annotated and explained, and emphasized the process of reasoning. 3. The third, there is "Discuss the Headwaters of Medicine, 醫學源流論" and Severance of Medical evils, 醫斷". Aiming the then medical theories fallen in confused state, these books brought order out of chaos, clarified the categories of medical research, and emphasized the scientific method that could put theories into practice and verify them. The difference is that "Severance of Medical Evils" researched only macroscopic viewable clinical phenomena, and even denied the existence of names of diseases and etiological causes. Thus, it emphasized the accumulation of experiences, laid emphasis on "watching and realizing (目認)", and "understand and taking in (解悟)". Discuss the Headwaters of Medicine extremely emphasized the research of 'something not occuring (未然)', that is to say, induced notions of a disease from observing clinical phenomena, furthermore based on these, predicted the 'something not occuring (未然)' and emphasized researching 'the reason why (所以然)'. As regards how they deal with the traditional theories and post-Zhang Zhongjing's medicines, "Severance of Medical evils" took completely denying attitudes. In case of "Discuss the Headwaters of Medicine", it could be used reasonably through specific situation and detailed analysis. Collectively speaking, there were some differences between medical theories of Xu Lingtai and Yoshimasu Todo. Actually, these differences were whether he tried to research the essence of disease, whether he tried to consider it rationally, and how he treated various opinions occurring in the theories of traditional medicine and clinical experience.

Fisher's Angle에 관한 연구 (A STUDY OF FISHER'S ANGLE)

  • 김영수
    • 대한치과보철학회지
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    • 제17권1호
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    • pp.7-21
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    • 1979
  • This investigation was to analyse normal protrusive and lateral condylar pantographic records written on the sagittal plane and to study components of Fisher's angle and their interrelations. The purpose of this study was limited to (1) discussing the significance of sagittal pantographic record in diagnosis of occlusal disease and(2) basing for reasoning validity of measuring Fisher's angle which has been reported so far. As a result followings were concluded. 1. In each protrusive and lateral condylar movement path, five complicate factors such as initial straightness, distributed simple sigmoid type, simple curvature, initial tiny protruding convexity and tiny repeated sigmoid patterns were noted. Generally each condylar movement path was composed of two to three of these factors. 2. The distribution of positional interrelations of protrusive and lateral condylar paths could be divided into five categories; (a) protrusive-upper, (b) completely coinciding, (c) partially initial coinciding, (d) partially inverted crossing, and (e) completely inverting. Among these, protrusive path-upper positioned condyles were prevailed (79.2%). 3. The distribution of interrelations of protrusive and lateral condylar paths could be devided into five categories according to their distances in the course of movement. Among these, opening (95.8%) and paralleling (66.7%) were prevailing. 4. The involved number of characteristic heterogenous patterns of five categories in protrusive and lateral condylar movement recording relations at one simultaneous recordings was limited to three. However, in case of homogeneous patterns were repeated, usually three to four were included. 5. The maximum distance between protrusive and lateral condylar paths was 1.45mm at the location of 4mm advanced position from centric relation point and 3.90mm at the location of protrusive movement terminal. 6. It seemed to be that ,pantographic records should be consulted other clinical symptoms in order to make certain occlusion diagnosis. 7. At the present moment of investigation, expressing Fisher's angle as a degree revealed a lack due to inherent complexity of protrusive and lateral condylar movement paths. 8. The typical pattern of protrusive and lateral condylar paths written on a pantographic sagittal plate might be described as follows; (a) protrusive condylar path should be positioned upwardly, (b) both mainly be simple curvature, (c) interrelations mainly be opening or paralleling. 9. The mean amounts of separation between protrusive and lateral condylar movement path were $0.75{\pm}0.46$ at 4mm advanced location from centric relation and $1.74{\pm}0.64mm$ at the location of protrusive path terminal.

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역량기반 간호교육과정을 위한 핵심역량 모델링 (Modeling Core Competencies in the Competency-based Nursing Curriculum)

  • 김정아;고자경
    • 한국산학기술학회논문지
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    • 제16권11호
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    • pp.7635-7647
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    • 2015
  • 본 논문은 간호사의 역량을 규명하고, 전체 간호업무의 80%를 통제할 수 있는 20%의 핵심간호역량을 도출하여 이를 기반으로 하는 간호교육과정 개발을 위한 간호역량을 모델링하기 위해 시도되었다. 각종 역량 관련 문헌고찰을 통하여 역량기반 교육과정, 역량 및 간호역량의 개념을 확인하고, 간호역량의 개념에 부합하는 각종 간호역량을 열거 및 유목화 하여 이들 간의 관계를 규명하였다. 또한 각종 역량 모델링의 방법을 검토하여 이를 토대로 역량기반 간호교육과정에 고유한 핵심역량 모델의 예시적 개념 지도를 제시하였다. 역량기반 간호교육과정을 위한 핵심역량은 기저역량, 실무역량, 인성역량으로 대별되고 기저역량은 전공(이론+실기)과 간호술로 역량의 기본이 된다. 실무역량은 임상적 판단, 대상자 교육, 의사소통, 환자 안전, 질 향상, 병동 및 자원 관리 등으로 구성되며 인성역량은 리더십, 책임 인식, 협력, 정책변화 대응 등으로 이루어진다. 이들은 자기주도적 학습과 비판적 사고 능력을 통하여 지속적인 순환 관계를 유지한다. 결국 이러한 역량을 가진 간호사는 지식근로자로써 자기주도적 학습자이며 전문적이고 효율적인 의사소통가이다. 간호역량을 확정시키는 후속연구가 계속되어야 하며 실제 역량기반교육과정에 적용하여 성과를 측정하고 이를 다시 반영하는 과정이 지속적으로 이루어져야 함을 제언한다.