• The Journal of Korean Physical Therapy
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• 제24권3호
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• pp.171-180
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• 2012

Purpose: The purpose of this study was to investigate the clinical decision making (CDM) development process throughout the comparison between novice and expert physical therapist as well as develop a CDM model for physical therapists under the fee-for-service (FFS) and physicians' prescriptions. Methods: Purposive sampling techniques were used to select 10 clinical physical therapists paired into five groups (each pair consisted of 1 novice and 1 expert physical therapist). The coding schemes were extracted from interviews and through within- and across-case analyses, cases were summarized. The reliability of coding schemes was confirmed by checking of case summaries by the participants. Results: Novice and expert physical therapists were influenced by two themes, internalized theme and external forces or information. Novice clinicians depended more on external forces or information. Although clinicians should care patients under the FFS and physician's prescription, expert clinicians were more likely to rely on internalized knowledge. Conclusion: The findings of the present study may be used by educators or association officials enhance CDM abilities and knowledge pools of student or novices as well as develop a guide to suitable novices or students under the specific context limiting the development of their CDM.

• 디지털융복합연구
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• 제16권12호
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• pp.511-521
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• 2018

본 연구의 목적은 간호대학생의 비판적 사고성향과 임상의사결정능력 및 환자안전 지식, 태도가 임상실습 시 환자안전수행능력에 미치는 영향을 조사하고 이들 변수간의 관련성을 파악하여 환자안전수행능력의 향상을 위한 중재 프로그램 개발의 기초자료를 마련하기 위함이다. 자료분석은 SPSS 21.0 프로그램을 이용하여 t-tests, one-way ANOVA 등을 실시하였다. 연구결과, 대상자의 환자안전 수행능력은 비판적 사고성향(r=.278, p=.001)과 양적 상관관계,. 임상의사결정능력(r=.202, p=.014)과 양적 상관관계, 환자안전 태도(r=.421, p<.001)와 양적 상관관계가 있었다. 환자안전 수행능력에 미치는 영향요인은 성별(${\beta}=.175$, p=.031), 환자안전 교육(${\beta}=-2.266$, p=.025), 비판적 사고성향(${\beta}=3.354$, p=.001), 환자안전 태도(${\beta}=.368$, p<.001)로서 설명력은 31.5%의 영향력을 보였다(R2=.561, F=4.56 p<.001). 간호대학생의 임상실습 교육에 필요한 환자안전 수행능력을 증진하기 위해서 비판적 사고성향, 임상의사결정능력, 환자안전교육에 대한 교과 과정의 수립이 필요하다.

• 대한치과의사협회지
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• 제53권11호
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• pp.770-778
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• 2015

This article discusses how to conduct treatment planning and decision making in special needs dentistry. Special needs patients often lack cooperative ability during dental treatment and have a deteriorated oral health status. To overcome the limitation in communication with special needs patients and solve their complicated dental problems, dentists need to have extensive preoperative information about the patients and their caregivers. Treatment procedures should be organized in a patient-centered and cost-effective manner. Additionally, clinical outcomes need to be predicted taking into consideration of the patients' condition. The clinical experience of committed dentists is another factor that enhances the benefits of extensive treatment in special needs patients with many limitations. The insightful treatment decision-making of dentists will contribute to improving the oral health of special needs patients despite the various obstacles.

• 한국응용과학기술학회지
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• 제38권1호
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• pp.88-98
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• 2021

본 연구는 간호대학생의 환자안전관리 수행자신감에 미치는 영향요인을 파악하기 위해 실시되었다. 분석결과 환자안전관리 지식 7.0점, 환자안전관리 태도 3.86점, 임상의사결정능력 3.47점, 환자안전관리 수행자신감 4.15점이었다. 환자안전관리 수행자신감은 환자안전관리 지식(r=.216, p<.01)과 환자안전관리 태도(r=.375, p<.01), 임상의사결정능력(r=.467, p<.01)과 양의 상관관계가 있었다. 환자안전관리 수행자신감에 미치는 영향요인은 임상의사결정능력(β=.409, p<.001)과 환자안전관리 태도(β =.198, p=.011) 이었고 설명력은 26.3%이었다.

• 성인간호학회지
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• 제22권5호
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• pp.488-498
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• 2010

Purpose: The purpose of this study was to explore clinical nurse's reported conflict experience toward end-of-life medical decision making. Methods: Data were collected by in-depth interviews with eight nurses from three different wards of university hospital in D city of Korea. Conventional qualitative analysis was used to analyze the data. Results: Results were three major themes and twelve categories from the analysis. The three major themes were prioritization of treatment, non-disclosure of diagnosis, and hierarchical and power relations. Conclusion: The results of this study suggest that shared decision making in end of life among patient, family members, physician, and nurse may contribute to improve end-of-life care performance as well as dignified dying of patient in end of life.

• 사상체질의학회지
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• 제27권2호
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• pp.222-230
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• 2015

Objectives The purpose of this study is to design a research to find clinical factors involved in the decision-making process for determining the constitutional prescription based on prospective clinical data. Methods We have created a draft of the case report form. Therefore, seven constitutional experts was interviewed for additional items to be important used to determine the constitutional prescription in clinic. Interviews were done from December 2012 to March 2014, experts per person 2-3 times, took time of about 120 minutes per interview. Since then, we developed the final case report form through the expert meeting. At the same time, the developing the electronic case report form (eCRF) and the protocol to collect constitutional treatment cases was also discussed. Results & Conclusions The items of the case report form were subject general, lifestyle, health measurement, record of expert, prescription and evaluation after medication. The part of the clinical symptoms of the record of expert allowed to be recorded in the 5-point scale for the collection of quantitative data as much as possible. Assuming a re-visit of the patient, if necessary, twice the recording were to be possible. At the same time, the eCRF and the protocol to collect constitutional treatment cases were also developed. In this study, it will be able to more objectively standardize the medical decision making process that the experts of constitutional prescription decision. As a result, it will be possible to provide the standardized constitutional medical services.

• Asian Pacific Journal of Cancer Prevention
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• 제16권18호
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• pp.8595-8598
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• 2016

Background: Decision making modalities for screening for many cancer conditions and different stages have become increasingly complex. Computer-based risk assessment systems facilitate scheduling and decision making and support the delivery of cancer screening services. The aim of this article was to survey electronic risk assessment system as an appropriate tool for the prevention of cancer. Materials and Methods: A qualitative design was used involving 21 face-to-face interviews. Interviewing involved asking questions and getting answers from exclusive managers of cancer screening. Of the participants 6 were female and 15 were male, and ages ranged from 32 to 78 years. The study was based on a grounded theory approach and the tool was a semi-structured interview. Results: Researchers studied 5 dimensions, comprising electronic guideline standards of colorectal cancer screening, work flow of clinical and genetic activities, pathways of colorectal cancer screening and functionality of computer based guidelines and barriers. Electronic guideline standards of colorectal cancer screening were described in the s3 categories of content standard, telecommunications and technical standards and nomenclature and classification standards. According to the participations' views, workflow and genetic pathways of colorectal cancer screening were identified. Conclusions: The study demonstrated an effective role of computer-guided consultation for screening management. Electronic based systems facilitate real-time decision making during a clinical interaction. Electronic pathways have been applied for clinical and genetic decision support, workflow management, update recommendation and resource estimates. A suitable technical and clinical infrastructure is an integral part of clinical practice guidline of screening. As a conclusion, it is recommended to consider the necessity of architecture assessment and also integration standards.

• Journal of Korean Neurosurgical Society
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• 제55권4호
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• pp.195-199
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• 2014

Objective : Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. Methods : We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3--8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. Results : Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. Conclusion : Ethical training and developing decision-making skills are necessary including shared decision making.

• Clinical and Experimental Pediatrics
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• 제53권6호
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• pp.669-679
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• 2010

The risk of mortality and morbidity of patients with congenital heart defects (CHDs) is highest during neonatal period and increases when diagnosis and proper management are delayed. Neonates with critical CHDs may present with severe cyanosis, respiratory distress, shock, or collapse, all of which are also frequent clinical presentations of various respiratory problems or sepsis in the newborn. Early diagnosis and stabilization and timely referral to a tertiary cardiac center are crucial to improve the outcomes in neonates with CHDs. In this review, the clinical presentation of critical and potentially life-threatening CHDs is discussed along with brief case reviews to help understand the hemodynamics of these defects and ensure proper decision-making in critically ill patients.

• Korean Circulation Journal
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• 제53권9호
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• pp.581-593
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• 2023

In the catheterization laboratory, the measurement of physiological indexes can help identify functionally significant lesions and has become one of the standard methods to guide treatment decision-making. Plaque vulnerability refers to a coronary plaque susceptible to rupture, enabling risk prediction before coronary events, and it can be detected by defining a certain type of plaque morphology on coronary imaging modalities. Although coronary physiology and plaque vulnerability have been considered different attributes of coronary artery disease, the underlying pathophysiological basis and clinical data indicate a strong correlation between coronary hemodynamic properties and vulnerable plaque. In prediction of coronary events, emerging data have suggested independent and additional implications of a physiology-based approach to a plaque-based approach. This review covers the fundamental interplay between coronary physiology and plaque morphology during disease progression with clinical data supporting this relationship and examines the clinical relevance of physiological indexes in prediction of clinical outcomes and therapeutic decision-making along with plaque vulnerability.