• Title/Summary/Keyword: Clinical Practice Examination

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A Study on the Clinical Usefulness of MMSE and BCRS for Cognitive Function Test in Patients with Non-Traumatic Subcortical Cerebrovascular Disease (비외상성 피질하 뇌혈관질환 환자에서 인지평가도구로서 정신상태소검사(MMSE)와 간이인지평가척도(BCRS)의 임상적 유용성에 대한 연구)

  • Choi, Hong;Lee, Young-Ho;Choi, Young-Hee;Ko, Dae-Kwan;Chung, Young-Cho;Park, Byoung-Kwan;Kim, Soo-Ji;Chung, Sook-Haui;Ko, Byoung-Hee;Song, Il-Byoung;Park, Kun-Woo;Lee, Dae-Hie
    • Sleep Medicine and Psychophysiology
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    • v.3 no.1
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    • pp.68-78
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    • 1996
  • Objective : The Mini-Mental State Examination(MMSE) and Brief Cognitive Rating Scale(BCRS) are frequently using screening tests fur evaluating the cognitive function in clinical practice and research. The authors tried to evaluate the clinical usefulness of these tests for the patients with non-traumatic subcortical cerebrovascular disease. Method : We administered the MMSE and BCRS to 85 patients and 195 normal control group. In order to compare the test results according to the lesion site, we divided patients into left sided lesion group(21 patients), right sided lesion group(31 patients) and both sided lesion group(13 patients). Their cognitive function was evaluated by the BNA and daily living functional activity was examined by the IADLs(Instrumental Activities of Daily Living Scale)and GERRI(Geriatric Evaluation by Relative's Rating Instrument). Results : The results are as follows : 1) In the BNA, the patients scored significantly lower than control group at all items(except Right-Left Orientation and Motor Impersistence), but there were no difference in the MMSE(total score and all 5 items), and only 2 items(recent memory and self-care) were significantly different between two groups in the BCRS. 2) In the comparison by lateralization, there were significant differences among three groups at 3 items(Left Tactile Form Perception, Left Finger Localization and Right Finger Localization) in the BNA. But, there were no difference in the MMSE and BCRS. 3) In the correlation between daily living functioning and the MMSE/BCRS, control group showed no relation(except item of cognitive functioning), but patient group was significantly correlated with 3 items(social functioning, instrumental activities of daily living and cognitive functioning). Conclusions : These findings suggest that MMSE and BCRS are not useful as the test for cognitive function and discrimination of lateralization in patients with non-traumatic subcortical cerebrovascular disease. However, scores of these tests may be related with the functional level(such as daily living function) of patients.

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Measurement of Nursing Service Quality using SERVQUAL Model (SERVQUAL 모델을 이용한 간호 서비스 질 측정)

  • Lim, Ji-Young;Kim, So-In
    • Journal of Korean Academy of Nursing Administration
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    • v.6 no.2
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    • pp.259-279
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    • 2000
  • This study is a descriptive analytic research measuring nursing service quality, using SERVQUAL model, to make fundamental data and strategies for nursing service improvement. Data were collected by self-reported questionnaire from 202 patients and 142 nurses, from June 7 to 14, 1999. The reliability of instrument were adequate(Cronbach ${\alpha}=.94$). SAS program was utilized for statistical analysis of collected data. The results were as follows; 1. There was a gab between patient's expectation and perception on nursing service(Gap B). Gap D was indicated an affecting factor to decide nursing service quality. Gap C was indicated an indirect affecting factor of nursing service quality. Because it was not statistically significant in total item analysis, but in individual item analysis, 7 items were appeared statistically significant. Gap A was not a gap occurrence factor of nursing service quality. 2. Focuses of nursing service quality improvement strategies were; (1) to direct qualitative improvement of nursing service in order to correspondence patient's nursing service expectation. (2) to make nurse's service activity modified because nurse's practice were not reached patient's expectation level. (3) to need internal, external factor analysis affecting nurse's service activity. 3. Nursing service quality was decided by rather environmental inappropriateness provided nursing service than itself. Therefore, to make nursing service quality improvement, it is required to improve nursing service environment. For this, followings are required; (1) to strengthen nurse's education on lower part of nursing service satisfaction and QI activities. (2) to balance demand and supply of nursing personnel. 3) to fix computerized system for reducing other duties weight except nursing care through analysis of nursing activity. (4) to construct rational cooperating system among related departments. 4. The important parts for nursing service quality improvement were indicated as follows: (1) Gap B: 'prompt reaction', 'examination symptom before patient's complaint', 'hearted nursing service reducing patient's dissatisfaction', 'explanation goals of nursing activities', 'having special Knowledge enough', 'maintenance position comfortably', 'management of patient's physical hygiene'. (2) Gap C: 'maintenance physical safety', 'explanation about hospital rules and facilities'. (3) Gap D: 'tender, safe injection and wound care'. Because above items are mostly improved through nurse's attitude change and quality improvement, it is required to establish nursing standardization and to strengthen nurse's clinical education. As the based on above results, followings are suggested; 1. SERVQUAL model is very useful to make strategies for nursing service quality improvement because it indicates multiple factors affecting hap occurrence. 2. At individual items analysis of Gap C, statistically significant 7 items appeared higher nurse's perception level than patient's perception level on nursing service were trouble perception level on nursing service quality improvement. So. it need further research to analysis about these difference occurring factors. 3. At analysis of Gap D, it is indicated that in nursing service performance process, multiple factors lowing nursing service quality were intruded. So it needs further research to analysis what these factors are and how each factors affect on nursing performance process. 4. nursing service quality measurement is changeable according to sample select time or sampled subject's characteristics. So to develope strategy for nursing service quality improvement is based on the results of periodical analysis.

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Patient Radiation Exposure Dose Evaluation of Whole Spine Scanography Due to Exposure Direction (Whole Spine Scanography의 검사방향에 따른 환자 선량 평가)

  • Kim, Jung-Su;Seo, Deok-Nam;Kwon, Soon-Mu;Kim, Jung-Min
    • Journal of radiological science and technology
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    • v.38 no.1
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    • pp.1-6
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    • 2015
  • Whole spine scanography (WSS) is a radiological examination that exposes the whole body of the individual being examined to x-ray radiation. WSS is often repeated during the treatment period, which results in a much greater radiation exposure than that in routine x-ray examinations. The aims of the current study were to evaluate the patient dose of WSS using computer simulation, image magnification and angulation of phantom image using different patient position. We evaluated the effective dose(ED) of 23 consecutive patients (M : F = 13:10) who underwent WSS, based on the automatic image pasting method for multiple exposure digital radiography. The Anterior-Posterior position(AP) and Posterior-Anterior position( PA) projection EDs were evaluated based on the PC based Monte Carlo simulation. We measured spine transverse process distance and angulation using DICOM measurement. For all patient, the average ED was 0.069 mSv for AP position and 0.0361 mSv for PA position. AP position calculated double exposure then PA position. For male patient, the average ED was 0.089 mSv(AP) and 0.050 mSv(PA). For female patient, the average ED was 0.0431 mSv(AP) and 0.026 mSv(PA). The transverse process of PA spine image measured 5% higher than AP but angulation of transverse process was no significant differences. In clinical practice, just by change the patient position was conformed to reduce the ED of patient. Therefor we need to redefine of protocol for digital radiography such as WSS. whole spine scanography, effective dose, patient exposure dose, exposure direction. protocol optimization.

Female College Students' Perception of Work Scope of Dental Hygienist and Boundaries of Medical Personnel according to the Major

  • Hong, Yang-Hee;Lee, Jung-Mi;Woo, Hee-Sun
    • Journal of the Korea Society of Computer and Information
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    • v.25 no.3
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    • pp.177-183
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    • 2020
  • The purpose of the study is to investigate the women's college students' perceptions on work scope of dental hygienists and the inclusion of dental hygienists in the category of medical personnel. A self-reported questionnaire was completed by 180 Suwon women's college students from August 26, to September 11, 2019. The questionnaire consisted of oral health condition of the subjects, perception of both legal and illegal work scope of dental hygienist, the degree of recognition of medical personnel occupations by subject, and the reason why they thought dental hygienists are medical personnel. The collected data were analyzed based on frequency, percentage, and descriptive statistics using IBM SPSS VER 22.0. It showed significantly different perception of work scope of dental hygienists according to the major. Percent of 70 of the subjects perceived dental hygienist as a medical personnel, the opinions on the necessity were as follows: The Ministry of Health and Welfare issues a license through the national examination role and dental hygienists assist the care of dentist. Therefore, clinical dental hygienists should be promoted to medical personnel through the amendment of the medical law so that the duties practiced by the dental hygienist can be matched with the legal practice.

Evaluation of Image Quality using Monte Carlo Simulation in Digital Mammography System (디지털유방영상시스템에서 몬테카를로 시뮬레이션을 이용한 영상평가)

  • Kim, Changsoo;Kang, Se-Sik;Kim, Jung-Hoon;Lee, Jin-Soo
    • The Journal of the Korea Contents Association
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    • v.14 no.6
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    • pp.247-254
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    • 2014
  • For the purpose of early diagnosis of the breast cancer, the attention on the screening mammography has been increasing-with supply of digital mammography day by day. Image quality is decided by target materials and filter combinations. Optimized selection by a glandular density and a thickness is needed, because these combinations change x-ray spectrum and effect to image quality. The purpose of this study is to find out optimized target and filter combinations through the evaluation of quantitative image quality and to suggest means which minimize patient dose through MCNPX. In results, spatial frequency resolution evaluation which is quantitative image quality evaluation method, MTF, NPS, DQE shows that we have to select Mo/Mo combinations or Mo/Rh combinations when compressed breast is thin. but in case of that when compressed breast is thick, we have to select Rh/Rh combinations or W /Rh combinations. In a comprehensive evaluation, W!Rh combinations which are not used in thin breasts in practice was superior to all image quality evaluation. This result is somewhat different-with clinical examination results. Secondary end point was organ dose evaluation, radiation dose of opposite breast was approximately 47 ~73% effectiveness when selecting standard breast. In conculsion, the most important point is that we have to select the optimal combinations-with considering dose evaluation and various thickness.

A study on the facial palsy patients' use of Western-Korean collaborative treatment: Using Health Insurance Review & Assessment Service-National Patients Sample (얼굴마비 환자의 의·한의 협진 의료이용 연구: 건강보험심사평가원 환자표본 데이터를 이용)

  • Park, Hyo Sung;Uhm, Tae Woong;Kim, Nam Kwen
    • Journal of the Korean Data and Information Science Society
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    • v.28 no.1
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    • pp.75-86
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    • 2017
  • The facial palsy is one of the most common illness in Western-Korean collaborative treatment (hereinafter "collaborative treatment"). The purpose of this study is to analyze facial palsy patients'collaborative treatment use patterns. By analysing the 2014 National Health Insurance Review and Assessment Patient Sample Data (NPS 2014) with the episode of care unit, we have found the following results. First, the collaborative treatment is preferred by patients over 50 years old and female. Second, western medicine mainly focuses on diagnosis and medical examination while korean medicine and collaborative treatment focus more on treatment activity. Third, western medicine showed the shortest treatment period, followed by korean medicine and collaborative treatment. However, the cost of medical treatment per day is highest in western medicine. The analysis of the use patterns of collaborative treatment shown in the study is expected to provide a direction for the development of clinical practice guidelines and the establishment of medical policies in the future.

Ultrasound Imaging of Normal Cardiac Structures with Convex Scanner in Puppies (강아지에서 컨벡스스캐너를 이용한 정상적인 심장구조물의 초음파상)

  • Jeong Soon-wuk;Park Hee-myung;Han Sook-hee;Yoon Jung-hee;Han Hong-ryul
    • Journal of Veterinary Clinics
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    • v.11 no.2
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    • pp.529-537
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    • 1994
  • Sector scanner which has a conical end is used to image through the intercostal space because heart is protected by the ribs. Cardiac data published all around the world were also obtained by sector scanner. Although scanners being used in every small animal practice and animal hospital at college in Korea include convex ape and linear type, linear type is not appropriate f3r cardiac scan because of a wide contact surface. The purpose of this study is to establish ultrasonographic images of normal cardiac structures by measuring shape, size of reflectable cardiac structure according to restraint position in scanning normal heart of the puppies with 6.5 MHz convex scanner(SonoAce 4500, Medison, Korea) used in our veterinary teaching hospital, Seoul national university. Seventeen male and female puppies considered having healthy hear by X-ray and clinical examination are used feom April to July 1994. Scanning point selection of probe head and the distinction of imaged cardiac structures were accomplished by necropsy and cardiac scanning performed through thoracotomy under general anesthesia. At 10 o'clock position of transducer(at an angle of 30$^{\circ}$ between imaginary line from elbow joint to 3rd sternum and probe head, 60$^{\circ}$ from body surface, 4th intercostal space of right thorax) with the marker of scanner toward the head of dogs right atrium, left atrium and left ventricle were observed in 2, 3, 4, 5 intercostal space(2cm from the sternum) of experimental dog positioned ventrodorsally under general anesthesia. Under these conditions, the numerical values of imaged diastolic hear are as follows : the distance from skin to apex(mean$\pm$S.D) 47.53$\pm$6.94mm, thickness of left ventricular wall 6.00$\pm$1.60mm, length of left ventricle 16.27$\pm$5.31mm, width of left ventricle 15,33$\pm$4.25mm, length of left atrium 12.33$\pm$3.82mm, width of left atrium 11. 33$\pm$3.94mm, length of right atrium 1.00$\pm$2.41mm, width of right atrium 11.21$\pm$2.76mm and the area of left ventricle 270.92$\pm$109.81mm$^2$, area of left atrium 98.00$\pm$41.08mm$^2$, area of right atrium 62.75$\pm$21.04mm$^2$.

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Role of PET in Evaluating Indeterminate Solitary Pulmonary Nodule with CT (CT상 악성여부가 불명확한 단일 폐결절에서의 양전자방출단층촬영술의 유용성)

  • Yoon, Seok-Boo;Choi, Joon-Young;Kim, Sun-Jung;Choi, Yong;Choe, Yearn-Seong;Lee, Kyung-Han;Kim, Sang-Eun;Kwon, O-Jung;Lee, Kyung-Soo;Kim, Byung-Tae
    • The Korean Journal of Nuclear Medicine
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    • v.31 no.1
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    • pp.83-89
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    • 1997
  • About one-third of radiologically indeterminate solitary pulmonary nodules (SPN) are eventually turned out to be malignant. It is very important to noninvasively determine whether the SPN is malignant or not for the decision of its way of management. PET imaging is highlighted by its unique ability of imaging the function and metabolism of cells. Glucose metabolism is increased in malignant transformed cells. We peformed FDG-PET studies in patients who had radiologically indeterminate SPN and compared the findings with histologic diagnoses to assess the diagnostic accuracy in the detection of malignancy and to decide which parameter is the most suitable for clinical practice among peak SUV (pSUV), average SUV (aSUV), 50/10 ratio, and time-activity curve (TAC), Thirty patients were included in this study and the most useful parameter was pSUV. The sensitivity and specificity in the detection of malignant SPN using 3.5 as a cut off pSUV were both 87%. Interestingly, all 2 false-negative cases were bronch-ioloalveolar carcinoma on histologic examination. If these cases, which could be strongly suspected by CT findings, were excluded, the sensitivity of pSUV was 100%. In conclusion, PET imaging is very helpful for determining malignancy in indeterminate SPN and pSUV is a conveniently measurable parameter which is valuable for interpretation.

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Evaluation of the feasibility of bony window repositioning without using a barrier membrane in sinus lateral approach (상악동측방접근법시 차폐막을 사용하지 않는 골창재위치술의 유용성 평가)

  • Jeon, Seung-Hwan;Cho, Yong-Seok;Lee, Byung-Ha;Im, Tae-Yun;Hwang, Kyung-Gyun;Park, Chang-Joo
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.37 no.2
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    • pp.122-126
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    • 2011
  • Introduction: In the lateral window approach for a maxillary sinus bone graft, there has been considerable controversy regarding the placement of a barrier membrane over the osteotomy site. In particular, when there is no damage to the Schneiderian membrane, clinicians should decide whether to use a barrier membrane or not, considering the benefits and costs. This study presents the clinical cases to demonstrate that only repositioning the detached window can lead to satisfactory bony healing of the grafted material without using a barrier membrane in the lateral approach for a maxillary sinus bone graft. Materials and Methods: Five consecutive patients were treated with the same surgical procedures. After performing the antrostomy on the lateral maxillary wall using a round carbide bur and diamond bur, the bony window was detached by a gentle levering action. After confirming no perforation of the Schneiderian membrane, the grafting procedure was carried out the detached window of the lateral maxillary wall was repositioned over the grafted material without using a barrier membrane. A gross examination was carried out at the postoperative 6 month re-entry, and the the preoperative and postoperative dental computed tomography (CT) at re-entry were compared. Results: All the procedures in the 5 patients went on to uneventful healing with no complications associated with the bone graft. Satisfactory bone regeneration without the interference of fibrous tissue on the gap between the repositioned window and lateral wall of the maxillary sinus was observed in the postoperative 6 month re-entry. The CT findings at re-entry revealed the, reconstruction of the external cortical plate including repositioned bony window. In addition, the loss of the discontinuity of the lateral maxillary wall was confirmed. Conclusion: This preliminary report showed that the detached window, which was just repositioned on the grafted material, could function as a barrier membrane in the lateral approach for a maxillary sinus bone graft. Therefore additional morphometric and histologic studies will be needed.

BUBBLE BEHAVIOR OF PIT AND FISSURE SEALANT (치면열구전색제의 도포 시 전색제에 따른 기포 발생 양태)

  • Kim, Hyun-Jin;Lee, Nan-Young;Lee, Sang-Ho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.34 no.1
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    • pp.99-105
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    • 2007
  • In clinical practice, air bubbles trapped in the pit and fissure may increase early loss of sealing materials for fracture, wear and microleakage. The purpose of this investigation was to examine the bubble behavior of pit and fissure sealant. The 140 replicas made of epoxy resin were used to this experiment. Following conditioning, light-polymerized sealants were applied and then exposed to the light source. After stereoscopic examination of standarized specimen by grinding, bubble behavior was analysed. The results obtained were as follows; 1. Ultraseal $XT^{(R)}$ plus grops irrespective of using time were higher than groups of $Helioseal^{(R)}$ with clinpro tip and metal tip in the frequency of bubble(p<0.05), 2. Ultraseal $XT^{(R)}$ plus old group was more than $Clinpro^{(R)}$, Teethmate $F-l^{(R)}$ and $Helioseal^{(R)}$ with brush tip in the number of bubble under 200 magnified cross section(p<0.05). 3. The widest mean area of bubble was shown in the Teethmate $F-1^{(R)}$. 4. No statistically significant difference of the frequency and the site of bubble between $Clinpro^{(R)}$ and $Helioseal^{(R)}$ groups(p>0.05).

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