• 제목/요약/키워드: Clinical judgement

검색결과 74건 처리시간 0.024초

환자안전 중심 간호인력 정책 도출을 위한 델파이 연구 (A Delphi Study to Elicit Policies for Nurse Workforce based on Patient Safety)

  • 장성옥;이병숙;김종임;신성례
    • 간호행정학회지
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    • 제20권2호
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    • pp.215-226
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    • 2014
  • Purpose: This study was done to suggest policies for nurse workforce based on patient safety. Methods: The two steps in developing the items were items related to what would be desirable policies and items on how the policies should be developed for patient safety regarding nurse workforce. A literature review was done and suggestions from experts through two rounds using the Delphi technique were outlined. The fifteen experts who participated in this study were six representatives of service consumers and nine representatives of service providers (four medical doctors and fives nurses). Results: To guarantee patient safety, accreditation of nursing practice and nursing education were found to be necessary, and to prevent medical and nursing accidents in clinical practice, the professional judgement of the nurses was found to be pivotal to the provision of safe nursing services. Conclusion: Polices on nursing for the nurse workforce based on patient safety in clinical settings should be established to ensure that nursing care is provided according to the nurses' clinical judgements based on their professional knowledge and assessment skills.

Clinical Significance of Expression and Amplification of the DcR3 Gene in Pancreatic Carcinomas

  • Zhou, Jian;Song, Shi-Duo;Li, De-Chun;Zhou, Jin;Zhu, Dong-Ming;Zheng, Shi-Ying
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권2호
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    • pp.719-724
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    • 2012
  • This study aimed to investigate the clinical significance of expression and amplification of decoy receptor 3 (DcR3) in pancreatic carcinomas (PC). mRNA expression was detected by PQ-PCR, and amplification was determined. DcR3 protein expression was detected by immunohistochemistry and ELISA. Correlations between DcR3 expression and clinical pathological factors were analyzed. The relative amount of DcR3 in PC tissues and non-cancerous tissues showed a statistically significant difference, 21 cases displaying more than two fold DcR3 amplification, while no such amplification was found in normal pancreatic tissues. DcR3 positive cell staining was located in the cytoplasm. The positive rate of DcR3 in PC and non-cancerous tissues showed a significant difference. DcR3 mRNA expression was correlated with clinical staging, size of the tumor, lymph node metastasis and histological staging, while protein expression was correlated with clinical data like tumor size. DcR3 gene amplification only correlated with tumor size. The level of DcR3 in serum of the PC resectable group before operation was $72.2{\pm}10.2$ pg/ml, showing a significant difference compared to gallbladder carcinoma group (GC) or pancreatic benign tumor (PBT) group (P < 0.01). In conclusion, DcR3 amplification is correlated with DcR3 expression in PC tissues, especially those clinical pathological factors which reflect tumor progression. Assessment of DcR3 level in sera of PC patients may be helpful for the early diagnosis and prognostic judgement.

임상 간호실습교육 평가도구 개발 (Development of Clinical Evaluation Tool for Nursing Student)

  • 이군자;장춘자;홍성순
    • 간호행정학회지
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    • 제7권3호
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    • pp.473-485
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    • 2001
  • This study is intended to develop a reliable and appropriate instrument of the clinical nursing education. This research consisted of 4 steps. First step is construction of the content validity by 1 Korean literature professor and 1 teaching professor in Ga Chon Gil College, the pilot study for the content validity by 14 professors and survey with four points Likert Scale, which includes from the point 'strongly valid' to the point of 'strongly non-valid', by 113 head nurses who guide and evaluate the students in clinical practice. The third step is the test of validity and reliability of the preliminary evaluation tool. The fourth step is the test of validity and reliability of the developmental evaluation tool. The data were collected from Sep. 10th, 2001 to Sep. 28th, 2001. This study was analyzed by SPSS PC+ for descriptive statistics, factor analysis and Cronbach's Co-efficient Alpha of the collected data. The results of these analysis are like as follows. 1. Evaluation tool of Clinical practice consists of 16 items including four categories : factor 1 was labeled 'desirable attitude'(5 items), factor 2 was labeled 'correctly judgement and nursing problem solving'(4 items), factor 3 was labeled 'adaptive ability of nursing knowledge and skill'(4 items), factor 4 was labeled 'desirable human relationship'(3 items) and these contributed 71.992% of the variance in the total score. 2. Cronbach's Co-efficient Alpha for internal consistency was .9128 for the total 16 items. For further research, it need to develop a variable and reliable instrument of the student self-evaluation and instrument that based on community.

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의약품 임상시험의 계약적 일고찰 (A Contractual Study on the Clinical Trial of Medicine)

  • 송영민
    • 의료법학
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    • 제12권1호
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    • pp.257-285
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    • 2011
  • This thesis has studied about the legal characteristic of injection of the trial drug, the position of the pharmaceutical firm as a contractor of the clinical trial, the possibility of compulsory performance of consistent injection of the trial drug, and the damage claim caused in the process of the clinical trial from the viewpoint of protecting the trial subject in the clinical trial. According to court's judgement in the United States, the lawsuit of the trial subject, although the trial subject had expected consistent injections, was dismissed because there was no direct contract between pharmaceutical and trial subject. However, Helsinki Declaration prescribe the medical research as follows. 'All patients who participated in the research should be able to use the best precaution, diagnosis, and treatment proved by the final outcome of the research'. The trial subject is entitled to demand only the pharmaceutical firm which developed and provided the trial drug, and the pharmaceutical firm has the obligation to supply the trial drug to the trial subject. Therefore, it would be not enough to protect the trial subject if the pharmaceutical firm which makes the trial drug is ruled out. In addition, especially, in case the trial drug has a constant effect with the aim of treatment, if the injection of the trial drug is suddenly stopped, the trial subject would not have the benefit of treatment by the trial drug. In this case, the best remedy against the damage is to urge a constant injection of the trial drug. Thus, in certain case, it is reasonable to consider that the pharmaceutical firm has the obligation to supply the trial drug to the trial subject constantly, and it is also necessary to compel it through effective means in case the pharmaceutical firm do not fulfill its obligation to supply the trial drug. However, as an essential prerequisite for the assertion mentioned above, it should be judged under the principle of good faith considering the concrete situation, that is, what roles the pharmaceutical firm has played.

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일부 의사들의 직무스트레스와 관련 요인 (Job Stress and Its Related Factors in South Korean Doctors)

  • 감신;이상원;천병렬;예민해;강윤식
    • Journal of Preventive Medicine and Public Health
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    • 제34권2호
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    • pp.141-148
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    • 2001
  • Objective : To investigate the sources, extent and related factors in South Korean doctors. Methods : The study subjects were 934 doctors in Taegu, Kyungpook Province, Korea(540 independent practitioners, 105 employed at hospitals and 289 residents in training). Information concerning job stress was obtained using a 9-item questionnaire. Information regarding related factors such as demographic characteristics(age, sex, marital status), perceptions on the socioeconomic status of doctors and working conditions(work time, on-call days per week) was also obtained by self-administered questionnaire during April and May, 2000. Results : Major sources of job stress included clnical responsibility/judgement factor, patient factor and work loading factor. The job stress score of residents was the highest among three groups. The score was lower in older doctors. The score was low among those who thought doctors' socioeconomic status was not good. The longer the work time, the higher the job stress score was. Multiple regression analysis was conducted to control for the mutual influence of independent variables. In regression analysis, the score of residents was higher than practitioners. Work time and socioeconomic status perception had negative effects on job stress score. Conclusion : The average job stress score of the doctors was high. Age, work type, working conditions and perceptions of socioeconomic status were found to besignificantly related to job stress score. Although the job stress of doctors is somewhat inevitable due to the nature of the doctor's job, control of work time, development of coping tools and other intervention methods are needed to reduce job stress of doctors. Further studies are required to understand the characteristics of iob stress and reduce the job stress of doctors.

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『황제내경(黃帝內經)』의 침구법(鍼灸法) 연구 - 시간(時間) 개념을 중심으로 - (A Study on the Acupuncture & Moxibustion of Huangdineijing - focused on Concept of Time -)

  • 류정아
    • 대한한의학원전학회지
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    • 제29권3호
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    • pp.57-74
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    • 2016
  • Subject : Treatment of acupuncture & moxibustion in Huangdineijing Objectives : Discover the principles and substances of acupuncture & moxibustion treatment of Huangdineijing Methods : The author reviewed the Huangdineijing: Suwen, Lingshu to gain a realistic sense of the facts and the medical book's contents that deal with the practices of acupuncture & moxibustion treatment for clinical praxis. Conclusions : 1. The acupuncture & moxibustion of Huangdineijing can be defined as follows. A treatment for correcting of meridian's drift by proper selection of surgical site, using suitable implementation and appropriate manipulation skill from a correct judgement of meridian's flowing through sensing the pulse for diagnosis when the meridian's flowing which come and go constantly driven by the tidal order of defensive Qi tactually appeared hard or soft caused by diseases, thus bring out the soft & gradual 50 laps circulation of nutrient Qi moderately driven by defensive Qi. 2. Today's acupuncture & moxibustion treatments greatly differ from those of Huangdineijing in that we do not know the substance of that treatment which is correcting of meridian's drift and do not obligatorily carry out feeling of the pulse for diagnosis which is a measure & judgement of meridian's flowing against a preliminary treatment in parallel with treatment so reduce use and power of that treatment. 3. I could form a list of general principle from the substances of acupuncture & moxibustion of Huangdineijing like as the flowing or fate of meridian Qi(tidally going in order of defensive Qi and nutrient Qi), deficiency or excess of Meridian flowing, comparing diagnosis before and after treatment, bring out the soft & gradual Qi. That was imposing "the concept of time" on recognition and treatment to human body.

청지각적 평가 방식에 따른 음성장애 심한 정도 판단과 자가 신뢰도에 대한 차이 (Effects of EAI and VAS on perceptual judgement and confidence rating by listeners for voice disorders)

  • 이옥분;김선희;정한진
    • 한국산학기술학회논문지
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    • 제15권5호
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    • pp.3046-3050
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    • 2014
  • 본 연구는 음성장애 청지각적 평가인 EAI(등간척도)와 VAS(시각적 아날로그 척도)의 차이점, 각 평가방법에 대한 평가자 자가-신뢰도(confidence rating)을 알아보았다. 30명의 언어병리전공 학생들이 음성장애로 진단받은 화자(N=25)의 발성과 읽기 샘플을 듣고 EAI는 7점 척도, VAS는 0-10cm의 직선에 음성장애 정도를 표시했고, 판단에 대한 자가 신뢰도 점수는 7점 척도로 실시했다. 음성장애 정도에 대한 판단의 준거가 제시되는 상황(조건 1)과 그렇지 않은 상황(조건 2)에서 모음 연장발성과 읽기 과제에 대해 각각 실시했다. 연구 결과, 발성이나 읽기과제에서 모두 동일하게 모두 VAS평가 점수가 높게 산출되었고, 통계적으로 유의하였다. 그 외 조건 1의 읽기과제와 조건 2의 발성과제에 대한 EAI와 VAS평가 점수 간에는 차이가 없었다. 이러한 결과는 음성장애 화자들의 발화 과제와 청지각적 평가유형이 청취자들의 지각적인 판단에 영향을 미칠 수 있으며, 이에 대한 보다 집중된 임상 연구가 계속되어야 할 것을 시사한다.

불안장애환자(不安障碍患者) 19례(例)에 대(對)한 임상적(臨床的) 고찰(考察) (The Clinical Analysis on 19 Cases of Anxiety Disorder)

  • 정인철;이상용
    • 동의신경정신과학회지
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    • 제9권2호
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    • pp.161-169
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    • 1998
  • A clinical analysis was carried out for 19 patients who was treated in Dept. of Neuropsychiatry of Taejon Oriental Medicine Hospital from I aug. 1997 to 31 Jul. 1998 and was ruled out as anxiety disorder. The results were summarized as follows. 1. In the distribution of the sex, ratio between female and male was 1:2.8, distribution of the age was even each age, and the primary motive of the onset were psychological trauma, question of money, discord of a household. 2. As for the duration in disease, the duration from a week to a month had a majority of all, and the most duration of the addmission-treatment was a week. 3. The most common symptom were palpitation ·anxiety, headache·dizziness, chest discomfort, the cases of generalized anxiety disorder and atypical anxiety disorder was a large number. 4. In the aromatherapy of absorptive method, the sort of many used essential oil were Lavenda and Rosewood, in the massage, that were Peppermint and Rosemary. 5. The most used recipes were BUNSIMKIYEM(分心氣飮) HACHULBOSIMTANG(夏朮補心湯), CHUNGGANSOYOSAN(淸肝逍遙散), BANHABAEKCHUCHUNMATANG(半夏白朮天麻湯), CUIBIONDAMTANG(歸脾溫膽湯) etc. 6. In the judgement of efficacy, 9 cases showed good efficacy, 9 cases showed no change, 1 case showed excellent efficacy.

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후두 발적에 대한 컴퓨터 평가 시스템의 신뢰도 연구 (Reliability of Computerized Measurement of Laryngeal Erythema)

  • 문병재;남순열;김상윤;최승호
    • 대한후두음성언어의학회지
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    • 제16권1호
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    • pp.19-22
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    • 2005
  • Background and Objectives : While considerable progress has been made in enhancing the quality of laryngoscopy and image processing, the evaluation of laryngeal erythema is still based on the clinician's judgement. The purpose of this study is to quantitatively measure the degree of erythema and to examine the relationship with clinical grading. Materials and Methods : Color images of larynx from 100 subjects were captured from video-documented examinations of laryngoscopy. The amount of erythema within the digitized larynx image was quantified using software developed and was compared with a grading system (0 to 3 scale) based on visual inspection by 4 experienced clinicians. The results were compared by deriving Kappa, Kendall and Spearman statistic. Results : There was high intra-observer(R=0.402-0.755) and inter-observer correlation (R=0.789). Among parameters, the red composite value had most remarkable agreement with clinical grading(R=0.827). Conclusion : The result suggest that the computer based analysis of laryngeal erythema can provide quantiative data on degree of erythema and the basis for further development of an expert system.

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액티브 러닝 학습방법을 활용한 심전도 개론 및 실습 교과과정의 학습효과와 만족도 조사 (Outcomes of active learning methods in an electrocardiography course; identifying the effects of flipped, case-based, and team-based learning)

  • 김철태;김정선
    • 한국응급구조학회지
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    • 제23권2호
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    • pp.61-73
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    • 2019
  • Purpose: This study aimed to introduce active learning methods, including flipped, case-based, and team-based learning in an electrocardiography (ECG) course and to investigate outcomes and satisfaction with these methods. Methods: To identify the learning effect of active learning, pre-and post-academic self-efficacy was compared between the experimental and control groups. In the experimental group, pre-and post-knowledge and clinical performance regarding ECG were also assessed. In addition, class satisfaction was investigated after application of active learning methods in the experimental group. Data were collected from 84 paramedic students and analyzed using SPSS 22.0 (IBM, Armonk, NY, USA). Results: The experimental group showed significant improvement in post-academic self-efficacy and knowledge. The experimental group also showed high clinical performance (9.83 out of 10 in ECG checking ability and 9.63 out of 10 in ECG reading ability). The mean satisfaction score was 4.23 out of 5 (responses based on a Likert scale) in the experimental group. Conclusion: Active learning in an ECG course was found to be highly effective and satisfactory. Furthermore, paramedic students can enhance their accountability and judgement with team-based learning through free engagement in discussion.