• 대한핵의학회지
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• 제37권6호
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• pp.341-354
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• 2003

Radioactive iodine therapy using I-131 for hyperthyroidism has been used for more than 50 years, and generally considered safe and devoid of major side effects. Appropriate patient selection criteria and clinical judgement concerning patient preparation should be employed for its optimal use. It has not been possible to resolve the trade-off between efficient definite cure of hyperthyroidism and the high incidence of post-therapy hypothyroidism. The dose of the I-131 needed to maintain euthyroid state remains an area of uncertainity and debate. Early side effects are uncommon and readily managable. Other than the need for long-term monitoring and, in most cases, lifelong thyroid hormone treatment for late adverse consequences of this treatment remains only conjectural. We have reviewed general principles and recent advances in radioiodine treatment for Graves' hyperthyroidism, specially regarding to several controversies.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1992년도 춘계학술대회
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• pp.71-74
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• 1992

This paper describes research about the realization of computerized radial pulse diagnosis system in order to remove the subjectivity of a diagnostician, when diagnostician diagnoses a sickness using tactile percept ion in korean traditional medicine. Using radial pulse wave detection system, we effectively measured pressure radial pulse rave and after analyzing it, we detected the characteristic parameters and also quantified it and then we objectified more or less the judgement standard of radial pulse diagnosis by the aids of a clinical expert. on this base, we confirmed the possibility for realizing of automatic radial pulse diagnosis by radial pulse diagnosis system.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권2호
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• pp.137-144
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• 1994

Inselecting scars for treatment, attention be paid not only to the features of the defect as seen objectively but also to the element of the defect most disturbing to the patient. We revised the scar tissues with simple elliptical excision, Z-plasty, modified Z-plasty, W-plasty and hand dermabrasion in varialbe pattern of scars and got the favorable results. The success rate of scar revision usually depends on the patient's subjective judgement. We must inform our patient the limitation of scar revision and importance of postoperative care. The oral and maxillofacial surgeons must resolve the variable scars which re involved in variable operations and traumas.

• 대한물리치료과학회지
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• 제9권3호
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• pp.179-186
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• 2002

This study addresses the need to adopt teaching-learning approaches in physical therapy education that develop links between theory and clinical practice in a meaningful way. Problem-based learning (PBL) is presented as a useful way to educate physical therapy for the future. The essential characteristics of problem-based learning include: curricular organization around problems rather than disciplines; an integrated curriculum rather than one separated into clinical and theoretical components; and an inherent emphasis on cognitive skills as well as on knowledge. PBL as implemented in the health sciences, is an educational method in which the focus of learning is a small-group tutorial in which students work through health care scenarios. The goals of the health care scenarios are to provide a context for learning, to activate prior knowledge, to motivate students, and to stimulate discussion. Learning is student-centered rather than faculty-centered, and self-directed learning is emphasized. Whereas the former focuses on critical thinking and clinical judgement, the latter's emphasis is on clinical competency. The physical therapist (PT) program at Cheju Halla college is a partial integrated problem-based curriculum. The history and process of PBL in general and in the PT program are reviewed. Long-term advocates of PBL stress that it is the only known method for preparing future professionals to be able to adapt to change, learning how to reason critically, enabling a holistic approach to health.

• 의료법학
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• 제17권2호
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• pp.125-144
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• 2016

모든 형태의 임상시험은 시험 자체가 불확실하며, 리스크가 다양하므로 피험자를 보호하기 위한 제도가 완비되어 있어야 한다. 그럼에도 불구하고 현행 임상시험에 관한 법률은 약사법과 의료기기법에서 일정한 규정을 두고 있으나 이는 '의약행정'을 원활하게 수행하기 위한 법목적에 비추어 피험자 보호에는 일정한 한계가 있다. 더 나아가 미성년 피험자를 대상으로 하는 임상시험은 약사법 등에서 직접적인 규정을 두지 않고, '소아를 대상으로 하는 임상시험 평가 가이드라인'이나 '의약품임상시험관리기준' 등에서 일정 부분 규율하고 있으나 이는 법적 효력이 없는 권고사항이라는 점에서 일정한 한계가 있다. 미성년자 대상 임상시험에 대한 법흠결 문제는 인체침습의 정도 면에서 통상적인 의료행위의 경우보다 강한 장기이식법상의 미성년자 취급제도와 기타 외국법상의 미성년자 임상시험 제도를 검토함으로서 입법적 해결이 가능하다고 할 것이다. 그러나 근본적으로는 현행법 체계상 약사법, 의료기기법 기타 가이드라인을 중심으로 이루어지고 있는 임상시험 규율체계를 이른바 "피험자보호법"이라는 법률제정을 통해 해결하는 것이 바람직하다고 본다.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.684-690
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• 2017

Objective : As increasing the size of the geriatric population, the number of elderly patients, who need the surgery for painful degenerative spinal stenosis has been increasing. The geriatric population may be relatively high complications, because of age and age-associated medical conditions. However, there is a lack of studies addressing the perioperative complications and outcomes in elderly patients with posterior lumbar inter body fusion with screw augmentation (PLIF). Methods : We retrospectively reviewed the medical records and radiographic studies of geriatric patients who had spine surgery of PLIF due to spinal stenosis for 11 years. We divided into 2 groups (A; 70-75 years, B; over then 76 years) according to the age. Surgical level of each groups, hospital day and postoperative day, co-morbidities, complications, clinical outcomes were analyzed. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed. Results : Group A was composed of 80 patients, their mean age was 72.21 and female dominant (n=46), and their mean surgically fused level was 1.52 level. Group B was 36 patients, their mean age was 78.83 and female dominant (n=20), and their mean surgically fused level was 1.36 level. Comparing between two groups, complications, postoperative hospital stay were slightly increase in group B and co-morbidity was statistically high in group B, however clinical outcomes were similar between two groups. Conclusion : Increasing age might be an important risk factor for complications in patients undergoing PLIF, however, we would like to recommend that if the situation of spine of extreme geriatric patients need PLIF, it should be in the surgeon's consideration after careful selection and clinical judgement.

• Child Health Nursing Research
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• 제21권2호
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• pp.98-106
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• 2015

Purpose: This study was done to develop and evaluate an algorithm-based simulation scenario for emergency measures for high-risk newborns presenting with apnea. Methods: A one shot case study design was used to evaluate the algorithm-based simulation scenario. Effects of the developed simulation scenario were evaluated using the Simulation Effectiveness Tool (SET) and the Lasater Clinical Judgement Rubric (LCJR). From March to November 137 senior nursing students completed the simulation using this scenario. Results: The eight-frame simulation scenario was developed based on the Neonatal Resuscitation Program (NRP) and the nursing clinical judgment process. After use of the scenario, overall scores for SET and LCJR were 21.0 out of 26.0 and 32.4 out of 44.0 respectively. There were no significant differences in scores according to general characteristics. Positive correlation coefficients were identified among overall and subcategories of SET and LCJR. In addition, students provided positive feedback on the simulation experience. Conclusion: Considering that nursing students have limited access to high-risk newborns during their clinical experience and that newborns presenting apnea are common in the neonatal intensive care unit, the simulation scenario developed in this study is expected to provide nursing students with more opportunities to practice emergency measures for high-risk newborns.

• 기본간호학회지
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• 제10권1호
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• pp.6-13
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• 2003

Purpose: A survey was done on knowledge of pain and pain interventions by clinical nurses in Deagu city and Kyoungbuk province. Method: The participants in this study were 209 nurses who worked in Daegu city, and 190 nurses who worked in Kyoungbuk province. The data were collected from August 5, to September 15, 2002. The data were analyzed with SPSS WIN 10.0 program using numbers, percentages, averages and standard deviation with t-test and ANOVA. Result: Out of a total of 30 points on general knowledge of pain, the clinical nurses had a high score of 28, and a low of 10. The average was 18.6 (SD=3.14). Of the participants, 57.9% reported not having had any pain education and 67.9% agreed that education is a necessity. Of pharmacological interventions, Tylenol had the highest score at 3.44 out of a possible 4 points. The most frequent route for giving medication was intramuscular injection (42.6%) and for 62.7%, there was a decision by the physician for routine medication or prn. On reactions after medication, moderate relief had the highest frequency (41.9%), and for side effects after the medication, feeling of nausea was most frequent (70.4%). Of the nonpharmacological approaches to pain relief, ice bag had the highest score with 2.95 out of a possible 4. Judgement to give medication was made by the nurse for 50.1% of the participants and 647% reported a little relief from pain. Conclusion: Based upon the results, continuing education and developing a better education programs (including pain mechanism, pain assessment, pharmacological interventions and nonpharmacological interventions) are needed for systematic pain management. Nurses need a high level of knowledge of pain, to be active in pharmacological interventions and nonpharmacological interventions.

• Child Health Nursing Research
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• 제20권4호
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• pp.294-303
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• 2014

목적 본 연구의 목적은 간호대학생의 비판적 사고성향과 문제해결과정 정도 및 시뮬레이션 기반 임상수행능력 평가 점수와의 상관관계를 파악하는 데에 있다. 방법 본 연구의 대상자는 일 간호대학 3학년 학생 214명으로 대상자의 비판적 사고성향과 문제해결과정 정도 및 시뮬레이션 기반 임상수행능력 평가 점수와의 관계를 파악하였다. 비판적 사고성향은 Yoon (2008)이 개발한 5점 척도의 도구를 사용하여 측정하였고, 문제해결과정 정도는 Lee 등(2008)가 개발한 5점 척도의 문제해결과정 측정도구, 시뮬레이션 기반 임상수행능력 평가는 연구자가 개발한 체크리스트를 사용하였다. 수집된 자료는 SPSS WIN 18.0 프로그램을 이용하여 기술통계, Pearson's correlation coefficients를 이용하여 분석하였다. 결과 간호대학생의 비판적 사고성향 정도는 $3.76{\pm}0.46$ (점수범위 1-5점), 문제해결과정 정도는 $3.67{\pm}0.47$ (점수범위 1-5점)으로 중간 이상의 점수를 보였다. 시뮬레이션 기반 임상수행능력 평가 점수는 비판적 사고 성향이 평균점수(3.67점) 이상으로 높은 간호대학생에게서 유의하게 높게 나타난 반면, 문제해결과정 정도와의 유의한 상관관계는 없는 것으로 조사되었다. 비판적 사고성향은 시뮬레이션 기반 임상수행능력 평가의 하부 영역 중 간호사정 영역에서 유의한 상관관계가 있는 것으로 나타났다. 결론 본 연구는 시뮬레이션 기반 학습은 간호학생들의 비판적 사고성향이 기반이 되어야 하며 비판적 사고 성향정도는 복합적인 상황에서 대상자의 상태를 파악하는 간호사정에서 긍정적 영향을 미친다는 근거를 제시하였다. 그러므로 간호대학생의 비판적 사고함양을 위한 지속적인 교육이 필요하다. 또한 시뮬레이션 기반 학습은 학습자의 이러한 강점과 약점을 고려하여 시뮬레이션 평가 전 단계에서 충분한 학습의 기회를 제공함으로써 질적으로 우수한 간호사에 대한 요구가 증대되는 현 시점에 효과적인 대응책이 될 수 있을 것이다.

• 보건행정학회지
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• 제27권2호
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• pp.114-120
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• 2017

The hospital standardized mortality ratio (HSMR) is a widely used generic measure for assessing quality of hospital care in many countries. However, the validity of HSMR as a quality indicator is still controversial. We critically reviewed characteristics of HSMR and suggested how to use HSMR as a quality indicator in the Korean setting. The association between HSMR and other quality measures of hospital care is inconclusive. In addition current HSMR model has shortcomings in risk adjustment because of the lack of clinical data, accuracy of disease coding, coding variation among hospitals, end-of-life care issues, and so on. Therefore, HSMR should be used as an indicator for improvement, not for judgement such as public reporting and pay-for-performance. More efforts will be needed to tackle practical and methodological weaknesses of HSMR in the Korean setting.