• Title/Summary/Keyword: Clinical reasoning

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

  • Park, Myoung-Ok
    • Journal of rehabilitation welfare engineering & assistive technology
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    • v.11 no.2
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    • pp.91-98
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    • 2017
  • Background & Object: Basic daily activity screening tool such as the Modified Barthel Index (MBI) has been used commonly in rehabilitation clinic and community based rehabilitation setting. Previous studies have shown the significant relations between the level of daily activities and driving ability on stroke or elderly people. However, there is a lack of studies to investigate the usefulness of MBI on prediction of driving ability for stroke patient. This study was to predict driving abilities of stroke survivor using Korean version Modified Barthel Index (K-MBI). Methods: A sample of 48 patients with stroke in rehabilitation hospital was recruited. All participants were tested level of basic daily activities using K-MBI. The driving ability of participants was tested using virtual reality driving simulator. The predictive validity was calculated of the K-MBI among pass or fail group of driving simulator test using receiver operating characteristics curves. Results: The cut-off score of >86.5 on the K-MBI is proper sensitivity to predict on driving performance ability. Conclusion: This pilot result offers clinical reference to therapists and caregivers for reasoning on driving recommendation period during rehabilitation stage of stroke survivors. Further studies need to identify prediction using real on-road test in a large population group.

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

  • Kim, Do-Hwan;Choi, Young-Hyu;Han, Sang Yun;Shin, Jwa-Seop;Lee, Seunghee
    • Korean Medical Education Review
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    • v.19 no.2
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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.

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

  • Lee, Mi-Sook;Kim, Hyang-Hee
    • The Journal of the Korea Contents Association
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    • v.12 no.5
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    • pp.280-292
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    • 2012
  • Cognitive-pragmatic language ability decreases during the normal aging process. Evaluating the ability might be useful in testing predicting cognitive level and diseases such as dementia. The aim of this study is to analyze various assessment protocols for normal aging, and evaluate the content validity of the currently developing cognitive-pragmatic language test domains and items. Content Validity Index(CVI) was calculated based on ratings judged by 17 experts including speech-language pathologists and clinical psychologists. As a result, it was found that CVIs of all 7 domains including attention, memory, organization, reasoning, problem solving, executive function, pragmatic language were above .75. It was concluded that the test items contained the appropriate content validity to assess cognitive-pragmatic language for normal aging.

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

  • Jang, Woo-Chang
    • Journal of Korean Medical classics
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    • v.28 no.4
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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.

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

  • Choi, Yunhyeong;Lee, Soo Jin
    • The Mathematical Education
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    • v.60 no.3
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    • pp.297-319
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    • 2021
  • The present study explored a relationship between mathematical understandings of teachers and ways in which their knowledge transferred in designing lessons for hypothetical students from Gess-Newsome (1999)'s transformative perspective of pedagogical content knowledge. To this end, we conducted clinical interviews with four secondary mathematics teachers of their solving and teaching of equation writing. After analyzing the teacher participants' attention to Key Developmental Understandings (Simon, 2007) in solving equation writing, we sought to understand the relationship between their mathematical knowledge of the problems and mathematical knowledge in teaching the problems to hypothetical students. Two of the four teachers who attended the key developmental understandings solved the problems more successfully than those who did not. The other two teachers had trouble representing and explaining the problems, which involved reasoning with improper fractions or reciprocal relationships between quantities. The key developmental understandings of all four teachers were reflected in their pedagogical actions for teaching the equation writing problems. The findings contribute to teacher education by providing empirical data on the relationship between teachers' mathematical knowledge and their knowledge for teaching particular mathematics.

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

  • Hyoseon Choi;Youngjon Kim;Hyo Hyun Yoo
    • Korean Medical Education Review
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    • v.25 no.2
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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.

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

  • Sung, Kiyoung;Kim, Seoyoung;Kim, Euitae
    • Korean Journal of Schizophrenia Research
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    • v.21 no.2
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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.

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

  • Yoon, Cheol-Ho;Huang, Huang
    • The Journal of Internal Korean Medicine
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    • v.31 no.4
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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.

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

  • Kim, Yung-Soo
    • The Journal of Korean Academy of Prosthodontics
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    • v.17 no.1
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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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Modeling Core Competencies in the Competency-based Nursing Curriculum (역량기반 간호교육과정을 위한 핵심역량 모델링)

  • Kim, Jeong Ah;Ko, Ja-Kyung
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.16 no.11
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    • pp.7635-7647
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    • 2015
  • The purpose of this study is modeling nursing competencies and reasoning out the core competencies, the ability for 20% of important actions for nursing jobs which can manage the rest 80% so that the competency-based nursing curriculum can be developed. A literature review of the vast studies regarding competencies was done to understand the concepts of competency-based curriculum, competency, and nursing competencies, identifying the relationships among each nursing competency categorized in accordance with those concepts. An exemplified concept map of core competencies for the competency-based nursing curriculum is suggested based on a thorough review of various competency modeling methodologies. The core competencies consist of base competency (theoretical/practical nursing knowledge and skills), practical competency (clinical judgment, patient education, communication, etc.), and personality competency (leadership, sense of responsibility, cooperation, etc.). The circular relationship among them can remain consistent through self-directed learning and critical thinking. Therefore, a nurse who have those core competencies is a knowledge worker, a self-directed learner, and also an effective, professional communicator. Further studies which solidify the concept of nursing competencies should be done, as well as the feedback procedures which evaluate the program outcomes and then reflect the evaluation results in the curriculum should be followed continuously.