• Korean Medical Education Review
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• v.22 no.3
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• pp.173-188
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• 2020

Medical humanities education (MHE) is as essential as basic medical sciences and clinical medicine education. Despite the importance of MHE, MHE curriculum development (CD) has proven to be challenging. This critical review examines the MHE CD at one medical school. The critical review methodology was developed based on Kern's six step CD model to systematically examine the CD of "Doctoring and Medical Humanities (DMH)" at the Yonsei University College of Medicine. Five review questions were developed related to (1) necessity, (2) direction and purpose, (3) design, (4) operation, and (5) evaluation of CD based on Kern's model. The review showed that the process of DMH CD mapped to components of Kern's model. The DMH curriculum content selected was closely related to medical practice and aimed to combine the acquisition of understanding and skills by designing a student-participatory curriculum based on clinical cases. Assessment methods that emphasized students' reflections were actively introduced in the evaluation section. Since the regular committee for DMH continued the work of the special ad hoc committees for DMH CD, the CD was effectively completed. However, the planning and evaluation functions and responsibilities of the DMH committee need to be strengthened. Despite the apparent limitations, the fact that students showed a high satisfaction rate and preferred small group discussions based on clinical cases has significant implications in the instructional design of MHE, where changes in self-awareness and attitude are more important than the acquisition of information. It is necessary to systematically review and study students' reflection results produced by the changed assessment methods and to develop assessment indicators for MHE that reflect the achievements of the MHE competencies of students.

• Health Policy and Management
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• v.26 no.4
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• pp.289-304
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• 2016

Background: Rehabilitations in subacute phase are different from acute treatments regarding the characteristics and required resource consumption of the treatments. Lack of accuracy and validity of the Korean Diagnosis Related Group and Korean Out-Patient Group for the acute patients as the case-mix and payment tool for rehabilitation inpatients have been problematic issues. The objective of the study was to develop the Korean Rehabilitation Patient Group (KRPG) reflecting the characteristics of rehabilitation inpatients. Methods: As a retrospective medical record survey regarding rehabilitation inpatients, 4,207 episodes were collected through 42 hospitals. Considering the opinions of clinical experts and the decision-tree analysis, the variables for the KRPG system demonstrating the characteristics of rehabilitation inpatients were derived, and the splitting standards of the relevant variables were also set. Using the derived variables, we have drawn the rehabilitation inpatient classification model reflecting the clinical situation of Korea. The performance evaluation was conducted on the KRPG system. Results: The KRPG was targeted at the inpatients with brain or spinal cord injury. The etiologic disease, functional status (cognitive function, activity of daily living, muscle strength, spasticity, level and grade of spinal cord injury), and the patient's age were the variables in the rehabilitation patients. The algorithm of KRPG system after applying the derived variables and total 204 rehabilitation patient groups were developed. The KRPG explained 11.8% of variance in charge for rehabilitation inpatients. It also explained 13.8% of variance in length of stay for them. Conclusion: The KRPG version 1.0 reflecting the clinical characteristics of rehabilitation inpatients was classified as 204 groups.

• Korean Journal of Clinical Pharmacy
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• v.31 no.1
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• pp.61-78
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• 2021

Background and Objective: The use of potentially inappropriate medications (PIMs) increases the risk of negative health outcomes, including drug-related admissions. Tools for structured medication review have been developed to ensure optimal medication use and safety. Here, we aimed to evaluate medication use review (MUR) tools for community-dwelling older patients. Methods: We performed a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). We searched PubMed, Embase, and the Cochrane Library from 1991 to 2020, excluding tools that are specifically applied to hospitalized patients or nursing home residents. We identified the most common inappropriate medications, drug-disease interactions, drug-drug interactions and prescribing omissions presented among tools. Results: From among 9,788 identified reports screened, 60 met our inclusion criteria; finally, 27 were eligible for data analysis considering originality and up-to-dateness. Most tools presented explicit criteria (93%), and only one was specific to community-dwelling elderly. The most common PIM was tricyclic antidepressants. Use of diltiazem and verapamil in patients with heart failure and the combination of nonsteroidal anti-inflammatory analgesics and warfarin were the most frequent disease-specific PIM and drug-interaction, respectively. Conclusions: Although several medication review tools have been developed for older adults, specific guidelines for community-dwelling populations remain limited. Furthermore, the list of PIMs differed among available tools. In future, specific but integrating MUR tools need to be developed for clinical practice considering this population.

• Korean Journal of Clinical Pharmacy
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• v.31 no.4
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• pp.268-277
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• 2021

Background: Most antipsychotic drugs studies have been mainly conducted on side effects, randomized clinical trials, utilization rates, and trends. But there have been few studies on the influencing factors in elderly patients. The purpose of this study was to analyze the influencing factors on the outpatient prescription of antipsychotic drugs in the elderly patients. Methods: Active ingredients of antipsychotic drugs in Korea were selected according to the Korean Pharmaceutical Information Center (KPIC)'s classification. Data source was Korean Health Insurance Review and Assessment Service (HIRA) claims data in 2020 and target patient group was the elderly patient group. We extracted patients who have been prescribed one or more antipsychotic drugs and visited only one medical institution. Data were analyzed using descriptive statistics, chi-square, t-test, negative binomial regression. Results: A number of outpatients were 245,197 and prescriptions were 1,379,092. Most characteristics of patients were 75-85 year's old, female, health insurance type, no disease (dementia, schizophrenia), atypical drugs, cci score (>2) and characteristics of medical institution were neurology in specialty, rural region, general hospitals. Results of regression showed that patient's characteristics and medical center characteristics had significant effect on the outpatient prescription of antipsychotic drugs in the elderly patients. Conclusion: This study suggests that national policy of antipsychotic drugs in the elderly patients, with the consideration of the patients' and medical institutions' characteristics, is needed.

• Korean Journal of Occupational Health Nursing
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• v.26 no.3
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• pp.160-171
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• 2017

Purpose: This review aimed to integrate the results of studies related to presenteeism in clinical nurses and to suggest directions for future research. Methods: The search for relevant studies was conducted using six data bases according to predetermined index terms, "$nurs^*$" and "presenteeism." Thirteen studies that met the inclusion criteria were selected and analyzed. Results: This review found that the conceptual use and scope of presenteeism were not consistent among the studies. Most studies investigated the nurses' health-related variables as the most important factors and reported their positive association with presenteeism. Presenteeism was also found to be associated with job stress, job satisfaction, social support, and organizational culture and had a negative impact on nursing outcomes such as patient safety. Conclusion: The research on presenteeism can be used as a way to explain outcomes in the field of nursing where direct measurement of productivity is difficult. Presenteeism is a multidimensional problem, and a theoretical foundation is needed to explain the presenteeism of clinical nurses.

• Korean Journal of Clinical Pharmacy
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• v.20 no.3
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• pp.262-267
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• 2010

Therapeutic duplication of prescriptions is the most frequently reported inappropriate drug use in Korea. To prevent significant problems during drug prescribing and dispensing, prospectively, development of standard including drug lists considered as therapeutic duplications for the prioritized drug classes first would be necessary. This study was aimed to analyze frequent drug classes of therapeutic duplications by healthcare providers in clinical practice settings. National health claims data for drug review and reimbursement (1,426,065 prescriptions dated March 19, 2008) were analyzed. Therapeutic duplication was defined as the prescription including more than 2 ingredients belonging to the same KFDA drug classification numbers that considered to have therapeutic similarities. The following 3 drug classes were mostly frequent therapeutic duplication classes: 114 anti-pyretics, analgesics and anti-inflammatory drugs; 117 drugs for psycho-nervous system; 141 Antihistamines. About 3.5% of overall prescriptions analyzed showed therapeutic duplications. This result might be starting step to develop DUR therapeutic duplication standard.

• Korean Journal of Adult Nursing
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• v.21 no.1
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• pp.117-128
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• 2009

Purpose: The purposes of this study were as follows; 1) To review the definitions of critical thinking from various perspectives, 2) To examine the critical thinking measurements throughout nursing research, and 3) To review the nursing studies with regard to critical thinking. Methods: This study was a literature review with regard to the critical thinking in nursing in aspects of conceptual meaning, measurements, and research. Results: The definition of critical thinking in nursing included decision making in clinical setting, inference with logical construct to increase nursing quality, interpretation in the context, and evaluation. The critical thinking was a core concept, which meant not only simple nursing process, but included decision making ability. The critical thinking has been conceptualized by both critical thinking disposition and skill. However, there was no nursing specified critical thinking measurement. Critical thinking research has been conducted to describe critical thinking disposition and critical thinking, to determine relationships between critical thinking and clinical competency, and to evaluate the effectiveness of educational programs. Conclusion: The instruments for measuring critical thinking disposition and skill that contain cultural difference and clinical specificity need to be developed to measure critical thinking and increase it.

• Korean Medical Education Review
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• v.23 no.1
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• pp.23-36
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• 2021

Residents serve as educators who teach patients, medical students, fellow residents, and other medical personnel while being trained as learners. The purpose of this study was to review the literature on the competencies, perceptions, and educational status of residents as teachers, and to suggest appropriate competencies and curricular components. A literature review was conducted and resident-related institutional homepages were searched. Many countries are developing the educational competencies of residents as teachers and implementing educational programs. Residents most often taught clinical knowledge and clinical skills to patients, medical students, fellow residents, and other medical professionals, and recognized the importance of education, the joy of teaching, and the role of teachers; however, the task of teaching was burdensome. Based on these findings, competencies and educational programs for the resident as teacher are proposed. The competencies consist of the five stages of ACCESS (active learner, clinical teacher, curriculum developer, educational scholar, social communicator, supervisor/leader), and specific teaching content, methods, and assessment methods are suggested to develop these competencies. Educating residents to develop their competencies as teachers is very important as a way to foster lifelong learning skills, help others, and assist in leadership roles.

• Korean Journal of Occupational Health Nursing
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• v.27 no.3
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• pp.139-151
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• 2018

Purpose: This review aimed to integrate the results of studies related to job embeddedness of clinical nurses and suggest directions for future research. Methods: A search for relevant studies was conducted using six databases according to the predetermined index terms "nurse" and "job embeddedness." A total of 28 studies that met the inclusion criteria were selected and analyzed. Results: The definition of job embeddedness was consistent in the articles, but the terms, scope, and use of tools to determine job embeddedness were not. In addition, no article suggested a theoretical framework. In all the studies except one, the tool used to measure job embeddedness was one revised from Mitchell et al. (2001). In 15 articles, a negative correlation was found between job turnover and turnover intention. Job embeddedness was also found to be associated with nurses' work environment, organizational citizenship behavior, and organizational commitment, and it had a positive impact on these variables. Conclusion: Job embeddedness can be used as a major variable to explain nurses's turnover intention. Job embeddedness is multidimensional, and a theoretical framework is needed to explain the job embeddedness of clinical nurses. Tools specific to Korea should be developed to measure the job embeddedness of Korean clinical nurses.

• Journal of Oriental Neuropsychiatry
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• v.29 no.2
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• pp.79-97
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• 2018

Objectives: The purpose of this systematic review was to investigate the clinical effects of neurofeedback training on reducing anxiety. Methods: Eight databases were used to extract clinical reports on neurofeedback intervention for anxiety reduction published until 2016. We analyzed the characteristics of selected studies and evaluated biases using the Risk of Bias (RoB) assessment. Results: A total of 22 clinical trials were extracted for the analysis. The risk of bias in most studies was high or unclear. The Chinese Classification of Mental Disorders-3 (CCMD-3) was the most frequently used diagnostic criteria, the Hamilton Rating Scale for Anxiety (HAMA) was the most frequently used assessment tool, and the alpha wave activity increase, sensorimotor rhythm (SMR), and theta wave training were the most frequently used intervention methods. All papers showed a statistically significant decrease of anxiety symptoms; however, significant adverse events were not reported. Conclusions: Neurofeedback intervention might be beneficial for reducing anxiety. However, the quality of the studies used in the analysis was low, and the heterogeneity of the population and interventions was revealed. Therefore, more scientifically designed clinical studies regarding neurofeedback training are required.