• Therapeutic Science for Rehabilitation
• /
• v.4 no.2
• /
• pp.33-50
• /
• 2015

Objective : This study was conducted to determine various interventions in accordance with the recovery and cognitive processes in order to improve executive function in stroke patients through a systematic review. Methods : The literature search focused on Level I-IV studies published between January 1996 and April 2015 for 20 years in electronic databases(e.g. MEDLINE, SCOPUS, RISS). The keyword search terms were 'Stroke', 'Executive function', 'Executive function deficit', 'Occupational therapy', 'Rehabilitation', 'Remedial', 'Compensatory' and 'Education'. Result : A total of 13 articles were appraised using the hierarchy of levels of evidence-based practice and 6 Level I evidence articles, 1 Level II articles, 2 Level III articles and 4 Level IV articles. Each intervention improved executive function but was different in degree of generalization. Conclusion : Through this systematic review, we found that there are a variety of applied interventions improving executive function in stroke patients and are different in effect depending on methods of interventions. This study provided evidences to occupational therapists for the clinical practice of interventions to improve executive function in stroke patients.

• Journal of Korean Academy of Nursing
• /
• v.53 no.3
• /
• pp.275-294
• /
• 2023

Purpose: This study aimed to develop an evidence-based extracorporeal membrane oxygenation (ECMO) nursing protocol for critically ill patients receiving ECMO treatment by using an adaptation process, and to verify the effects of the protocol. Methods: The protocol was developed according to the adaptation guidelines. A non-randomized controlled trial was conducted to test the protocol's effects. Data were collected between April 2019 and March 2021. The differences in physiological indicators and complication rates between the two groups were investigated using a chart review to evaluate patient outcomes. The nurses' outcome variables were evaluated using a questionnaire. Results: First, after reviewing 11 guidelines by appraisal of the guidelines for research and evaluation collaboration II, 5 guidelines with a standardization grade of over 50 points were selected. An ECMO nursing protocol was developed based on these guidelines. Second, there were no statistically significant differences in physiological indicators between the two groups of patients. However, the experimental group showed a statistically significant decrease in the infection rate (p = .026) and pressure injury rates (p = .041). The levels of satisfaction with ECMO nursing care, and empowerment and performance of the nurses who used the ECMO nursing protocol were higher than those of nurses who did not (p < .001). Conclusion: This protocol may help prevent infections and pressure injuries in patients, and improve nurses' satisfaction and empowerment. The nursing protocol developed for critically ill patients receiving ECMO treatment can be utilized in evidence-based nursing practice.

• The Journal of the Korea Contents Association
• /
• v.18 no.6
• /
• pp.38-49
• /
• 2018

The nursing education with evidence-based practice(EBP) should set a differentiated education strategy according to the level of the learner, so that the students experience it step by step and it leads them to be skilled. The purpose of this study was to integrate and operate the EBP in the fundamental nursing classes of the second grade students and to verify the effectiveness on improvement of EBP basic competency of them. A non-equivalent control group pretest-posttest design was used. The subjects were 108 students in the second year of nursing at the two universities. The experimental group participated in the class for 8 weeks and 24 hours during the 15-weeks, second semester 2016 and the control group participated in general fundamental nursing class. Data were collected proactivity in problem solving, future use of EBP, and critical thinking disposition instrument and analyzed using SPSS/WIN 23.0 program with Chi-square test, independent t-test. The experimental group had a significant increase in proactivity in problem solving and future use of EBP compared to the control group. However, there was no significant difference in critical thinking disposition between the two groups. Findings indicate that the fundamental nursing class used EBP was an effective lesson to improve proactivity in problem solving and future use of EBP, which is the EBP basic competency for the lower grader. Long-term efforts are needed to improve the EBP competence and critical thinking of nursing students by curriculum appropriate to grade-based goals of EBP.

• IE interfaces
• /
• v.20 no.4
• /
• pp.488-497
• /
• 2007

In order to provide appropriate decision supports in medical domain, it is required that clinical knowledge should be implemented in a computable form and integrated with hospital information systems. Healthcare organizations are increasingly adopting tools that provide decision support functions to improve patient outcomes and reduce medical errors. This paper proposes a process centric clinical decision support system based on medical knowledge. The proposed system consists of three major parts - CPG (Clinical Practice Guideline) repository, service pool, and decision support module. The decision support module interprets knowledge base generated by the CPG and service part and then generates a personalized and patient centered clinical process satisfying specific requirements of an individual patient during the entire treatment in hospitals. The proposed system helps health professionals to select appropriate clinical procedures according to the circumstances of each patient resulting in improving the quality of care and reducing medical errors.

• Korean Circulation Journal
• /
• v.53 no.5
• /
• pp.294-312
• /
• 2023

Heart failure (HF) is a global health problem closely related to morbidity and mortality. As the burden of HF increases, it is necessary to manage and treat this condition well. However, there are differences between real-world practice and guidelines for the optimal treatment for HF. Patient-related, healthcare provider-related, and health system-related factors contribute to poor adherence to optimal care. This review article aims to examine HF treatment patterns and treatment adherence in real-world practice, identify clinical gaps to suggest ways to improve the quality of care for HF and clinical outcomes for patients with HF. Although it is important to optimize treatment based on evidence-based guidelines to the greatest extent, it is known that there is still poor treatment adherence, and many patients do not receive guideline-directed medical therapy, especially at the early stages. To improve medication adherence, qualitative evaluation through performance measurement, as well as education of patients, caregivers and medical staff through a multidisciplinary approach are important.

• Journal of the Korea Society of Computer and Information
• /
• v.26 no.4
• /
• pp.169-179
• /
• 2021

The purpose of this study is to examine types and characteristics of self-regulation which explain how individual diabetic patients determine their behavior in terms of diabetes management. Based on the results, we proposed the management method of the diabetic patients. As a method of analyzing the subjectivity of each item, a Q method study was used. There were 38 subjects who were treated with oral drugs or insulin injections, but not currently hospitalized. And 40 statements in Q samples were classified in the form of a normal distribution using a 9-point scale. Research results regarding self-regulation in diabetic patients, type 1 is evidence-based compliance, type 2 is crisis responding denial reaction, type 3 is information-based orientation to relationship, type 4 is independent practice, and type 5 is willingness deficit impulse reaction. Therefore, for effective management of diabetic patients, it is necessary to understand the characteristics of each type of self-regulation and develop a program that reflects motivation for diabetes management, improvement of confidence, and countermeasures for negative emotions related to disease.

• The Journal of Health Technology Assessment
• /
• v.6 no.2
• /
• pp.81-87
• /
• 2018

With the recent change of healthcare environment including rapid technological development, evidences are more and more important and necessary to support relevant policies in health technology assessment to provide safe and effective health services, utilizing medical resources efficiently. Despite of the emphasis on the importance of real world data and real world evidence in health care research, current infrastructure supporting clinical research is considerably weak due to absence of legal and institutional basis. However, in accordance with the Article 26 of the Health and Medical Technology Promotion Act, there is a limited legal apparatus that can be used only in public data with other dataset for the purpose of healthcare technology assessment at the National Evidence-based Collaborating Agency. Although the use of linked data from various sources was often required in the field of clinical research, it was not yet working well due to insufficient environmental conditions. In order to support the decision-making of medical practice and health care policies, data-linking platform for clinical research is needed. If the legal system that can link up to the data of the private institutions without violating the significant value such as the protection of private informations is established, it will be a decisive foundation reinforcing the researches and policy making processes for the improvement of the national health care system.

• Journal of Society of Preventive Korean Medicine
• /
• v.21 no.2
• /
• pp.45-53
• /
• 2017

Background and Aim : Lately the age of competition has come among the medical service area. At the same time disputes over the medical practice related to the medical person's territory tend to increase. In part it is due to the increased medical persons but in part it is because the medical practice is not defined clearly in the Medical Service Act for the practice of each medical person. So the legal definition of medical practice will be discussed here. Materials and Method : The cases from the court have been confirmed the difference between the two medical persons regarding the actual events. Legal aspects of medical practice in Korean medicine and the related cases will be reviewed and analysed. Results : The form of medical practice consists of administrating Korean medicine treatment and providing guidance for health based on Korean medicine. For medical doctors the practice includes medical treatment and guidance for health. Circular definition in the Medical Service Act over the medical practice, medical person and medical instruments makes it difficult to understand the whole idea. Therefore, the court has a tendency to decide the medical practice of medical doctor of Korean medicine from the some reliable points which is: 1) it is based on the principle of traditional Korean Medicine, 2) it is practiced by the medical doctor of Korean Medicine, 3) it can do harm to the patient without proper involvement of the medical doctor of Korean Medicine. Now the Act on the promotion of Korean Medicine and Pharmaceuticals makes it include the concept of "scientifically applied and developed" medical practice of Korean Medicine. Conclusions : With the essential change in the Act on the promotion of Korean Medicine and Pharmaceuticals, it is expected that even slight change can be seen in the court cases. However, still the concept of medical practice in the Medical Service Act remains the same. Modernisation of Korean Medicine, enhancement of textbooks and clinical practice training and the effort to amend the law to clearly define the medical practice of Korean Medicine will contribute to the clinical and academic environment. Evidence based Korean Medicine and even the unification of east-west medicine could be considered for the situation.

• Korean Journal of Radiology
• /
• v.23 no.5
• /
• pp.517-528
• /
• 2022

Due to its excellent diagnostic performance, CT is the mainstay of diagnostic test in adults with suspected acute appendicitis in many countries. Although debatable, extensive epidemiological studies have suggested that CT radiation is carcinogenic, at least in children and adolescents. Setting aside the debate over the carcinogenic risk of CT radiation, the value of judicious use of CT radiation cannot be overstated for the diagnosis of appendicitis, considering that appendicitis is a very common disease, and that the vast majority of patients with suspected acute appendicitis are adolescents and young adults with average life expectancies. Given the accumulated evidence justifying the use of low-dose CT (LDCT) of only 2 mSv, there is no reasonable basis to insist on using radiation dose of multi-purpose abdominal CT for the diagnosis of appendicitis, particularly in adolescents and young adults. Published data strongly suggest that LDCT is comparable to conventional dose CT in terms of clinical outcomes and diagnostic performance. In this narrative review, we will discuss such evidence for reducing CT radiation in adolescents and young adults with suspected appendicitis.

• Journal of Korean Clinical Nursing Research
• /
• v.17 no.2
• /
• pp.176-191
• /
• 2011

Purpose: This methodological study translated, adapted, and validated the evidence based guideline of RNAO (Registered Nurses Association of Ontario) in Canada, for acute stroke care to domestic circumstances. Methods: Quality of the RNAO guideline was evaluated using AGREE tool. Then the guideline was translated into Korean and a preliminary guideline was established After checking content validation by an expert group, the Korean version of the guideline was applied to clinical settings to see its applicability. Results: The RNAO guideline in Korea was deemed appropriate. The Korean version of the guideline was drawn up with 56 items in 3 areas in stroke system related nursing, nursing of acute stroke inpatients, and stroke nursing assessment. A questionnaire survey was performed on appropriateness, enforceability, and applicability of those recommendations. A total of 54 recommendations were finalized after deleting 2 items below CVI 0.7 and correcting 3 items by taking professional advices. After trial application of the guideline to 40 stroke patients hospitalized at a ward of a hospital in Seoul, its performance was improved but was not statistically significant. Conclusion: This guideline is expected to contribute to improving nursing quality by offering it as a guide to evidence based practices for acute stroke care in Korea.