• CELLMED
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• v.5 no.3
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• pp.16.1-16.3
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• 2015

Evidence based medicine involves using both the individual clinician's expertise and the current best available external clinical evidence from systematic research in deciding on the appropriate care for individual patients. The current approach to evidence based practice in healthcare adds a third component which is patient values. Evidence based practice is thus a triad, in which the practitioner's expertise, research evidence and the patient's values are all given consideration. The balance to be struck between them depends on the individual case. The literature indicates that complementary medicine practitioners are moving away from traditional knowledge and towards the use of evidence based practice in their clinical discussions. In the context of the daily practice of complementary medicine practitioners and their continuing development of their knowledge base of evidence based practice, this short review discusses the good and bad of a review journal article.

• The Journal of Korean Medicine
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• v.32 no.1
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• pp.121-129
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• 2011

Objective: The propose of this study is to build a conceptual framework for representing clinical findings in Traditional East Asian Medicine(TEAM). As the existing standard models have been developed without considering features of Traditional Medicine, in this study we introduced unique characteristics for the TEAM. Method: This study was composed of three steps. First, we analyzed whether the existing clinical information models are suitable for representing clinical findings. Second, we analyzed ISO/TS 22789 model which is a ISO medical informatics standard, to find out the problem by applying clinical findings of TEAM into the model. Finally, we defined semantic links and a concept hierarchy in our model based on the analyzed results. The model includes the concepts for clinical findings and terms, and the semantic links can be regarded as relations between concepts, so that the representating clinical findings are completed by connecting concepts with other concepts. Results: Our framework was developed by removing unnecessary semantic links, and adding some necessary ones based on ISO/TS 22789 model. The ISO/TS 22789 model has a simple concept hierarchy, but in this study we subdivided the hierarchy and also considered interoperability with other terminological systems and standard models. Conclusions: This research needs more discussions, but is meaningful as proposing a way how to develop Traditional Medicine terminological systems. This study shows the limitations of existing models in describing clinical findings for TEAM, and what should be considered to represent Traditional Medicine knowledge, and propose a solution to improve the problem.

• Journal of Korean society of Dental Hygiene
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• v.19 no.2
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• pp.207-219
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• 2019

Objectives: This study investigates the dental hygienist's main duties in clinical dental practice and examine whether dental hygienists can safely perform each duty by referring to the educational contents of dental hygiene departments and national examinations of dental hygienists. Methods: A questionnaire on the main duties of dental hygienists was administered to 477 clinical dental hygienists working at dental clinics and hospitals, general dental hospitals, and university dental hospitals in Seoul, Gyeonggi-do, and Incheon. We divide the dental hygienists' clinical dental hygiene practice and clinical dental assist and analyze the legal scope of practice, university educational contents, and national examination contents. Statistical analysis was performed through frequency analysis, and multi-frequency data were analyzed using Excel 2013. Results: All 48 items (except 2 items of 29 dental hygiene practice and 21 assist practice items) surveyed were covered in the National Examination for Dental Hygienists and included in the Dental Hygiene Education Learning Objective. The multi-frequency clinical dental practice of eight items of clinical dental hygiene practice and two assist practice items were within the legal scope of the dental hygienist's role. Conclusions: Further discussions are needed to redefine the legal scope of the role of the dental hygienist.

• Translational and Clinical Pharmacology
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• v.26 no.3
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• pp.128-133
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• 2018

Appropriate prescription writing is one of the critical medical processes affecting the quality of public health care. However, this is a complex task for newly qualified intern doctors because of its complex characteristics requiring sufficient knowledge of medications and principles of clinical pharmacology, skills of diagnosis and communication, and critical judgment. This study aims to gather data on the current status of undergraduate prescribing education in South Korea. Two surveys were administered in this study: survey A to 26 medical schools in South Korea to gather information on the status of undergraduate education in clinical pharmacology; and survey B to 244 intern doctors in large hospitals to gather their opinions regarding prescribing education and ability. In survey A, half of the responding institutions provided prescribing education via various formats of classes over two curriculums including lecture, applied practice, group discussions, computer-utilized training, and workshops. In survey B, we found that intern doctors have the least confidence when prescribing drugs for special patient populations, especially pregnant women. These intern doctors believed that a case-based practical training or group discussion class would be an effective approach to supplement their prescribing education concurrently or after the clerkship in medical schools or right before starting intern training with a core drug list. The results of the present study may help instructors in charge of prescribing education when communicating and cooperating with each other to improve undergraduate prescribing education and the quality of national medical care.

• Korean Journal of Clinical Pharmacy
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• v.23 no.3
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• pp.239-247
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• 2013

Background: Fixed drug combinations are formulations containing two or more active ingredients in a single dosage form. Such combination therapies are commonly applied to improve efficacy, reduce adverse events and replace co-administration, etc. National and international guidelines for hypertension treatment recommend addition of other classes of antihypertensive drugs rather than incremental dose of mono-therapy, when blood pressure is not adequately controlled. Thus, many dual combinations of antihypertensive drugs have been approved and pharmaceutical companies are recently interested in developing antihypertensive triple combinations. Clinical trial designs for the fixed combinations are various depending on the target patients, dosage and clinical endpoints. Thereby, further discussions for the clinical trials of antihypertensive triple therapies are required regarding the indication claimed. Conclusion: This article provides a review for the assessment of the label and medical reports of the clinical trials on antihypertensive triple therapies in advanced foreign countries.

• The Journal of Korean Medical History
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• v.29 no.2
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• pp.61-69
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• 2016

This study was performed to examine the clinical discussion records where Lee Gong-yoon, participated in Royal treatment at Joseon Dynasty, was involved. Lee Gong-yoon who scouted from the outside had participated in the medical center of the Royal Family for several years as a royal doctor. But he preferred aggressive prescriptions and behaved indiscreet. Eventually, he was exiled when Kyung-Jong who was the 20th king of the Joseon Dynasty died. He was harshly criticized until the year crown prince ascended the throne following Kyung-Jong. But some officials started to defend him since March of the next year. They recognized Lee Gong-yoon's aggressive prescriptions and indiscreet behavior. But mentioned that some very aggressive prescriptions didn't come from his own idea. After they proved their insistence true, his place of exile was changed from island to outland. Different from other doctors who focused on patients' 元气 ($yu{\acute{a}}nq{\grave{i}}$), Lee Gong-yoon focused on removing patients' symptoms when he decided to cure a disease. And also he had considerable insight of "醫學入門 ($y{\bar{i}}xu{\acute{e}}r{\grave{u}}m{\acute{e}}n$)". Despite of his high degree of medical knowledge, unconventional character and behavior made the end of his life unfortunate.

• Journal of Korean Medical classics
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• v.32 no.4
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• pp.17-33
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• 2019

Objectives : The verse, "冬不藏精, 春必病溫", which had much influence, has been falsely referenced as contents of "Neijing". This study aims to examine this process, while looking at its theoretical meaning within clinical practice. Methods : The origins of the concept "冬不藏精, 春必病溫" are explained through annotations of "Neijing" and Li Dong Yuan(李東垣)'s interpretation of Shanghan(傷寒), while its clinical meaning is examined through theories of doctors's who applied the concept in their practices. Results : The beginning of "冬不藏精, 春必病溫" could be traced back to Li's annotation of the verse "冬傷于寒, 春必病溫" from the "Neijing", where he based his understanding on the concept "少陰不藏." Since then, the discourse on "冬傷于寒, 春必病溫" has been replaced by "冬不藏精, 春必病溫" as a new concept to explain the pathology of Wenbing(溫病). These discussions followed the line of thought that by failure to store Jing(精) during the winter, Cold pathogen would infiltrate, hiding itself in Shaoyin(少陰). Various arguments on how the Cold pathogen would develop into Wenbing and its treatment followed. Conclusions : "冬不藏精, 春必病溫" can be understood as the result of a new interpretation of "冬傷于寒, 春必病溫" through the perspective of Cold pathogen infiltration based on "少陰不藏".

• Korean Journal of Radiology
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• v.23 no.7
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• pp.732-741
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• 2022

Objective: To determine the impact of dedicated subspecialized radiologists in multidisciplinary team (MDT) discussions on the management of lower gastrointestinal (GI) tract malignancies. Materials and Methods: We retrospectively analyzed the data of 244 patients (mean age ± standard deviation, 61.7 ± 11.9 years) referred to MDT discussions 249 times (i.e., 249 cases, as five patients were discussed twice for different issues) for lower GI tract malignancy including colorectal cancer, small bowel cancer, GI stromal tumor, and GI neuroendocrine tumor between April 2018 and June 2021 in a prospective database. Before the MDT discussions, dedicated GI radiologists reviewed all imaging studies again besides routine clinical reading. The referring clinician's initial diagnosis, initial treatment plan, change in radiologic interpretation compared with the initial radiology report, and the MDT's consensus recommendations for treatment were collected and compared. Factors associated with changes in treatment plans and the implementation of MDT decisions were analyzed. Results: Of the 249 cases, radiologic interpretation was changed in 73 cases (29.3%) after a review by dedicated GI radiologists, with 78.1% (57/73) resulting in changes in the treatment plan. The treatment plan was changed in 92 cases (36.9%), and the rate of change in the treatment plan was significantly higher in cases with changes in radiologic interpretation than in those without (78.1% [57/73] vs. 19.9% [35/176], p < 0.001). Follow-up records of patients showed that 91.2% (227/249) of MDT recommendations for treatment were implemented. Multiple logistic regression analysis revealed that the nonsurgical approach (vs. surgical approach) decided through MDT discussion was a significant factor for patients being managed differently than the MDT recommendations (odds ratio, 4.48; p = 0.017). Conclusion: MDT discussion involving additional review of radiology examinations by dedicated GI radiologists resulted in a change in the treatment plan in 36.9% of cases. Changes in treatment plans were significantly associated with changes in radiologic interpretation.

• Journal of Korean Clinical Nursing Research
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• v.26 no.2
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• pp.240-253
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• 2020

Purpose: This study was conducted to provide basic data for the systematization of 13 areas related to Advanced Practice Nurses (APN). Methods: The three-phase study was conducted as follows. 1) review of APN system and curriculum, 2) Focus Group Interviews (FGI) with 9 APNs, 6 physicians, and 3 nursing professors on the APN system, 3) analysis of clinical practice of the 13 APN areas, and of the accreditation and certification system for APNs, medical board, and medical subspecialty board. Based on the above data, a systematic plan was drawn. Results: The 13 APN areas could be divided into 7 groups based on a review of the APN system and curriculum for the 13 areas. Analysis based on clinical practice showed that the 13 APN areas could be divided into 4 groups. Two themes and seven categories emerged in FGI. The two themes were 1) 13 APN areas that need to be discussed, 2) improving the curriculum for APN. Considering these themes from FGI and the system of the medical subspecialty board, results could be integrated into 2 groups - clinical area and non-clinical area. Conclusion: The 13 APN areas need to be integrated in order to activate the APN system. For that, further discussions on improvements and a standard curriculum according to legislation related to APN should be carried out.

• Quality Improvement in Health Care
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• v.24 no.1
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• pp.23-29
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• 2018

Background: The purpose of this study was to examine undergraduate medical students' perceptions and intentions regarding patient safety during clinical clerkships. Methods: Cross-sectional and self-administered questionnaire survey was conducted on 34 students from one medical school using a modified version of the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS). We assessed $4^{rd}-year$ medical students' perceptions of the cultures ('safety', 'teamwork', and 'error disclosure'), 'behavioural intentions' concerning patient safety issues and 'overall patient safety'. The overall response rate was 66.4%. Results: Among safety domains, "teamwork culture" was rated highest. "Error disclosure culture" received the lowest ratings. Regarding the error disclosure domain, only 10% of respondents reported that they have received education or training on how to disclose medical error to patients. Independent of survey domains, when students were asked "Overall, do you think your hospital is safe based on your clinical rotation?", 61.8% reported that the hospital was safe. Conclusions: Assessing students' perceptions of safety culture can provide clerkship directors and educators with information that enhances the educational environment and promotes patient safety. Discussions of medical errors, patient safety, and how best to incorporate an analysis of these issues into the existing curriculum are needed.