• Title/Summary/Keyword: clinical examination experience

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Awareness of the Guidelines for Institutionalization of Physical Therapist Specialization (물리치료사 전문화 제도 기준에 대한 인식)

  • Roh, Hyo-Lyun
    • Journal of the Korean Society of Physical Medicine
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    • v.16 no.4
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    • pp.67-75
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    • 2021
  • PURPOSE: This study examined the level of awareness of the guidelines of the physical therapist specialization system. METHODS: This study was a cross-sectional survey of 364 clinical physical therapists working in hospitals. A structured questionnaire consisting of 17 questions was used. The questionnaire consisted of standards and management for the institutionalization of physical therapist specialization, intentions to acquire specialized physical therapist qualifications, specialized fields, and general information of the research subjects. RESULTS: At least five years of clinical experience and a bachelor's degree or higher were required to obtain a specialized physical therapist qualification. Many physical therapists said they would accept the qualification of a specialized physical therapist. Training and examination were appropriate for acquiring specialized physical therapist qualifications, and it was desirable to manage qualifications at the national level or the association of physical therapists. As for the specialized fields of physical therapy, musculoskeletal physical therapy, pediatric physical therapy, and nervous system physical therapy were prioritized, and electrotherapy was not recognized as a specialized field. CONCLUSION: A detailed discussion is needed on the system and cost for acquiring a specialized physical therapist qualification and economic benefits after acquiring the qualification.

Diagnostic Approaches for Idiopathic Pulmonary Fibrosis

  • Jae Ha Lee;Jin Woo Song
    • Tuberculosis and Respiratory Diseases
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    • v.87 no.1
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    • pp.40-51
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    • 2024
  • Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing interstitial pneumonia with a very poor prognosis. Accurate diagnosis of IPF is essential for good outcomes but remains a major medical challenge due to variability in clinical presentation and the shortcomings of existing diagnostic tests. Medical history collection is the first and most important step in the IPF diagnosis process; the clinical probability of IPF is high if the suspected patient is 60 years or older, male, and has a history of cigarette smoking. Systemic assessment for connective tissue disease is essential in the initial evaluation of patients with suspected IPF to identify potential causes of interstitial lung disease (ILD). Radiologic examination using high-resolution computed tomography plays a pivotal role in the evaluation of patients with ILD, and prone and expiratory computed tomography images can be considered. If additional tests such as surgical lung biopsy or transbronchial lung cryobiopsy are needed, transbronchial lung cryobiopsy should be considered as an alternative to surgical lung biopsy in medical centers with experience performing this procedure. Diagnosis through multidisciplinary discussion (MDD) is strongly recommended as MDD has become the cornerstone for diagnosis of IPF, and the scope of MDD has expanded to monitoring of disease progression and suggestion of appropriate treatment options.

Reliability of Standardized Patients as Raters in Objective Structured Clinical Examination (객관 구조화 절차 기술 평가에서 채점자로서의 표준화환자의 신뢰도)

  • Son, Hee-Jeong;Moon, Joong-Bum;Lee, Hyang-Ah;Roh, Hye-Rin
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.12 no.1
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    • pp.318-326
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    • 2011
  • The purpose of this study is to investigate whether standardized patient(SP) can be used as a reliable examiner in Objective Structured Clinical Examination(OSCE). 4 SPs and 4 faculties who have more than 2 years experience of OSCE scoring were selected. For 1 assignment 2 members of faculty and 2 SPs were designated as raters. SPs were educated for assessing 2 technical skills, male Foley catheter insertion and wound dressing, for 8 hours (4 hours / day, each topic). The definition, method, cautions and complications for each of procedural skills were covered in the education. Theoretical lectures, video learning, faculty demonstration and practical training on mannequins were employed. The 8 raters were standardized for an hour with simulated OSCE scoring using previous videos on the day before the OSCE. Each assessment was composed of 14 checklists and 1 global rate. The allotted time for each assignment was 5minutes and for evaluation time 2 minutes per student. The evaluation from the faculty and SPs were compared and analyzed with the GENOVA program. The overall generalizability coefficient (G coefficient) was 0.839 from two cases of OASTS. The reliability of the raters was high, 0.946. The inter-rater agreement between faculty group and SP group was 0.949 for checklist and 0.908 for global rating. Therefore SPs can play a role of raters in OSCE for procedural skills, if they are given the appropriate training.

Artifacts and Troubleshooting in Intraoperative Neurophysiological Monitoring (수술중신경계감시검사에서 발생하는 인공산물의 종류와 해결 방법)

  • Lim, Sung Hyuk;Kim, Kap Kyu;Jang, Min Hwan;Kim, Ki Eob;Park, Sang-Ku
    • Korean Journal of Clinical Laboratory Science
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    • v.53 no.1
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    • pp.122-130
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    • 2021
  • The types of artifacts that are observed in intraoperative neurophysiological monitoring (INM) is truly diverse. The removal of artifacts that interfere with the examination is essential. In addition, improving the quality of the examination by removing artifacts is a reflection of the competency of the examiner and is also the best way to ensure patient safety. However, if knowledge of the equipment or anesthesia in the operating room is insufficient due to lack of experience, artifacts cannot be removed even with a method appropriate to the situation. If artifacts are not separated and removed, the reading of the examination results in confusion in the operation process. This can be a fatal problem in neurosurgery that requires rapid and sophisticated procedures. In this paper, the causes of artifacts that occur during surgery are classified into electrical factors, non-electrical factors, and other factors, and a method and examination method for removing artifacts according to the specific situation is mentioned. Although the operating room environment is a very critical place to simultaneously consider various scenarios, we hope that a stable and optimal INM will play a role by knowing the types and causes of various artifacts and how to tackle them.

A Study on Needle Stick Injuries in Health Professionals (의료인의 바늘자상 실태에 관한 연구)

  • 김영분
    • Journal of Korean Academy of Nursing
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    • v.26 no.3
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    • pp.605-622
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    • 1996
  • Needle stick injury, in which blood-borne pathogens including Human Immune-Deficiency virus and hepatitis B virus are transmitted, is one of the major occupational hazards that health professionals face everyday. In order to provide basic data for the development of educational programs for health professionals aimed at preventing and effectively managing needle stick injuries, a retrospective descriptive study was carried out .The subjects of the study were 630 health professionals, 499 nurses and 131 physicians, from two university hospitals in Seoul, Korea. Data on episodes of needle stick experiences over the past is months September 1994 through August 1995, were collected between September 1 and 7, 1995. A Questionaire developed by the researcher was used. The frequencies and the percentile score for episodes of needle stick injuries were calculated using the PC-SAS program. The differences and similarities in reference to the structure, career, and specialty variables were analysed by X$^2$-tests. Results are as follows : 1. Of the sample, 521(82.7%) reported a needle stick injury, 33.4% reported 3 or more episodes of needle stick injuries. 2. The needle stick injuries occured in the following processes : process of percutaneous venepuncture for intra-venous injection and infusion(55.3%), medical examination and treatment(48.9%), per-cutaneous venepuncture for blood sampling (46.3%) and intra-muscular injection(42.2%). 3. The study showed that needle stick injuries occured before(19%), during(25%), and after (56%) client treatment. The major causes of needle stick injuries were perceived to be hastiness(82.2%) and carelessness(48.3%). Of these injuries, 91.8% occured in emergency situations. 4. Follow of care for the injury consisted of : treating the injured site immediately using disinfectants(89.7%), reviewing the clinical records of the patient involved(84.2%), immunological investigation for the status of antibodies(11.1%) and self-medication of antibiotics (10.7%). Only 16.3% of the total episodes were founded to have been reported to the administrative unit. 5. The length of clinical experience of the nurses, clinical specialty and length of clinical experience in physicians were found to have influenced the episodes of needle stick injuries ; nurses with less than 1 year and with more than 6 years of clinical experiences had significantly lower levels (X$^2$=25.04, P=.00), surgeons had significantly higher levels (X$^2$=9.89, P=.02) compared to that of internists and interns, higher(X$^2$=4.54, P=.03)than residents.

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Preliminary Study for Development of Pattern Identification Tool of Chronic Cough (만성기침 변증도구 개발을 위한 기초연구)

  • Kim, Kwan-il;Shin, Seung-won;Lee, Na-la;Lee, Beom-joon;Jung, Hee-jae;Jung, Sung-ki;Lee, Jun-hee
    • The Journal of Internal Korean Medicine
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    • v.36 no.1
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    • pp.22-39
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    • 2015
  • Objectives : The aim of this study was to develop a standard tool of pattern identification for chronic cough, which will be applied to clinical research. Methods : The items and structures of the instrument were based on reviews of textbooks and published literature. The advisor committee on this study consisted of 11 Korean respiratory internal medicine professors, one clinical fellow, and five clinicians with 10 years of experience. The questionnaire, which includes the signs and symptoms of chronic cough, was studied by the delphi method. Delphi examination was carried out via email, through evaluating the importance of symptoms included in each pattern. Results : We divided the pattern identification of chronic cough into five patterns: Wind-Cold, Phlegm-Turbidity, Liver-Fire, Lung Deficiency, and Kidney Yang Deficiency. By the Delphi method and a score evaluation, 38 items were chosen for pattern identification of chronic cough. Conclusions : Through this study, we created a Korean instrument for the pattern identification tool for chronic cough. We expect to apply this tool to subsequent research as its validity and reliability are further confirmed.

Communication between paramedic students and patients in clinical practice (임상현장실습에서 응급구조(학)과 학생들과 환자간의 의사소통능력에 관한 연구)

  • Jae-Hyoung, Jang;Ye-Eun, Jeong;So-Eun, Jeon;Keun-Ja, Cho
    • The Korean Journal of Emergency Medical Services
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    • v.26 no.3
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    • pp.47-60
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    • 2022
  • Purpose: This study aimed to identify the level of communication ability between paramedic students and patients in clinical practice. In addition, it was performed to produce essential data contributing to the qualitative improvement of communication ability. Methods: Data were collected from paramedic students with clinical experience after they provided online consent. Data collection was performed from June 3 to July 12, 2022. One hundred forty-seven questionnaires with 92 items were analyzed using SPSS statistics 28.0. Results: 57.1% of students took communication as a subject despite 92.5% of respondents saying that communication education is necessary for them. The average level of participant communication ability was 4.60 (±1.05) points (measured on a 7-point Likert scale). Among the subdivided communication ability levels, the highest level was demonstrated in the physical examination-related interview (5.36±0.96), and the lowest was shown in the completion part (3.93±1.51). Furthermore, a statistically significant difference was found in communication ability level according to school grade (F=4.709, p=.000). The highest correlation (r=.972, p<.001) was obtained between total communication ability and understanding the patient's point of view. Conclusion: Paramedic students should improve their communication skills to serve patients more effectively. Finally, more educational content should be developed on field-based situations in communication courses.

Incidence and Features of Cognitive Dysfunction Identified by Using Mini-mental State Examination at the Emergency Department among Carbon Monoxide-poisoned Patients with an Alert Mental Status (의식이 명료한 일산화탄소 중독환자를 대상으로 응급실에서 시행한 간이정신상태검사의 임상적 의의)

  • Youk, Hyun;Cha, Yong Sung;Kim, Hyun;Kim, Sung Hoon;Kim, Ji Hyun;Kim, Oh Hyun;Kim, Hyung Il;Cha, Kyoung Chul;Lee, Kang Hyun;Hwang, Sung Oh
    • Journal of The Korean Society of Clinical Toxicology
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    • v.14 no.2
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    • pp.115-121
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    • 2016
  • Purpose: Because carbon monoxide (CO)-intoxicated patients with an alert mental status and only mild cognitive dysfunction may be inadequately assessed by traditional bedside neurologic examination in the emergency department (ED), they may not receive appropriate treatment. Methods: We retrospectively investigated the incidence and features of cognitive dysfunction using the Korean version of the Mini-Mental State Examination (MMSE-K) in ED patients with CO poisoning with alert mental status. We conducted a retrospective review of 43 consecutive mild CO poisoned patients with a Glasgow Coma Scale score of 15 based on documentation by the treating emergency physician in the ED between July 2014 and August 2015. Results: Cognitive dysfunction, defined as a score of less than 24 in the MMSE-K, was diagnosed in six patients (14%) in the ED. In the MMSE-K, orientation to time, memory recall, and concentration/calculation showed greater impairments. The mean age was significantly older in the cognitive dysfunction group than the non-cognitive dysfunction group (45.3 yrs vs. 66.5 yrs, p<0.001). Among the initial symptoms, experience of a transient change in mental status before ED arrival was significantly more common in the cognitive dysfunction group (32.4% vs. 100%, p=0.003). Conclusion: Patients with CO poisoning and an alert mental status may experience cognitive dysfunction as assessed using the MMSE-K during the early stages of evaluation in the ED. In the MMSE-K, orientation to time, memory recall, and concentration/calculation showed the greatest impairment.

Association with Self-Perception for Obesity and Mental Health among Korean Adolescent (한국청소년에서 자가비만인식도와 정신건강과의 관련성)

  • Hwang, In-Cheol;Lee, Kyoung-Shik;Park, Dong-Kyun;Jung, Eun-Young;Choi, Chung-Hyun;Cho, Seong-Jin;Bae, Seung-Min
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.22 no.2
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    • pp.112-119
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    • 2011
  • Objectives : Obesity has been linked to various psychological problems as well as medical complications, especially among adolescents. Previous studies have suggested an association between body weight and depression or self-esteem ; however, there has been little evidence on self-perception of weight and mental health. The aim of this study was to examine the association of perceptional weight status with mental health in Korean adolescents. Methods : This study was based on data obtained from the third Korean National Health and Nutritional Examination Survey (2005). The study sample consisted of 583 adolescents (268 boys, 315 girls) aged 12-18 years, who had completed the health survey, the health examination, and the nutritional survey. Participants were divided into two groups based on the actual or perceptional weight status: non-obese and obese. Questionnaires for stress, depressive mood, and suicidal thoughts were utilized as mental health indicators. Results : The agreement between actual and perceptional weight status was moderate (k value, 0.585 ; p<0.01). The influencing factors for the discrepancy between actual and perceptional weight status were body mass index of subjects and their parents' education. The obese group was likely to have higher stress levels and more experience of depressive mood or suicidal ideation in regard to both actual and perceptional weight status. A multiple logistic regression analysis revealed that girls who had perceived themselves as obese were more likely to have an experience of depressive mood than other girls (unadjusted OR, 4.98 ; adjusted OR, 5.15). Conclusion : An experience of depressive mood was significantly associated with the perception of weight status and not actual weight status in Korean female adolescents.

Two Cases of Korean Medicine Treatment for Patients Complaining of Long-lasting Discomfort after COVID-19 Vaccination (장기간 지속된 코로나 백신 접종 후유증에 대한 한의 치험 2례)

  • Lee, Hye-Jin;Hwang, Ye-Chae;Lee, Kyeong-Hwa;Yim, Tae-Bin;Jung, Sang-Yeon;Park, Seong-Uk;Park, Jung-Mi;Ko, Chang-Nam;Cho, Seung-Yeon
    • The Journal of Korean Medicine
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    • v.43 no.2
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    • pp.124-139
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    • 2022
  • Objectives: This study examined the effectiveness of Korean medical treatment for two patients complaining of discomfort after receiving Pfizer COVID-19 vaccine. Methods: The patients were hospitalized for 50 days and 12 days, respectively. They were treated with herbal medicine, acupuncture, electroacupuncture, and moxibustion. We used the Numerical Rating Scale (NRS) on numbness in extremities and headache, Manual Muscle Testing Grading System (MMT), Criteria for Sweating Categorization, and 36-Item Short Form Health Survey (SF-36) to evaluate the clinical effects of the treatment. Results: In Case 1, headache improved from peak NRS 9 and average NRS 7 on admission day to both NRS 3 on discharge. The SF-36 score was also increased, suggesting that the quality of life was improved. In Case 2, numbness in the extremities improved from NRS 8 on the day before admission to NRS 2 on discharge, and general condition also improved. Conclusions: This study suggests that Korean medicine can be an effective treatment for patients who experience long-lasting discomfort after being vaccinated with COVID-19, but with no abnormal findings in the examination.