Medical education, competency, and outcome-based medical education started as part of the basic medical education curriculum in advanced countries 20 years ago, and such an approach was adopted in residency training. General competency training is at the core of residency training in advanced countries, and it goes beyond competency and outcome-based training to the extent that in a milestone training system, competency development is expected and measured with set competency achievements at each level. Recently, for the purpose of ensuring that doctors uphold patient safety and fulfill their obligations, entrustable professional activities (EPA) were applied at the beginning of residency when doctors move away from clinical trials and start actual care. The adoption of EPA in all residency training curriculum has spread very rapidly in the United States, United Kingdom, and Canada. Presently, Korea lags behind other countries significantly as the adoption of competency and outcome-based medical education in residency training has just begun. It is time to identify the current state of the Korean residency training system, and then design and practice a well-established system with a long-term view based on cooperation across the whole medical industry.
In clinical clerkships, residents function as trainees, workers, and teachers for other medical students. Although residents care for patients in harsh environments and encounter precarious patient-safety situations, they are working towards becoming competent specialists. Residency education programs are very important in cultivating specialists able to adapt to the rapidly-changing medical environment, and are also necessary to improve the quality of specialist training. Competent specialists not only need clinical competency, but also a wide range of abilities including professionalism, leadership, effective communication, cooperation, and attention to continuous professional development/continuing medical education activities. Each Korean association of specialties has its own educational goals and standardized education programs to help residents learn specific techniques and competencies related to medical care for patients, though the training environment of each residency is different within each trainee hospital. Although it is also important to evaluate residency education programs, currently there is only an examination of knowledge and assessment of skills based on mini-clinical evaluation exercises or direct observation of procedural skills. In order to develop an objective and estimable evaluation tool that can assess the overall achievement level within each training course, it is necessary to evaluate the knowledge, skills, and attitudes of residents. Residency education programs need further attention and reform.
Purpose: This study was conducted to develop an evaluation framework for QI activity in medical institutions and to analyze QI activity cases by applying the developed evaluation framework. Method: A four-phase process was employed to develop the evaluation framework, and a descriptive survey was used for the QI case study. Data were collected in April, 2010 by examining 157 QI activity cases presented at conferences and published in Journal of Korean Society of Quality Assurance in Health Care over the past three years. Developed QI activity evaluation instruments were used for data collection. Data were analyzed using the SPSS 18.0 for Windows program. Result: A QI Activity Evaluation Framework was developed. This framework consisted of 45 items. The department with the highest level of QI participation was the nursing department. The most frequent QI activity theme was patient safety. QI activity levels in Korean medical institutions are relatively equalized without significant differences according to institution characteristics. Conclusions: From the quality aspect of QI activity, more systematic and scientific approaches are required to upgrade QI activity. This study could provide methodological guidelines for QI activity and be useful in setting goals and directions for QI activity in medical institutions in Korea.
Development of lightweight implant plates are important to reduce the stress shielding effect for a prosthesis of femur bone fractures. Stainless steel (SS-316L) is a widely used material for making implants. Stress shielding effect and other issues arise due to the difference in mechanical properties of stainless steel when compared with bone. To overcome these issues, composite materials seem to be a better alternative solution. The comparison is made between two biocompatible composite materials, namely Ti-hydroxyapatite and Ti-polypropylene. "Titanium (Ti)" is fiber material while "hydroxyapatite" and "polypropylene" are matrix materials. These two composites have Young's modulus closer to the bone than stainless steel. Besides the variety of bones, present paper constrained to femur bone analysis only. Being heaviest and longest, the femur is the most likely to fail among all bone failures in human. Modelling of the femur bone, screws, implant and assembly was carried out using CATIA and static analysis was carried out using ANSYS. The femur bone assembly was analyzed for forces during daily activities. Ti-hydroxyapatite and Ti-polypropylene composite implants induced more stress in composite implant plate, results less stress induced in bone leading to a reduction in shielding effect than stainless steel implant plate thus ensuring safety and quick healing for the patient.
Purpose: This study aimed to determine the effect of curved walking training on balance confidence and fall efficacy in early stroke patients. Methods: The study included 16 early stroke patients who were randomly allocated to a curved walking training group (experimental group, N=8) and a straight walking training group (control group, N=8). Both groups performed the exercise 5 times a week for 3 weeks. Outcomes were assessed using the Activities-specific Balance Confidence (ABC) Scale, Fall Efficacy Scale (FES), Berg Balance Scale (BBS), and Timed Up and Go (TUG) test. Results: After 3 weeks of training, both groups showed significantly improved ABC, FES, BBS, and TUG (p<.05 in both groups). However, the ABC, FES, BBS, and TUG scores in the experimental group were significantly better than those in the control group (p<.05). Conclusion: These findings indicate that curved walking training may be effective at improving balance confidence and decreasing fall risk in early stroke patients. Therefore, curved walking training can be used as a recommended walking method in early stroke patients.
Background: Self-checked monitoring home exercises are recommended for preventing falls among people with Parkinson's disease. However, as these home exercises are performed autonomously by patients without professional management, their accuracy and efficiency can be compromised. Objective: To investigate the effects of providing regular training sessions to patients and caregivers and of patient self-monitoring of exercise performance following the implementation of a self-checked monitoring exercise program for people with Parkinson's disease. Design: Randomized Pretest-Posttest Control Group Design. Methods: We provided regular self-checked monitoring home exercise and general home exercise programs to 30 participants for 12 weeks. Once a month at the first, fifth, and ninth-week sessions, a rehabilitation team attended the Parkinson's group education. In addition to the subject in the experimental group perform the home exercises program to provide feedback regarding the home exercises program and to carry out a self-monitoring checklist performance for 12 weeks. Results: The 10 m walk test, functional reach test, and sit to stand test and the modified Barthel index significantly improved in the self-checked monitoring home exercise group. Conclusion: These results suggest that self-checked home exercise programs, which facilitate safety and consistent performance of exercises at home, are beneficial for people with Parkinson's disease.
Purpose: The purpose of this study was to review the influence of robot systems on nursing and robotics technology. Methods: The research design was a review article. The literature was done to help understand the current status and effects of robotic technology in the healthcare field, both domestic and overseas. The keywords searched were 'Nursing', 'Robot', and 'Patient safety' in Pubmed, CINAHL etc, and 'Nursing Activity', 'Nursing Care Integration Service' in RISS and KISS. Results: In healthcare, robotics is used in five areas; personal care robots, mobility and transfer robots, cognitive and emotional robots, nursing assist robots and care robots in palliative home care settings. Nurses' demands for utilization of robotic systems are high. Especially, if robotics is used for indirect and non-value-added nursing activities, efficiency may increase. Therefore, robotics should be used to help nurses focus on bedside care and perform better nursing care. Conclusion: Future robots and technology can help nurse to provide optimal nursing to patients, and will improve the quality life of patients. It is suggested that nursing research should be actively pursued in the future. Especially, it is an urgent field to improve nursing quality and reduce the burden of nurses.
Purpose: The purpose for this study was to identify the present state of Clinical Nurses with Expanded Role (CNERs) and provide basic data to refine the roles of CNERs. In this study, CNREs refers to nurses who perform techniques traditionally done by doctors and use titles such as clinical nursing specialist, educator with consultation, research assistant, coordinator, physician assistant and special examiner. Method: This study was conducted from September 1 to November 12, 2007. Data from 684 nurses from 38 hospitals who responded to the questionnaire were analyzed with descriptive statistics using the SPSS 14.0 program. Results: The mean percentage of time spent was, for direct practice, 41.1%, for education and counseling, 22.8%, for consultation and coordination, 10.4%, for research, 6.8%, for administration, 8.9% and for other activities, 10.0%. The most frequently implemented CNERs, activities included consultation and education for patients and their families, counseling by telephone, history taking, physical examination, reading examination results, psychosocial assessment, managing treatment, input of prescriptions, and writing up patient records, Although not frequently performed, nurses in some fields carried out invasive procedures and prescribed medication and laboratory tests. Conclusion: Although the number of hospital CNERs are rapidly increasing, there is still confusion about the title and framework as well as standards. Furthermore, because some nurses are prescribing medication and laboratory tests as well as performing techniques not traditionally done by nurses, there is an absolute need for a legalized system and systematic education system for the safety of patients who are being cared by all CNERs.
Purpose: The treatment of thyroid cancer patients was continuously increased. According to the increment of thyroid cancer patients, the establishment of iodine therapy site was also increased in each hospital. This treatment involves the administration of radioactive iodine, which will be given in the form of a capsule. Therefore, protections and managements for radioactive source pollution and radiation exposure should be necessary for radiation safety. Among the many problems, the problem of disposing the radioactive wastes was occurred. In this study, The date for self-disposal for radioactive wastes, which were contaminated in clothes, bedclothes and trash, were calculated. Materials and Methods: The number of iodine therapy ward was 15 in Korea Institute of Radiological Medical and Sciences. Recently, 8 therapy wards were operated for iodine therapy patients and others were on standby for emergency treatment ward of any radiation accidents. Radioactive wastes, which were occurred in therapy ward, were clothes, bedclothes, bath cover for patients washing water and food and drink which was leftover by patients. Each sample was hold into the marinelli beaker (clothes, bedclothes, bath covers) and 90 ml beaker (food, drink, and washing water). The activities of collected samples were measured by HpGe MCA device (Multi Channel Analysis, CANBERRA, USA) Results: The storage period for the each kind of radioactive wastes was calculated by equation of storage periods based on the measurement outcomes. The average storage period was 60 days for the case of clothes, and the maximum storage period was 93 days for patient bottoms. The average storage period and the maximum storage period for the trash were 69 days and 97 days, respectively. The leftover foods and drinks had short storage period (the average storage period was 25 days and maximum storage period was 39 days), compared with other wastes. Conclusion: The proper storage period for disposing the radioactive waste (clothes, bedclothes and bath cover) was 100 days by the regulation on self-disposal of radioactive waste. In addition, the storage period for disposing the liquid radioactive waste was 120 days. The current regulation for radioactive waste self-disposing was not suitable for the circumstances of each radioactive therapy facility. Therefore, it was necessary to reduce the leftover food and drinks by adequate table setting for patients, and improve the process and regulation for disposing the short-half life radioactive wastes.
The desire to maintain health is increasing, consequently the role of nursing which has as one chief aim the solving of man′s basic problems is more and more important. Today, in spite of a growing concern about the nursing activities which nurses provide for individual human having specific needs, clinically in fact, it is questionable that individual′s expectation of nursing activities agrees with nurse′s performance of nursing activities. In this study the importance and agreement of the importance of the nursing activities during the hospitalized puerperal period as viewed by women in the puerperal period and by nurses caring for them, were assessed. The present study was undertaken in an attempt to furnish the basic data for expediting the progress of research activities in this area and further to be helpful in planning maternity nursing practice. The study population defined and selected was nurses (13) caring for women in the puerperal period and doing duty on obstetric & gynecologic ward at Y. hospital, and the women in puerperal period (39) as sum of 3 women selected by each nurse during the period of May 13th-June 4th 1976. The study data was collected by the direct interview method based on the questionnaire which the investigator made out. The study result was analyzed by percentage, t - test. The findings can be summarized as follows: 1. General characteristics of nurses doing duty on puerperal ward: a. Nurses′average age was 24.8 years old. b. 84.6% had educational background of 4 years of college. c. 69.2% had a religion. d. 53.8% were married. e. 53.8% had clinical experience of 1 year -3 years. f, 61.5% did duty on puerperal ward during 1 year -3 years. g. 46.2% desired to do duty on obstetric ? gynecologic ward. 2. General characteristics of the women who were studied during their puerperal period: a. Women′s average age was 26.4 years old. b. 79.5% had educational background above high school. c. 56.4% had a religion. d. 84.6% had living standard above medium. e. 89.7% had no occupation. f, 53,8% had previous hospitalization experience. g. 56.4% had previous delivery experience. 3. Examining the importance of 39 nursing activities during puerperal period selected by investigator, studied group of women considered that the most important nursing activity was "Record precisely about condition, medical treatment and nursing activity results etc". Nurses considered that the most important nursing activity was "Notice whether having pain and care for that". Both groups considered that the least important nursing activity was "Talk with her about topics such as news, hobbies, other interests". 4. Examining the importance of nursing activities in 4 specific categories, studied group of women considered that the most important nursing activity in physical nursing category was "Be sure of safety measure to prevent accidents, injuries", and nurses considered that the most important nursing activity was "Make her sleep and rest sufficiently". Studied group of women considered that the most important nursing activity in psychological category was "Explain about medical treatment and nursing activity ahead of time so she knows what to expect" , and nurses considered that the most important nursing activity was "Explain about puerperal period so she understands". Studied group of women considered that the most important nursing activity in relation to medical care was "Record precisely about condition, medical treatment and nursing activity results etc.", and nurses considered that the most important nursing activity was "Observing, cleaning and protecting the perineum" Studied group of women considered that the most important nursing activity in nursing category in preparation for discharge was "Instruct about personnel hygiene during puerperal period", and nurses considered that the most important nursing activity was "Instruct self-care to protect the perineum". 5. The analysis of this study showed a significant amount of disagreement computed by subtracting the nurse′s score from the patient′s score. Studied group of women put greater importance on physical nursing category, psychological nursing category, nursing in relation to medical care, than the nurses. These results were statistically significant at 0.01 level.
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