PURPOSE: The purpose of this study is to investigate the reliability and validity of new clinical performance examination (CPX) for assessing clinical reasoning skills and evaluating clinical reasoning ability of the students. METHODS: Third-year medical school students (n=313) in Busan-Gyeongnam consortium in 2014 were included in the study. One of 12 stations was developed to assess clinical reasoning abilities. The scenario and checklists of the station were revised by six experts. Chief complaint of the case was rhinorrhea, accompanied by fever, headache, and vomiting. Checklists focused on identifying of the main problem and systematic approach to the problem. Students interviewed the patient and recorded subjective and objective findings, assessments, plans (SOAP) note for 15 minutes. Two professors assessed students simultaneously. We performed statistical analysis on their scores and survey. RESULTS: The Cronbach α of subject station was 0.878 and Cohen κ coefficient between graders was 0.785. Students agreed on CPX as an adequate tool to evaluate students' performance, but some graders argued that the CPX failed to secure its validity due to their lack of understanding the case. One hundred eight students (34.5%) identified essential problem early and only 58 (18.5%) performed systematic history taking and physical examination. One hundred seventy-three of them (55.3%) communicated correct diagnosis with the patient. Most of them had trouble in writing SOAP notes. CONCLUSION: To gain reliability and validity, interrater agreement should be secured. Students' clinical reasoning skills were not enough. Students need to be trained on problem identification, reasoning skills and accurate record-keeping.
Checklist ; *Clinical Competence ; Communication ; Comprehension ; *Education, Medical, Undergraduate ; Educational Measurement/*standards ; Humans ; Medical History Taking ; Medical Records ; Observer Variation ; Physical Examination ; Physician-Patient Relations ; *Problem-Based Learning ; Reproducibility of Results ; Republic of Korea ; *Schools, Medical ; *Students, Medical ; Surveys and Questionnaires ; *Thinking ; Universities

INTRODUCTIONWe aimed to report the outcomes of inguinal hernia repair performed at Tan Tock Seng Hospital and compare them with those performed at dedicated hernia centres.

METHODSWe retrospectively analysed the medical records and telephone interviews of 520 patients who underwent inguinal hernia repair in 2010.

RESULTSThe majority of the patients were male (498 [95.8%] men vs. 22 [4.2%] women). The mean age was 59.9 ± 15.7 years. Most patients (n = 445, 85.6%) had unilateral hernias (25.8% direct, 64.3% indirect, 9.9% pantaloon). The overall recurrence rate was 3.8%, with a mean time to recurrence of 12.0 ± 8.6 months. Risk factors for recurrence included contaminated wounds (odds ratio [OR] 50.325; p = 0.004), female gender (OR 8.757; p = 0.003) and pantaloon hernias (OR 5.059; p = 0.013). Complication rates were as follows: chronic pain syndrome (1.2%), hypoaesthesia (5.2%), wound dehiscence (0.4%), infection (0.6%), haematoma/seroma (4.8%), urinary retention (1.3%) and intraoperative visceral injury (0.6%). Most procedures were open repairs (67.7%), and laparoscopic repair constituted 32.3% of all the inguinal hernia repairs. Open repairs resulted in longer operating times than laparoscopic repairs (86.6 mins vs. 71.6 mins; p < 0.001), longer hospital stays (2.7 days vs. 0.7 days; p = 0.020) and a higher incidence of post-repair hypoaesthesia (6.8% vs. 1.8%; p = 0.018). However, there were no significant differences in recurrence or other complications between open and laparoscopic repair.

CONCLUSIONA general hospital with strict protocols and teaching methodologies can achieve inguinal hernia repair outcomes comparable to those of dedicated hernia centres.

Adult ; Aged ; Aged, 80 and over ; Female ; Hernia, Inguinal ; surgery ; Herniorrhaphy ; methods ; standards ; Hospitals, General ; organization & administration ; Hospitals, Special ; organization & administration ; Humans ; Male ; Medical Records ; Middle Aged ; Recurrence ; Retrospective Studies ; Singapore ; Treatment Outcome ; Young Adult

Electronic medical records (EMR) is the clinical diagnosis, guiding intervention and digital medical service record of outpatient, hospital patients (or care object) in medical institution. And it is the complete, detailed clinical information resource which has produced and recorded in all previous medical treatments. Radiotherapy electronic medical records contain texts, images and graphics, therefore the information is more complicated. This paper proposes an EMR information system based on DICOM-RT standard, through the use of seven objects of DICOM-RT to achieve the information exchange and sharing between different systems, equipments, convenient radiotherapy treatment data management, improve the efficiency of radiation treatment.
Computer Communication Networks ; Humans ; Medical Records Systems, Computerized ; standards ; Radiographic Image Enhancement ; methods ; Radiology Information Systems ; organization & administration ; Radiotherapy, Computer-Assisted ; methods ; User-Computer Interface

This paper is aimed to research into the information model of the Digital Imaging and Communication in Medicine (DICOM) Structured Reporting (SR), and to introduce DICOM information object definitions (IODs) and services used for the storage and transmission of SR. The DICOM services are concerned with storage, query, retrieval, and transfer of data, and give a brief introduction to DICOM DIR. DICOM DIR is a file based on medical information. According to the DICOM DIR definition in the DICOM part ten, it may be found that the composite objects referenced in the DICOM SR. So putting forward the management of DICOM files by DICOM DIR sets, It effectively improves the efficiency of the object referenced by SR. This can increase the ability to access the data. For scientific research, medical data mining and applications, DICOM SR can profit the communication of medical information in different hospitals, and this can be useful for the analysis, research, summary, classification and extraction of a large quantity of medical information.
Computer Communication Networks ; Humans ; Information Storage and Retrieval ; methods ; standards ; Medical Records Systems, Computerized ; standards ; Radiographic Image Enhancement ; methods ; Radiology Information Systems ; organization & administration ; User-Computer Interface

Enhanced extracorporeal counterpulsation (EECP) information consists of both text and hemodynamic waveform data. At present EECP text information has been successfully managed through Web browser, while the management and sharing of hemodynamic waveform data through Internet has not been solved yet. In order to manage EECP information completely, based on the in-depth analysis of EECP hemodynamic waveform file of digital imaging and communications in medicine (DICOM) format and its disadvantages in Internet sharing, we proposed the use of the extensible markup language (XML), which is currently the Internet popular data exchange standard, as the storage specification for the sharing of EECP waveform data. Then we designed a web-based sharing system of EECP hemodynamic waveform data via ASP. NET 2.0 platform. Meanwhile, we specifically introduced the four main system function modules and their implement methods, including DICOM to XML conversion module, EECP waveform data management module, retrieval and display of EECP waveform module and the security mechanism of the system.
Computer Communication Networks ; standards ; Counterpulsation ; methods ; Heart-Assist Devices ; Hemodynamics ; Humans ; Internet ; Medical Records Systems, Computerized ; standards ; Programming Languages

The development of external counterpulsation (ECP) local area network system and extensible markup language (XML)-based remote ECP medical information system conformable to digital imaging and communications in medicine (DICOM) standard has been improving the digital interchangeablity and sharability of ECP data. However, the therapy process of ECP is a continuous and longtime supervision which builds a mass of waveform data. In order to reduce the storage space and improve the transmission efficiency, the waveform data with the normative format of ECP data files have to be compressed. In this article, we introduced the compression arithmetic of template matching and improved quick fitting of linear approximation distance thresholding (LADT) in combimation with the characters of enhanced external counterpulsation (EECP) waveform signal. The DICOM standard is used as the storage and transmission standard to make our system compatible with hospital information system. According to the rules of transfer syntaxes, we defined private transfer syntax for one-dimensional compressed waveform data and stored EECP data into a DICOM file. Testing result indicates that the compressed and normative data can be correctly transmitted and displayed between EECP workstations in our EECP laboratory.
Computer Communication Networks ; standards ; Counterpulsation ; methods ; Humans ; Information Storage and Retrieval ; Medical Records Systems, Computerized ; standards ; Programming Languages

This paper Analys the design goals of Medical Instrumentation standard information retrieval system. Based on the B /S structure,we established a medical instrumentation standard retrieval system with ASP.NET C # programming language, IIS f Web server, SQL Server 2000 database, in the. NET environment. The paper also Introduces the system structure, retrieval system modules, system development environment and detailed design of the system.
Database Management Systems ; Equipment and Supplies ; standards ; statistics & numerical data ; Information Systems ; Internet ; Medical Records Systems, Computerized

Gastric cancer is the most common cancer in Korea and has overall survival rate of around 50%. Gastric cancer detected in early stage can be cured by endoscopic resection or less invasive surgical treatment and the subsequent prognosis is excellent. National cancer screening program for gastric cancer has been available for several years. The evaluation for efficacy of our screening strategy is strongly needed in terms of mortality reduction and cost-effectiveness. Accurate diagnosis and staging evaluation is important for proper management and prediction of a patient's prognosis. It is recommended to understand the advantages and limitations of currently available guidelines and diagnostic modalities. The 7th edition of gastric cancer staging system from AJCC may have significant effect on our knowledge and patient management.
*Early Detection of Cancer ; Humans ; Medical Records/standards ; Neoplasm Staging ; Stomach Neoplasms/*diagnosis/pathology/radiography

OBJECTIVES: To increase the booster vaccination rate, the Korean government legislated a measles vaccination for elementary school students in 2001, requiring parents to submit a certificate of vaccination upon the admission of the students to elementary school. The purpose of this study was to evaluate the validity of measles vaccination certificates which were issued to parents. METHODS: Using questionnaire survey data of 890 general practitioners and 9,235 parents in 2005, we investigated the evidence for booster vaccination certificates of measles. RESULTS: In the survey of general practitioners, 59.5% of the certificates depended on the medical records of clinic, 13.5% was immunization booklets, 23.7% was re-immunizations, 1.9% was confirmation of record of other clinics, and 1.4% was parents' statements or requests without evidence. In the survey of parents, 36.2% of the certificates depended on the medical records of clinic, 43.4% was immunization booklets, 18.0% was reimmunizations, and 2.4% was parents statements or requests without evidence. CONCLUSIONS: Our findings show that a majority of the booster vaccination certificates of measles was issued on the basis of documented vaccinations and it means that the implementation of the law requiring the submission of elementary school students' vaccination certificates has been very successful in Korea.
Adult ; Aged ; *Certification ; Documentation ; Female ; Humans ; Korea ; Male ; Measles Vaccine/*administration & dosage ; Medical Records ; Middle Aged ; Parents ; Questionnaires ; *Schools ; Vaccination/legislation & jurisprudence/*standards/statistics & numerical data

The records of 58 children's general anesthesia children (ASA I) were investigated. The handwritten records and the automatic anesthetic records were applied simultaneously to collect data from each patient. The total duration of anesthesia (T), the time for handwritten record (H), and the time for automatic record (A) were recorded by 3 timers respectively. Fifty-four records were available and were divided into two groups: group I, T > 1h (n = 29), group II: T < 1h (n = 25). Automatic record saved time (P < 0.001) in both groups. Furthermore, in group I, automatic record kept more vital sign notes (P < 0.001), but had no more event notes (P = 0.407); In group II, automatic record kept more event notes (P = 0.015), but had no more vital signs notes (P = 0.374). In general, automatic anesthetic record is suitable for all kinds of duration of anesthesia. When the time extends, it can provide a better platform for the anesthesiologist to improve the quality of management.
Anesthesiology ; organization & administration ; standards ; Forms and Records Control ; Hospital Information Systems ; organization & administration ; standards ; Humans ; Medical Records ; standards ; Medical Records Systems, Computerized ; Time Factors