著者

Hiroaki Furuta Katsuhiro Mizuno Kei Unai Hiroki Ebata Keita Yamauchi Michiko Watanabe

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.8, pp.20230039, 2023 (Released:2023-11-07)

参考文献数

33

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Objectives: This study investigated the transition patterns of activities of daily living (ADL) status based on the Functional Independence Measure (FIM) motor and cognitive items in patients who experienced subacute stroke.Methods: In this single-site, retrospective investigation, 1592 FIM samples were collected during the hospitalization of 373 stroke patients who were admitted between April 2018 and March 2020. FIM item levels were transformed from seven to three (FIM1–2, Complete Dependence; FIM3–5, Modified Dependence; FIM6-7, Independence). FIM samples were classified by latent class modeling into six latent ADL states based on the independence levels of FIM motor and cognitive items. We created an ADL status transition diagram based on the FIM sample’s probability of belonging to each status at different hospitalization timepoints.Results: Transition diagrams for each ADL status at admission revealed distinct patterns. In two ADL statuses for which patients required full assistance in FIM motor items, the patients remained motor-dependent without achieving independence on discharge. In contrast, patients in transition from the other four ADL statuses largely achieved independence in motor items by the time of discharge. The time required to reach higher ADL status varied according to the initial ADL status at admission; the slowest improvement was observed in statuses initially classified as needing the most assistance, whereas many patients achieved transition within 3 months from admission.Conclusions: Based on the characteristics of patient ADL status and timing of its changes, the classification of ADL status and visualization of ADL transition can contribute to improved treatment.

著者

一杉 正仁 菅谷 仁 平林 秀樹 妹尾 正 上田 秀一 下田 和孝 田所 望 古田 裕明 Masahito Hitotsugi Hitoshi Sugaya Hideki Hirabayashi Tadashi Seno Shuichi Ueda Kazutaka Shimoda Nozomu Tadokoro Hiroaki Furuta 獨協医科大学国試教育センター 獨協医科大学国試教育センター 獨協医科大学国試教育センター 獨協医科大学国試教育センター 獨協医科大学国試教育センター 獨協医科大学国試教育センター 獨協医科大学国試教育センター 獨協医科大学国試教育センター Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine

雑誌

Dokkyo journal of medical sciences (ISSN:03855023)

巻号頁・発行日

vol.37, no.2, pp.77-81, 2010-07-25

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試験におけるヒューマンエラーの実態を明らかにし,予防教育の効果を検証するために,医師国家試験模擬試験を利用して受験生がおかすヒューマンエラーを包括的に調査解析した.医学部6年生が2回の医師国家試験模擬試験を受験し,自己採点結果と,マークシートによる機械的採点結果を対比した.2回の試験を通じて,受験生1人が1回の試験で平均1.4個のエラーをおかしていた.エラーの分類別頻度では,2肢選択すべきところを1肢しか選択しなかったエラーが49.1%,1肢選択すべきところを2肢以上選択したエラーが31.6%,選択したものと異なる記号をマークしたエラーが10.5%と続いた.全ての受験者(全受験者)と,2回の試験に参加した受験者(2回受験者)に大別してエラーの発生頻度,エラーの内容について比較した.2 回受験者は,1人当たりがおかすエラー数および2問以上のエラーをおかす人の割合ともに2回目の試験で有意に減少していた. これは,受験者自らがエラーの実態に気付き,そして適切な助言のもとに注意を払って試験に臨んだ結果と思われる.試験におけるヒューマンエラーの実態を明らかにし,それを最小限にくい止める対策は,単に医師国家試験における失点防止だけでなく,ミスをおかしてもそれに気付き,問題解決ができるようなerror tolerantの考え方を養う上でも重要と思われる.We analyzed inadvertent human errors made by 6thgrade medical students during two trial examinations madeup of 500 multiple-choice questions where either one or twocorrect answers were required. Forty and 39 students, respectively,took the two examinations. Students averaged1.4 errors each during the examinations. Most errors( 80.7%) involved selecting the wrong number among the answeroptions( i.e. when a two option selection was required,only one option was selected). The students who had takenboth examinations made significantly less errors in the latterexamination than the former. Furthermore, the prevalenceof students who had made more than one inadvertenterror was significantly lower among students who tookboth examinations. We showed the effectiveness of interventionregarding inadvertent errors during 500 multiplechoicequestion examinations and of educating the studentsabout preventive measures. These results might have auseful application to improved safety promotions based onerror-tolerant theories.