• Title/Summary/Keyword: 임상의사결정

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Computer-Aided Diagnosis for Liver Cirrhosis using Texture features Information Analysis in Computed Tomography (컴퓨터단층영상에서 TIA를 이용한 간경화의 컴퓨터보조진단)

  • Kim, Chang-Soo;Ko, Seong-Jin;Kang, Se-Sik;Kim, Jung-Hoon;Kim, Dong-Hyun;Choi, Seok-Yoon
    • The Journal of the Korea Contents Association
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    • v.12 no.4
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    • pp.358-366
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    • 2012
  • Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules leading to loss of liver function. Liver Cirrhosis is most commonly caused by alcoholism, hepatitis B and C, and fatty liver disease, but has many other possible causes. Some cases are idiopathic disease from unknown cause. Abdomen of liver Computed tomography(CT) is one of the primary imaging procedures for evaluating liver disease such as liver cirrhosis, Alcoholic liver disease(ALD), cancer, and interval changes because it is economical and easy to use. The purpose of this study is to detect technique for computer-aided diagnosis(CAD) to identify liver cirrhosis in abdomen CT. We experimented on the principal components analysis(PCA) algorithm in the other method and suggested texture information analysis(TIA). Forty clinical cases involving a total of 634 CT sectional images were used in this study. Liver cirrhosis was detected by PCA method(detection rate of 35%), and by TIA methods(detection rate of 100%-AGI, TM, MU, EN). Our present results show that our method can be regarded as a technique for CAD systems to detect liver cirrhosis in CT liver images.

The Usefulness of Video Fluoroscopic Swallowing Study in Post-Stroke Dysphagia Patients (뇌졸중 후 연하장애 환자에서 비디오 투시 연하 조영검사의 유용성)

  • Eun, Sung-Jong;Kim, Sung-Gil;Hong, Jea-Ran
    • Journal of the Korean Society of Radiology
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    • v.4 no.3
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    • pp.19-25
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    • 2010
  • Dysphagia is common and serious problems in post-stroke patients. The post-stroke dysphagia with aspiration is associated with dehydration, malnutrition, pneumonia, sepsis and death. Up to date, gag reflex and choking history used to decide the aspiration in clinical. The purpose of this study was to evaluate the aspiration and to choice the proper meal formation using by video fluoroscpic swallowing study(VFSS) with post-stroke dysphagia patients. 58 post-stroke patients and ten normal person participated to perform the VFSS with liquid type, puding, yoplait, rice mixed with barium(Ba). Two rehabilitation medicine doctors and a radiological technologist analysed the phase(oral, pharyngeal, esophageal phase)with video film, and checked the pharyngeal transition time(PTT). 38 patients showed abnormality in pharyngeal phase, 13 patients in oral and pharyngeal phase, 3 patients in oral phase, and 2 patients in pharyngeal and esophageal phase. 43 patients(65.2%) occured the aspiration, but 23 of 43 patients improved by the chin tuck position. Aspiration occured 34 patients in liquid type, 2patients in rice gruel and nothing in boiled rice. After VFSS, 13 of 23 patients change the intaking pathway from nasogastric tube(NGT) to oral, On the contrary with 3 of 42 patients from oral to NGT. Consequently VFSS is clearly effective to evaluate the aspiration with post-stroke dysphagia patients.

An Empirical Study on the Economical Competition Factors of Internet Retailers (인터넷 소매상의 경제적 경쟁요인에 관한 실증연구)

  • 이수정;남순해;고석하
    • Proceedings of the Korea Society of Information Technology Applications Conference
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    • 2002.11a
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    • pp.3-13
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    • 2002
  • 고석하 등(2002)은 인터넷 소매상이 상품 품목의 명목 가격과 배송료를 이용해서 고객의 일회 총 구매 비용을 조절한다는 것을 밝혔다. 고석하 등(2002)은 같은 내용의 상품 조합을 인터넷 시장에서 구매하기 위한 비용과 전통 시장에서 구매하기 위한 비용을 비교하였다. 분석 결과, 그 교호작용과 함께, 상품 종류와 일회 구매액/가격의 크기의 두 요소가 인터넷 시장의 전통 시장에 대한 총 구매비용 할인율의 변동의 약 60%내지 80%를 설명할 수 있다는 것을 보여주었다. 한편, 구매액/가격은 인터넷 시장에서의 해당 산포도(전통 시장의 그것에 대비한)에는 거의 영향을 미31지 못하며, 상품의 종류도 산포도에는 할인율에서와 같이 큰 영향을 미치지 않았다. 인터넷 시장의 가격이나 구매비용 산포도는 상품 특성이나 구매액 크기 이외의 다른 요인에 의해서 주로 영향을 받는 것으로 나타났다. 따라서, 본 논문에서는 가격 요인 이외의 경제적 경쟁요인에 관한 실증연구로서, 2002년 6월 17일부터 20일까지, 소프트웨어, PC와 주변기기, 휴대폰, 가전제품, CD, 화장품, 그리고 책의 7가지 산업 전문 쇼핑몰과 종합 쇼핑몰을 대상으로, 인터넷 시장에서 수행되고 있는 경제적인 비가격 경쟁요인에 관한 실증 조사를 실시하였다. 조사 결과, 인터넷 시장에서 수행되고 있는 경제적인 비가격 경쟁요인은 매우 다양하며, 상품별로도 다른 특성을 보이고 있는 것으로 밝혀졌다. 인터넷 소매상의 경제적인 비가격 경쟁요인은 크게 배송료 면제와 배송료 외 인센티브 제도로 구분된다. 본 논문에서는 경제적인 비가격 경쟁요인의 모든 경우의 수를 고려할 수 있도록, 코드표를 작성하여 정리하고 분석하였다.기호로 인식하였다. 실험결과, 표준패턴을 음표와 비음표의 두개의 그룹으로 나누어 인식함으로써 DP 매칭의 처리 속도를 개선시켰고, 국소적인 변형이 있는 패턴과 특징의 수가 다른 패턴의 경우에도 좋은 인식률을 얻었다.리되고 이원화된 코드체계와 데이터 형태의 이질화를 통일하는 방법으로 데이터웨어하우스 시스템을 제시하였다. 결국 병원에서 데이터웨어하우스 시스템의 구축은 임상, 연구, 교육의 유기적 순환관계를 정립하여 지식의 순환적 고리인 수집, 공유, 확산, 재창출을 지속적 유지할 수 있는 인프라를 구축해 준다. 반면 상이한 정보들간의 충돌과 이에 따른 해석의 오류로 잘못된 의사결정을 위한 정보를 제공할 수 있고 기초정보의 접근 및 추출의 유용성에 의해서 정보유출에 대한 문제가 한계점으로 나타났다.로세스 개선을 위해서 무엇을 정말로 필요로 하는지를 밝힘으로써, 한국 소프트웨어 산업의 현실적인 특수성을 고려한 소프트웨어 프로세스 평가와 개선 모델의 개발을 위한 기초적인 자료를 제공할 것으로 예상된다. 또한, 본 연구 결과는, 우리나라 소프트웨어 조직들이 실제로 무엇을 필요로 하는지를 밝힘으로써, 우리나라의 소프트웨어 산업을 육성하기 위한 실효성 있는 정책 입안을 위한 기초 자료를 제공할 것으로 예상된다.를 검증하려고 한다. 협력체계 확립, ${\circled}3$ 전문인력 확보 및 인력구성 조정, 그리고 ${\circled}4$ 방문보건사업의 강화 등이다., 대사(代謝)와 관계(關係)있음을 시사(示唆)해 주고 있다.ble nutrient (TDN) was highest in booting stage (59.7%); however no sig

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Hospice and Palliative Care in Chronic Obstructive Pulmonary Disease (만성 폐쇄성 폐질환의 호스피스 완화의료)

  • Shin, Jinyoung;Park, Hye Yun;Lee, Jungkwon
    • Journal of Hospice and Palliative Care
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    • v.20 no.2
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    • pp.81-92
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    • 2017
  • Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive. It is a major cause of morbidity and mortality worldwide, leading to substantial and increasing economic and social burden. Palliative care for COPD patients aims to reduce symptoms and exacerbations and improve exercise tolerance and quality of life. It is difficult to make a prognosis for COPD patients due to the variable illness trajectory and advanced care of patients. However, severity of breathlessness, assessment of lung function impairment, and frequency of exacerbations can help to identify palliative care needs and determine effective methods to mitigate symptoms, which is discussed in this paper. In these patients, it is recommended to provide individualized palliative care along with curative/restorative care at the onset of COPD symptoms. Before launching a palliative care system in Korea, it is necessary to prepare pulmonary rehabilitation resources, patient-centered communication, timely palliative responsiveness, and a program for effective advanced care planning. A multidisciplinary approach involving collaboration with not only the respiratory and palliative care teams but also primary care offers a new model of care for these patients and should be considered with a priority.

Unusual MR Features of Extravasation of Contrast Material in Hyperacute Intracerebral Hemorrhage (초급성 두개내 출혈 환자에서 조영제의 혈관외 누출을 동반한 비전형적 자기공명영상)

  • Choi Seung Hong;Chun Woo Sun;Kim Ji-Hoon;Kang Hyun Seung;Kwon Bae Ju;Na Dong Gyu;Kim Jae Hyung;Han Moon Hee;Chang Kee-Hyun
    • Investigative Magnetic Resonance Imaging
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    • v.9 no.1
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    • pp.50-56
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    • 2005
  • Contrast extravasation in hyperacute intracerebral hemorrhage (ICH) indicative of active bleeding is a predictor of possible enlargement of hematoma, providing clinician with valid management decisions. We report unusual MR imaging features of contrast extravasation in hyperacute ICH in three patients: Case 1 with hypertension revealed dual foci of contrast extravasation, one in right basal ganglia and the other in left lateral ventricle, suggesting simultaneous bleeding of the two foci. Case 2 with presumed diagnosis of vasculitis showed relatively large area of contrast extravasation mimicking enhancing tumor or vascular lesion. Case 3 with hypertension showed the findings of active bleeding which was likely to occur during the time of MR imaging acquisition.

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Development of a Smartphone Application for Clinical Decision Making of Medication Administration (투약적용의 임상적 의사결정을 위한 스마트폰 어플리케이션의 개발)

  • Kim, Myoung-Soo;Park, Jung-Ha;Kim, Sungmin
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.15 no.3
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    • pp.1650-1662
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    • 2014
  • This study aimed to develop smartphone application contents for the medication reconciliation of high-alert medications and to evaluate the satisfaction for this application. The xcode 4.5 and ios 6.1 SDK(software development kit) were used for constructing screen of the system. After implementation during 4 weeks, thirty five ICU(Intensive Care Unit) nurses were asked function related, contents related, and usage related satisfaction using 12 items. And differences of satisfaction according to the number of daily use and the frequency of use were evaluated. Data were analyzed using descriptive analysis, ANOVA with the SPSS 18.0. We developed the formula for drug dosage calculation, the alarming procedure, and the information of the high alert medication. In the satisfaction items, the mean score of 'This application is helpful to perform drug dosage calculation' was 3.14. However, 'I satisfy this application' was relatively low as 2.94. There were no differences in satisfaction according to the daily use and frequency of use. Based on the results of this study, more advanced smartphone application for medication reconciliation of high-alert medications will provide an important platform for patient safety.

Depression during Pregnancy and the Postpartum (임신 및 산후 우울증)

  • Kim, Youl-Ri
    • Korean Journal of Psychosomatic Medicine
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    • v.15 no.1
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    • pp.22-28
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    • 2007
  • The pregnancy and postpartum period appear to be a time of heightened vulnerability for the development of major depression in some women. Postpartum depression affects 10% of women within a few weeks immediately postpartum. Postpartum depression is associated with disturbances in the mother-infant relationship, which in turn have an adverse impact on the course of child cognitive and emotional development. Depression during pregnancy is also common, although it has been relatively neglected. Psychopathological symptoms during pregnancy have physiological consequences for the fetus. Understanding the aetiology of perinatal depression requires integrating of multiple psychosocial and biological risk factors. The treatment of depressed pregnant women requires skilled decision making by psychiatrists. Risk-benefit analysis is appropriate method for intervention fur depression in pregnancy. Effective treatments for depression in pregnancy include psychotherapy, antidepressant medication and electroconvulsive therapy. In treatment of postpartum depression, the biological, psychological, and social interventions are included. Prescribing antidepressants(such as fluoxetine), estrogen in severe and chronic cases, and counselling can be effective for improving maternal mood and aspects of infant outcome. Ongoing research is directed to further elucidating neurohormonal and psychosocial contributions to depression during pregnancy or postpartum. Screening for risk factors and symptoms for depression need to be incorporated into antenatal and pediatric clinics.

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The Assessment Tools in Palliative Medicine (완화 의학에서의 평가도구)

  • Gwak, Jung-Im;Suh, Sang-Yeon
    • Journal of Hospice and Palliative Care
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    • v.12 no.4
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    • pp.177-193
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    • 2009
  • The assessment of patient status in palliative medicine is essential for determining treatments and for clinical outcomes. The objective of assessment tools is to raise the quality of care for individual patients and their families. There are a number of tools available to assess pain, non-pain symptoms and quality of life. The tools are either uni-dimensional or multi-dimensional measures. Unfortunately, however, no single tool is recommended to be a superior to others in symptoms or quality of life assessment. Therefore, to select an appropriate assessment tool, one should consider the time frame and unique characteristics of tools depending on purpose and setting. The combination of prognostic index is highly recommended in prognostication, and web-based prognostic tools are available. Recently, a new objective prognostic score has been constructed through multicenter study in Korea. It does not include clinicalestimates of survival, but includes new objective prognostic factors, therefore, anyone can easily use it. For beginners in palliative medicine, relatively easy-to-use tools would be convenient. We recommend Eastern Cooperative Oncology Group performance status to assess functional status, numeric rating scale for pain assessment and the Korean version of brief pain inventory for initial pain assessment. Asking directly with numeric rating scale or the Korean version of MD Anderson Symptom Inventory would be desirable to assess various symptoms together. We think that European Organization Research and Treatment Quality of Life Questionnaire Core 15 for Palliative Care is good to assess the quality of life, while Objective Prognostic Score is convenient as prognostic index for beginners.

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Signal-Averaged P Wave Analysis in Patients with Paroxysmal Atrial Fibrillation (발작성 심방세동 환자의 신호평균 P파 분석)

  • 김인영;이종연;이병채;이용희;이종민;김선일;김준수
    • Journal of Biomedical Engineering Research
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    • v.23 no.1
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    • pp.1-8
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    • 2002
  • Atrial fibrillation(AF). chronic or paroxysmal is the most frequent arrhythmia in human subjects Duration of P wave in signal-averaged electrocardiography(SAECG) reflects intra-atrial conduction time and therefore. could be used as an electrophysiological marker for atrial conduction chance at the earthy stave. So we apply the analysis method using SAECG to diagnose Paroxysmal atrial fibrillation(PAF) . Subjects Participated for the study consisted of two groups: a control group(n=34) of normal healthy volunteers and a group of AF Patients(n=38) with a documented history of PAF but no other history of cardiac disease. We evaluated the effect of several filtering and determination methods to find the starting and ending feints of the P wavy on its duration. To increase the measurement reliability of P wave duration. the automatic detection method was proposed. Also. to increase the detection rate for PAF risk, the decision threshold value was optimized using receiver operation characteristics(ROC) curve. Results showed that the highest statistical difference (p〈0.001) of the P wane duration between controls and subjects was obtained at the Processing condition, using absolute threshold vague(8.75 $\mu N$) , a least mean square(LMS) high pass filter and 30 Hz cutoff frequency. The most outstanding difference(sensitivity 88 % specificity 64.4 %) between controls and subjects was obtained at the decision threshold value of 112 ms.

Radiographic Evaluation of Condyle Position at Maximum Intercuspal Position Using Cone-beam CT (Cone-beam CT를 이용한 최대교두간접촉위(MIP)에서 과두 위치에 대한 방사선적 평가)

  • Oh, Sang-Chun;Chee, Young-Deok
    • Journal of Dental Rehabilitation and Applied Science
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    • v.26 no.2
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    • pp.111-120
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    • 2010
  • Purpose: This investigation was designed to evaluate the condyle position and the symmetry of the both condyle heads at the maximum intercuspal position on the sagittal CT image of the temporomandibular joint. Materials and Methods: Cone-beam CT was used to assess 400 joints in 100 symptom and 100 symtom-free subject(100 male, 100 female). Three independent observers(dentists) determined the positions classified with Anterior Position(AP), Middle Position(MP), and Posterior Position(PP), and the symmetry of the both condyle. Results: According to gender, the mean percentages of AP, MP, and PP were 48.5, 28.5, and 23 in male group, and 34, 38, and 28 in female group. The symmetry of condylar heads was more common than asymmetry in the both of groups. In the respect of symptom or symptom-free, the mean percentages of AP, MP, and PP were 44.5, 34, and 21.5 in the symptom-free group, and 37, 33.5, and 29.5 in the symptom group. The symmetry of condylar heads was more common in the symptom-free group, but the asymmetry of condylar heads was more common in the symptom group. Conclusions: These data might serve as useful criteria for the clinical assessment of condyle position at the maximum intercuspal position optained by Cone-beam CT.