• Korean Circulation Journal
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• 제52권6호
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• pp.414-428
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• 2022

Although tricuspid regurgitation (TR) is a general medical issue with growing prevalence and socioeconomic burden, most clinicians have not paid much attention to TR in the past. Several problems of TR have been pointed out in clinical practice, which include: ambiguous clinical manifestations and the difficulty in initial detection, limitations in generally used diagnostic tools, the absence of objective criterion for therapeutic intervention, high operative morbidity and mortality, and lack of long-term clinical data after the intervention for TR. Therefore, patients with TR usually visit clinicians at a much-advanced state, and this delay gives a major dilemma in clinical decision-making in a routine clinical practice. To improve the clinical outcome of TR, we need more knowledge about TR for solving the current problems and making strategies for better clinical practice. With this background, we have discussed in the present article about the pathophysiology of TR and the problems frequently experienced by clinical physicians in the diagnosis and treatment of TR. Furthermore, we have discussed the future strategy to improve the treatment of TR.

• 대한치과보철학회지
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• 제55권4호
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• pp.444-450
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• 2017

보철적 의사 결정(decision-making)은 다양한 요소가 작용하므로 복잡하며, 치과의사가 분석한 자료를 바탕으로 환자와의 소통을 통해 이루어진다. 다양한 치료 옵션과 그에 따른 결과의 경우의 수가 많아짐에 따라 이러한 의사 결정 과정의 지속적인 재평가가 요구된다. 본 증례는 교합평면의 부조화를 보이는 환자의 교합평면을 재형성하는 치료 방법으로 고정성 보철 수복을 선택하고, 진단 납형 제작을 통한 치료계획의 수립으로 교합평면을 재설정하였다. 충분한 기간 동안 사용하면서 지속적인 재평가를 시행하여 얻은 임시 보철물을 CAD/CAM (Computer-aided design/computer-aided manufacturing)을 이용하여 지르코니아 최종 보철물로 이행하였다. 치료 종결 후 3개월 간의 주기적 내원을 통해 관찰하였을 때 만족스러운 결과를 얻었다.

• 대한치과의사협회지
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• 제51권1호
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• pp.39-45
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• 2013

Radiographic examinations are used to discover and define the type and extent of disease in many clinical situations. Currently, it is common for dental patients to receive dental radiographic examinations on a routine schedule with little variation in spite of different patient signs and symptoms. Such routine scheduling of radiographic examinations may result in unnecessary patient exposure. There is also the possibility of under-utilization of radiography; this can result in inadequate or excessively delayed diagnosis. Patient selection criteria are descriptions of clinical conditions derived from patient signs, symptoms and history that identify patients who are likely to benefit from a particular radiographic examination. It makes possible making individual decisions based on history, clinical examination and risk factors. The radiographic selection criteria of dentistry have been revised in accordance with recent guidelines and peer-reviewed research in USA and Europe, but the studies of these subjects are not sufficient in our nation. In this review article, the relating factors and update necessity of radiographic selection criteria are discussed.

• 한국전문물리치료학회지
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• 제27권1호
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• pp.53-62
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• 2020

Background: Pregnancy-related low back pain (PLBP) has fewer systematic guidelines than pregnancy-related pelvic girdle pain, previous studies have not evaluated physical therapy for this ailment in Korea. Objects: We aimed to provide a detailed account of clinical decision making by Korean physiotherapists while treating PLBP. Methods: In total, 955 questionnaires were distributed mainly in places of continuing education held by the Korean Physical Therapy Association from April to July 2019. The same questionnaire was posted on a website used by physiotherapists. We collected subject information, a specific Vignette typically represent symptoms of PLBP, and responses to multiple questions about decision making, subjective recognition and interest level in the field of women's health physiotherapy (WHPT). Results: The overall response rate was 56% (n = 537); of these, responses to 520 questionnaires were analyzed. Most respondents chose various combinations of physical therapy methods. There were significant differences in subjective recognition levels of WHPT according to gender (p < 0.05), age (p < 0.01), education level (p < 0.01), and clinical experience (p < 0.05). There were significant differences in interest according to gender (p < 0.01) and education level (p < 0.01). With respect to the types of treatment, significant differences were noted in selective rates for "manual therapy", "pain control", and "supportive devices" based on gender. Manual therapy tended to be chosen more with increasing age and clinical experience. With increased education level, there were fewer choices for the use of pain control. Conclusion: This is the first data on how Korean physiotherapists manage PLBP patients using the vignette method. We were able to recognize the Korean physical therapist's decision on PLBP patients, and observed statistically significant correlations. This may aid in developing future research and education plans in the WHPT field.

• 임상간호연구
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• 제21권2호
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• pp.234-242
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• 2015

Purpose: The purpose of this study was to investigate the levels of knowledge and medication adherence to hormonal therapy (HT) and to identify the factors influencing medication adherence for patients with breast cancer. Methods: Data were collected from 136 patients undergoing adjuvant HT for breast cancer in 3 general hospitals from July 1 to August 14 in 2014 using self-report questionnaires. Data were analyzed using descriptive statistics, independent t-test, ANOVA, $Scheff{\grave{e}}$ test, and multiple regression. Results: The average of knowledge about HT was $5.15{\pm}2.22$ (Max 9), and that of medication adherence was $5.76{\pm}1.65$ (Max 8). Younger age, shorter duration of HT, more active participation in decision making for treatment, positive perception for impacts of HT, and stronger belief in cure were influencing factors on higher adherence level. Age, duration of HT, and perception on the impacts of hormonal therapy, and belief in cure explained 25.2% of the adherence. Conclusion: To improve the treatment adherence to hormonal therapy, patient education and involvement in decision making, and the tailored intervention for the patients with older age, and long treatment period of HT are needed. Additionally, the strategies for diminishing unintentional forgetting is necessary to be developed.

• 여성건강간호학회지
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• 제26권4호
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• pp.285-299
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• 2020

Purpose: This systematic review aims to identify factors associated with risk-reducing salpingo-oophorectomy (RRSO), including the uptake rate and decision timing, among women at high risk for hereditary breast and ovarian cancer (HBOC). Methods: We found 4,935 relevant studies using MEDLINE, Embase, CINAHL, and PsycINFO on July 6, 2020. Two authors screened the articles and extracted data. Twenty-four studies met the inclusion criteria. Quality assessment of articles was conducted using the Risk of Bias for Nonrandomized Studies tool. Results: Five types of factors were identified (demographic factors, clinical factors, family history of cancer, psychological factors, and objective cancer risk). The specific significant factors were older age, having child(ren), being a BRCA1/2 carrier, mastectomy history, perceived risk for ovarian cancer, and perceived advantages of RRSO, whereas objective cancer risk was not significant. The uptake rate of RRSO was 23.4% to 87.2% (mean, 45.2%) among high-risk women for HBOC. The mean time to decide whether to undergo RRSO after BRCA testing was 4 to 34 months. Conclusion: RRSO decisions are affected by demographic, clinical, and psychological factors, rather than objective cancer risk. Nonetheless, women seeking RRSO should be offered information about objective cancer risk. Even though decision-making for RRSO is a complex and multifaceted process, the psychosocial factors that may influence decisions have not been comprehensively examined, including family attitudes toward RRSO, cultural norms, social values, and health care providers' attitudes.

• Journal of Korean Neurosurgical Society
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• 제59권4호
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• pp.327-333
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• 2016

Adult spinal deformity (ASD) is one of the most challenging spinal disorders associated with broad range of clinical and radiological presentation. Correct selection of fusion levels in surgical planning for the management of adult spinal deformity is a complex task. Several classification systems and algorithms exist to assist surgeons in determining the appropriate levels to be instrumented. In this study, we describe our new simple decision making algorithm and selection of fusion level for ASD surgery in terms of adult idiopathic idiopathic scoliosis vs. degenerative scoliosis.

• 한국지능정보시스템학회:학술대회논문집
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• 한국지능정보시스템학회 2001년도 The Pacific Aisan Confrence On Intelligent Systems 2001
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• pp.478-485
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• 2001

In this study, we have developed a prototype of clinical decision support systems (CDSS) for diagnosing neurogenic bladder and compared its predicted diagnoses with the actual diagnoses using 92 patient\`s Urodynamic study cases. The CDSS was developed using a Visual Basic based on the evidence-based rules extracted from guidelines and other references regarding a diagnosis of neurogenic bladder. To compare with the 92 final diagnoses made by doctors at the Yonsei Rehabilitation Center, we classified all diagnoses into 5 groups. The predictive rates of the CDSS were: 48.0% for areflexic neurogenic bladder; 60.0% for hyperreflexic neurogenic bladder in a spinal shock recovery stage; 72.9% for hyperreflexic neurogenic bladder, and 80.0% for areflexic neurogenic bladder in a spinal shock stage, which was the highest predicted rate. There were only 2 cases for hyperreflexic neurogenic bladder in a well controlled detrusor activity, and its predictive rate was 0%. The study results showed that CDSS for diagnosing neurogenic bladder could provide a helpful advice on decision-making for doctors. The findings also suggest that physicians should be involved in all development stages to ensure that systems are developed in a fashion that maximizes their beneficial effect on patient care, and that systems are acceptable to both professionals and patients. The future studies will concentrate on including more validating the system.

• 생물정신의학
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• 제19권4호
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• pp.153-158
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• 2012

Understanding of a clinical trial is essential in developing clinical guideline and adopting evidence based practice. In designing and executing clinical trials, following ethical requirements should be considered : social value, scientific validity, fair subject selection, informed consent, favorable risk-benefit ratio, institutional review board, and respect for human subjects. According to the stage of drug development, purpose of trials, accumulated scientific data, clinical trials for drug development are classified as phase 1, 2, 3, and 4. Phases of clinical trials can be overlapped and the judgment of entering into the next phase should be considered highly strategically. In reading, evaluating and interpreting clinical trial reports, various skills and challenges exist. Patient sample composition, trial duration, selection of endpoints, responders and non-responders, placebo effect, patient recruitment, and extrapolation to the real world are the examples of those challenges. Treatment success will come from the well balanced approach of evidence based decision making and consideration of specific single case.

• Journal of Korean Neurosurgical Society
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• 제50권2호
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• pp.81-88
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• 2011

Objective : The purpose of this study was to analyze the clinical and anatomic features involved in determining treatment modalities for anterior communicating artery (AcoA) aneurysms. Methods : The authors retrospectively evaluated 112 AcoA aneurysms with pretreatment clinical features including age, Hunt and Hess grade, medical or neurological comorbidity, and anatomical features including aneurysm size, neck size, dome-to-neck ratio, vessel incorporation, multiple lobulation, and morphologic scoring system. Post-treatment clinical results were classified according to the Glasgow Outcome Scale, and anatomic results in coiled patients were classified according to the modified Raymond scale. Using multivariate logistic regression, the probabilities for decision making between surgical clipping and coil embolization were calculated. Results : Sixty-seven patients (60%) were treated with surgical clipping and 45 patients (40%) with endovascular coil embolization. The clinical factor significantly associated with treatment decision was age (${\geq}$65 vs. <65 years) and anatomical factors including aneurysm size (small or large vs. medium), dome-to-neck ratio (<2 vs. ${\geq}$2), presence of vessel incorporation, multiple lobulation, and morphologic score (${\geq}$2 vs. <2). In multivariate analysis, older patients (age, 65 years) had significantly higher odds of being treated with coil embolization relative to clipping (adjusted OR=3.78; 95% CI, 1.39-10.3; p=0.0093) and higher morphological score patients (${\geq}$2) had a higher tendency toward surgical clipping than endovascular coil embolization (OR=0.23; 95% CI, 0.16-0.93; p=0.0039). Conclusion : The optimal decision for treating AcoA aneurysms cannot be determined by any single clinical or anatomic characteristics. All clinical and morphological features need to be considered, and a collaborative neurovascular team approach to AcoA aneurysms is essential.