• Title/Summary/Keyword: Clinical Decision-Making

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Analysis on Relation between Rehabilitation Training Movement and Muscle Activation using Weighted Association Rule Discovery (가중연관규칙 탐사를 이용한 재활훈련운동과 근육 활성의 연관성 분석)

  • Lee, Ah-Reum;Piao, Youn-Jun;Kwon, Tae-Kyu;Kim, Jung-Ja
    • Journal of the Institute of Electronics Engineers of Korea CI
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    • v.46 no.6
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    • pp.7-17
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    • 2009
  • The precise analysis of exercise data for designing an effective rehabilitation system is very important as a feedback for planing the next exercising step. Many subjective and reliable research outcomes that were obtained by analysis and evaluation for the human motor ability by various methods of biomechanical experiments have been introduced. Most of them include quantitative analysis based on basic statistical methods, which are not practical enough for application to real clinical problems. In this situation, data mining technology can be a promising approach for clinical decision support system by discovering meaningful hidden rules and patterns from large volume of data obtained from the problem domain. In this research, in order to find relational rules between posture training type and muscle activation pattern, we investigated an application of the WAR(Weishted Association Rule) to the biomechanical data obtained mainly for evaluation of postural control ability. The discovered rules can be used as a quantitative prior knowledge for expert's decision making for rehabilitation plan. The discovered rules can be used as a more qualitative and useful priori knowledge for the rehabilitation and clinical expert's decision-making, and as a index for planning an optimal rehabilitation exercise model for a patient.

Feasibility and Clinical Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients with Traumatic Shock: A Single-Center 5-Year Experience

  • Gyeongho Lee;Dong Hun Kim;Dae Sung Ma;Seok Won Lee;Yoonjung Heo;Hancheol Jo;Sung Wook Chang
    • Journal of Chest Surgery
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    • v.56 no.2
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    • pp.108-116
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    • 2023
  • Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has recently gained popularity as an adjunct to resuscitation of patients with traumatic shock. However, the effectiveness of REBOA is still debated because of inconsistent indications across centers and the lack of medical records. The purpose of this study was to investigate the effectiveness and feasibility of REBOA by analyzing clinical results from a single center. Methods: This study included 96 patients who underwent REBOA between August 2016 and September 2021 at a regional trauma center according to the center's treatment algorithm for traumatic shock. Medical records, including the time of the decision to conduct the REBOA procedure, time of operation, type of aortic occlusion, and clinical outcomes, were collected prospectively and analyzed retrospectively. Patients were classified by REBOA protocol (group 1, 2, or 3) and survival status (survivor or non-survivor) for analysis. Results: The overall success rate of the procedure was 97.9%, and the survival rate was 32.6%. In survivors, blood pressure was higher than in non-survivors both before the REBOA procedure (p=0.002) and after aortic occlusion (p=0.03). The total aortic occlusion time was significantly shorter (p=0.001) and the proportion of partial aortic occlusion was significantly higher (p=0.014) among the survivors. The non-survivors had more acidosis (p<0.001) and higher lactate concentrations (p<0.001) than the survivors. Conclusion: REBOA may be a feasible bridge therapy for resuscitation of patients with traumatic shock. Prompt and accurate decision-making to perform REBOA followed by damage control surgery could improve survival rates and clinical outcomes.

Mission and Operation of Institutional Review Board (임상시험심사위원회의 임무와 운영)

  • Kim, Yong-Jin
    • Journal of Yeungnam Medical Science
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    • v.30 no.2
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    • pp.73-78
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    • 2013
  • An institutional review board (IRB) should independently safeguard the right, safety, and well-being of all clinical trial subjects. It should consist of members who are qualified and experienced to review and evaluate the science, medical aspects, and ethics of the proposed trial. They have to pursue continuing efforts to improve the standards of review. The levels of review include the full board review, expedited review, continuing review, or exempt from review, while the levels of decision-making include approval, conditional approval, deferred approval, and disapproval. Investigators must follow the approved protocols and regulations honestly, and it is the IRB's mission to audit clinical trial sites as well.

Radiomics and Deep Learning in Brain Metastases: Current Trends and Roadmap to Future Applications

  • Park, Yae Won;Lee, Narae;Ahn, Sung Soo;Chang, Jong Hee;Lee, Seung-Koo
    • Investigative Magnetic Resonance Imaging
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    • v.25 no.4
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    • pp.266-280
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    • 2021
  • Advances in radiomics and deep learning (DL) hold great potential to be at the forefront of precision medicine for the treatment of patients with brain metastases. Radiomics and DL can aid clinical decision-making by enabling accurate diagnosis, facilitating the identification of molecular markers, providing accurate prognoses, and monitoring treatment response. In this review, we summarize the clinical background, unmet needs, and current state of research of radiomics and DL for the treatment of brain metastases. The promises, pitfalls, and future roadmap of radiomics and DL in brain metastases are addressed as well.

Nursing Students' Experiences on Pediatric Nursing Simulation Practice (간호대학생의 아동간호시뮬레이션 실습경험)

  • Shin, Hyun-Sook;Shim, Ka-Ka
    • Journal of East-West Nursing Research
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    • v.16 no.2
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    • pp.147-155
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    • 2010
  • Purpose: The purpose of this study is to identify the simulation experiences of nursing baccalaureate students in their pediatric rotation. Methods: Fifty-three students responded to open-ended questions after three sessions of pediatric simulation experiences. The practice reflection notes of the students were also analyzed to identify educational outcomes coming from nursing simulation experiences. Results: The open-ended questions and practice reflection notes showed that simulated pediatric practice provided a virtual experience within safe environment. It also increased learning motivation, clinical decision making, and overall self-confidence of the nursing students. Conclusion: The findings of this study suggest that simulation can enhance the quality of nursing education through positive clinical experiences.

Ethical Awareness and Attitudes of Patients' Families towards DNR(Do-Not-Resuscitate) (심폐소생술금지(Do-Not-Resuscitate)에 대한 환자보호자의 윤리적 인식 및 태도)

  • Song, Kyung Ok;Jo, Hyun Sook
    • Journal of Korean Clinical Nursing Research
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    • v.16 no.3
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    • pp.73-84
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    • 2010
  • Purpose: The purpose of this study was to investigate the ethical awareness and attitude of patients' families towards Do-Not-Resuscitate(DNR), and thus provide basic information required to develop Korean appropriate DNR instructions and practice informed consent for DNR. Methods: During April 2010, 219 patient family members visiting the hospital were surveyed using a questionnaire. Results: Most of the participants preferred DNR to meaningless treatment for incurable patients. They recognized the necessity of explaining DNR to the patient with a terminal disease. They also requested DNR orders for themselves if they were in the same medical condition. In making a DNR decision, the patient's family agreed and preferred that it reflect the opinion of the patient and the doctor in charge. They also agreed that treatment should be given with the best efforts even if a DNR decision had been made for the patient. Conclusion: To make a decision on DNR for a patient who is terminally ill or for whom survival is not possible, a practice of informed consent and guidelines for executing the DNR reflecting the patient's opinion are required.

Types of Perception toward End-of-Life Medical Decision-making of Clinical Nurses: Q-Methodological Approach (말기환자의 의료적 의사결정에 관한 임상간호사의 인식: Q 방법론적 접근)

  • Jo, Kae-Hwa;Kim, Yeon-Ja;Sohn, Ki-Cheul
    • Journal of Hospice and Palliative Care
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    • v.15 no.1
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    • pp.18-29
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    • 2012
  • Purpose: We analyzed how clinical nurses in Korea perceive terminally ill patients' medical decision-making. Methods: The Q-methodology which analyzes the subjectivity of each item was used. We selected 34 Q-statements among those provided by each of 37 subjects and grouped them into a shape of normal distribution using a 9 point scale. The collected data were analyzed using a QUANL PC program. Results: Four types of perception toward medical decision-making were identified. Type I focuses on patient participation, and Type II emphasizes the role of health professionals. Type III is characterized by an open-minded culture toward death, and Type IV values the role of family members. Conclusion: The results of this study indicate the need for development of a multi-disciplinary curriculum medical decision-making and death for medical and nursing students.

The Problem-Solving Approach for Improving Walking Ability in Patient with Total Hip Replacement: Applied ICF Tool for Case Study (고관절 인공관절 치환술 환자의 보행능력 증진을 위한 문제해결 접근: ICF Tool을 적용한 단일사례연구)

  • Song, Hyun-seung;Kim, Suhn-yeop
    • The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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    • v.21 no.2
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    • pp.63-71
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    • 2015
  • Background: The purpose of the study, using the ICF Tool in the process of rehabilitation of artificial joint replacement surgery of the hip joint, goal setting and understanding of the problem, through the process of creating intervention strategies, useful clinical practical course for rehabilitation I try to present the data. Methods: Fracture was the left total hip replacement (THR) surgery due to women of 76 years old. I proceed in order screening, evaluation, diagnosis, prognosis, treatment planning and intervention, re-screening. Needs of the patient was walking short distances for using the toilet. In order to improve was carried out arbitration, after you have created a list of issues that limit the ability to walk short distances. Results: It was revealed improved results in self-paced walk test (SPWT) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to examine whether the goals. In addition, MMT VAS, DGI, and TUG is a detailed goal was improved. Conclusions: It can be shown objectively the results of interventions performed for the purpose of solving the problem which is grasped through clinical Practical course for short-range walking ability enhance patient THR. I considered practical clinical course using the ICF Tool would be useful.

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Congenital heart disease in the newborn requiring early intervention

  • Yun, Sin-Weon
    • Clinical and Experimental Pediatrics
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    • v.54 no.5
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    • pp.183-191
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    • 2011
  • Although antenatal diagnostic technique has considerably improved, precise detection and proper management of the neonate with congenital heart disease (CHD) is always a great concern to pediatricians. Congenital cardiac malformations vary from benign to serious conditions such as complete transposition of the great arteries (TGA), critical pulmonary and aortic valvular stenosis/atresia, hypoplastic left heart syndrome (HLHS), obstructed total anomalous pulmonary venous return (TAPVR), which the baby needs immediate diagnosis and management for survival. Unfortunately, these life threatening heart diseases may not have obvious evidence early after birth, most of the clinical and physical findings are nonspecific and vague, which makes the diagnosis difficult. High index of suspicion and astute acumen are essential to decision making. When patent ductus arteriosus (PDA) is opened Widely, many serious malformations may not be noticed easily in the early life, but would progress as severe acidosis/shock/cyanosis or even death as PDA constricts after few hours to days. Ductus dependent congenital cardiac lesions can be divided into the ductus dependent systemic or pulmonary disease, but physiologically quite different from each other and treatment strategy has to be tailored to the clinical status and cardiac malformations. Inevitably early presentation is often regarded as a medical emergency. Differential diagnosis with inborn error metabolic disorders, neonatal sepsis, persistent pulmonary hypertension of the newborn (PPHN) and other pulmonary conditions are necessary. Urgent identification of the newborn at such high risk requires timely referral to a pediatric cardiologist, and timely intervention is the key in reducing mortality and morbidity. This following review deals with the clinical presentations, investigative modalities and approach to management of congenital cardiac malformations presenting in the early life.

Clinical Nurses' Attitudes towards Termination of Pregnancy, Knowledge of, and Information Needs for, Prenatal Genetic Screening and Diagnosis (임상간호사의 낙태 태도, 산전기형아 검사 관련 지식도 및 정보요구도)

  • Shin, Gyeyoung;Jun, Myunghee;Kim, Hye-Kyung;Wreen, Michael
    • Journal of muscle and joint health
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    • v.26 no.3
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    • pp.184-194
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    • 2019
  • Purpose: There has been a considerable increase in the number of women giving birth at advanced age. The genetic screening of such women is highly desirable. Clinical nurses, however, are not adequately trained to assist such clients. This study aims at identifying the educational needs of nurses in order for them to provide better care and treatment for such women. Methods: 206 South Korean clinical nurses participated in this study. Study variables were measured by nurses' attitudes toward terminating pregnancy (ATP), knowledge of prenatal genetic screening and diagnosis (K-PGSD), and information needs for prenatal genetic screening and diagnosis (I-PGSD). The statistical analysis included T-test, analysis of variance and Pearson's Correlation Coefficient. Results: Mean scores were 34.57±5.73 for ATP, 16.44±3.04 for K-PGSD, and 78.81±10.95 for I-PGSD. The findings demonstrate that nurses have high information needs (I-PGSD) to take better care of women who have positive results from their amniocentesis tests. Conclusion: Information needs among clinical nurses are not currently being met. Education for nurses must include training in counseling to encourage patients' autonomous decision-making regarding their pregnancies.