• 제목/요약/키워드: Clinical Decision-Making

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한의진단 Ontology 구축과 평가 (Development and Evaluation of Ontology for Diagnosis in Oriental Medicine)

  • 신상우;정길산;박경모;김선호;박종현
    • 동의생리병리학회지
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    • 제20권1호
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    • pp.202-208
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    • 2006
  • The goal of this study is to develop knowledge representation method for the construction and evaluation of ontology for diagnosis in oriental medicine. To develop the expert system for decision making on diagnosis and treatment, the systematic and structural knowledge which can be processible in EMR(Electronic Medical Record) must be precedent, and the Computational Process which control the system as well. This study set up an ontology as a trial model to represent the oriental medical knowledge into the machine processible one. Protege 2.1 has been used to build the ontology, and the serialization format of our ontology is the XML document based on OWL. The components of oriental medical diagnosis was arranged with the combination of symptoms which belong to the certain symptom patterns. Then natural language which expresses the oriental medical diagnosis components were converted into the logical sentence, and individual characteristic symptoms into each values of specific properties. In addition to the study, the diagnosis software for oriental medicine was developed and it used the ontology which we developed. Sequently, we tested the software to confirm the appropriateness of ontology. The result of the test shows that diagnostic questions are automatically formulated according to the diagnosis components of this ontology and that as such diagnostic results are induced. Therefore, the ontology system in this study will be efficient to develop the diagnosis program and useful as a tool for doctors to make decision. But, it is not recommendable to apply the system to the clinical environment until the clear diagnosis standards are introduced, and the more reliable diagnosis program can be developed based on the more appropriate ontology mentioned above.

혈관성 치매에 대한 근거기반 의한 협진 매뉴얼 제안 (Proposal of Evidence-based East-West Integrative Medicine Manual for Vascular Dementia)

  • 김보민;조희근;강형원;최성열;송민영;설재욱;임정태
    • 대한한의학회지
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    • 제40권1호
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    • pp.46-62
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    • 2019
  • Objectives: This study was made by Chung Yeon Korean Medicine Hospital in order to perform appropriate East-West integrative medicine. The purpose of this manual is to support decision-making and communication in the implementation of the East-West cooperative treatment of vascular dementia. Methods: In order to carry out this study, it is based on search terms such as 'vascular dementia', 'acupuncture', 'herbal medicine', 'integrative medicine', 'chinese traditional medicine', and 'cognitive function' in databases such as MEDLINE, EMBASE, OASIS and CNKI We collected references. The drafting proceeded with the collaboration of two specialists of the Korean medicine, and the disagreement on the basis of the quotation was determined through a two person agreement. After, The draft was reviewed by a western medical doctor(rehabilitation specialist). Then, The opinions of the entire medical staff of the committee were reflected in the draft and finalized the agreement. Results: Through this study, manuals for diagnosis, treatment, and other considerations in the process of applying East-West integrative medicine to vascular dementia were derived. Conclusions: This study has significance in that it provides manual information about the decision structure, treatment contents, role distribution, etc. of East-West integrative medicine within the medical institution that conducts the vascular dementia consultation. In order for this study to function as a generalized medical guideline, it is necessary to improve the research methodology and carry out professional consensus procedures.

Endoscopic Ultrasonography in Pediatric Patients with Pancreatobiliary Disease: Single-Center Trial

  • Demirbas, Fatma;Kaymazli, Mustafa;Caltepe, Gonul;Abbasguliyev, Hasan;Kalayci, Ayhan Gazi;Bektas, Ahmet
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제24권2호
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    • pp.164-172
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    • 2021
  • Purpose: The use of Endoscopic ultrasonography (EUS) in pediatric patients is not as common as in adults. The aim of this study is to evaluate the role of EUS in the diagnosis of pancreatobiliary disease in childhood. Methods: Between December 2016 and January 2018, the findings of patients who underwent EUS were evaluated retrospectively. Results: Of the 41 patients included in the study 25 were girls (61.0%), mean age was 12.2±4.2 years. EUS was performed for biliary colic in 21 (51.2%), for recurrent pancreatitis in 12 (29.2%), for cholecystitis/cholangitis in 5 (12.2%), and for acute pancreatitis in 3 (7.4%) patients. EUS had a significant clinical effect in the decision of treatment and follow-up of 6/21 biliary colic cases, in diagnosis and follow-up of 6/12 recurrent pancreatitis cases, in decision-making and monitoring of invasive procedures (ERCP/surgery) of 3/5 acute cholecystitis/cholangitis and 2/3 of acute pancreatitis cases as well as in follow-up of the other cases. The effectiveness of EUS in determining direct treatment and invasive intervention was 43.9%. None of the patients had complications related to the EUS procedure. Conclusion: Although current guidelines show that EUS can be used in pediatric patients, this is limited to a few published studies. In this study, it is shown that EUS is a safe method for the diagnosis, follow-up and treatment of common pancreatobiliary pathologies in childhood.

Deep-learning performance in identifying and classifying dental implant systems from dental imaging: a systematic review and meta-analysis

  • Akhilanand Chaurasia;Arunkumar Namachivayam;Revan Birke Koca-Unsal;Jae-Hong Lee
    • Journal of Periodontal and Implant Science
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    • 제54권1호
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    • pp.3-12
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    • 2024
  • Deep learning (DL) offers promising performance in computer vision tasks and is highly suitable for dental image recognition and analysis. We evaluated the accuracy of DL algorithms in identifying and classifying dental implant systems (DISs) using dental imaging. In this systematic review and meta-analysis, we explored the MEDLINE/PubMed, Scopus, Embase, and Google Scholar databases and identified studies published between January 2011 and March 2022. Studies conducted on DL approaches for DIS identification or classification were included, and the accuracy of the DL models was evaluated using panoramic and periapical radiographic images. The quality of the selected studies was assessed using QUADAS-2. This review was registered with PROSPERO (CRDCRD42022309624). From 1,293 identified records, 9 studies were included in this systematic review and meta-analysis. The DL-based implant classification accuracy was no less than 70.75% (95% confidence interval [CI], 65.6%-75.9%) and no higher than 98.19 (95% CI, 97.8%-98.5%). The weighted accuracy was calculated, and the pooled sample size was 46,645, with an overall accuracy of 92.16% (95% CI, 90.8%-93.5%). The risk of bias and applicability concerns were judged as high for most studies, mainly regarding data selection and reference standards. DL models showed high accuracy in identifying and classifying DISs using panoramic and periapical radiographic images. Therefore, DL models are promising prospects for use as decision aids and decision-making tools; however, there are limitations with respect to their application in actual clinical practice.

전통적 원가계산과 활동기준 원가계산의 비교연구 (A Case Study on Activity-Based Costing for a hospital)

  • 정용모;양동현;이용철;임복희
    • 한국병원경영학회지
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    • 제10권1호
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    • pp.25-47
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    • 2005
  • This study was purposed to find out the difference of the accounting of practical cost between the ABC system and the traditional costing system applied in a hospital, to verified general effect of ABC. Methods: This case study deals with the method of calculation, the cost information that is produced at K hospital in Busan. To examine ABC system and traditional costing system, applying them to the clinical pathology, radiology, physics in K hospital. Results: As a result of costing analysis, it is showed maximum difference of 50% between ABC and traditional cost. compared in revenue center, it occurs the difference of 15% of them. considering the result, it is confirmed that ABC could be used as a means to offer more precise information. therefore, ABC makes possible to produce precise costing information and grasp the driver of cost, and it is possible to reduce cost effectively. Conclusion: ABC provide six benefits: (1) more accurate of service delivered (2) inproved pricing and contracting strategies (3) improved management decision making capability (4) greater ease of determining relevant costs (5) reduced nonvalue added costs.

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간호실무현장에서 요구하는 간호대학 졸업생들의 간호핵심역량 (Nursing Core Competencies Needed in the Fields of Nursing Practice for Graduates in Nursing)

  • 이선경;박선남;정석희
    • 간호행정학회지
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    • 제18권4호
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    • pp.460-473
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    • 2012
  • Purpose: This study was done to provide information on issues of nursing core competencies needed in the fields of nursing practice for graduates in nursing, from the perspective of nursing managers, and to make suggestion for improving nursing education programs. Methods: Ten nursing managers participated in this study. They were in charge of clinical nursing education in the fields of nursing practice. Data were collected using focus group interviews and analyzed with the content analysis methodology of Downe - Wamboldt's. Results: Six types of nursing core competency - therapeutic nursing competency, professional nursing competency, administrative nursing competency, humanistic nursing competency, relational nursing competency, and personal nursing competency - were identified as nursing core competencies needed in the fields of nursing practice for graduates in nursing. Conclusion: Results of the study show important evidence for decision-making about nursing curriculum revision based on nursing core competency, both in the classroom and in nursing practice areas. These results should contribute to the development of evaluation indicators for nursing students or new nurses. Further research is required to measure degree of nursing core competency in graduates of nursing and to identify the effect of competency-based education for improving nursing core competency.

레이저 우식진단기기 'DIAGNODent$^{(R)}$'의 활용 (Use of laser fluorescence device 'DIAGNODent$^{(R)}$' for detecting caries)

  • 이병진
    • 대한치과의사협회지
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    • 제49권8호
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    • pp.461-471
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    • 2011
  • The detection of carious lesions is a key point to apply appropriate preventive measures or operative treatment of dental caries. A laser fluorescence device DIAGNOdent$^{(R)}$ (KaVo, Biberach, Germany) has also been shown to be of additional clinical value in the detection of initial caries. This report focus on the DIAGNOdent$^{(R)}$ for caries detection. DIAGNOdent$^{(R)}$ irradiate visible red light at a wavelength of 655 nm to elicit near-infrared fluorescence from caries lesion. This device is known as a reproducible method for caries detection, with good sensitivity and specificity especially for caries detection on occlusal and accessible smooth surfaces. DIAGNOdent$^{(R)}$ tended to be more sensitive method of detecting occlusal dentinal caries, however, showed more false-positive diagnoses than the visual inspection. So Clinician should not use the device as a clinician's primary diagnostic method and it is recommended that the device should be used in the decision-making process in relation to the diagnosis of caries as a second opinion in cases of doubt after visual inspection. The trend of modern dentistry would be a preventive approach rather than invasive treatment of the disease. This is possible only with early detection and respective preventive measures, DIAGNOdent$^{(R)}$ can help the changes.

미만성 간질성 폐질환의 개흉 폐 생검 (Open Lung Biopsy for Diffuse Interstitial Lung Disease)

  • 성숙환;서필원
    • Journal of Chest Surgery
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    • 제27권10호
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    • pp.850-853
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    • 1994
  • Open lung biopsy was performed in thirty patients for the diagnosis and staging evaluation of interstitial lung disease during the period from January 1987 until December 1992. The age of the patients ranged from 14 to 71 years [mean 48 years], and the patients consisted of 14 males and 16 females. Preoperative FEV1`s were from 0.80 liter to 3.88 liters [mean 1.66]. Other non-invasive diagnostic studies such as PCNA, bronchoalveolar lavage, TBLB, and gallium scan were also done in addition to X-ray and high-resolution chest CT. Tweaty-eight were correctly diagnosed and 2 cases were not [diagnostic yield rate 93.3%]. Among the 28 cases,pathologic diagnosis influenced further treatment regimens and prognostic expectations in 23 cases [82.1%]. The diagnostic non-invasive studies other than open lung biopsy yielded a correct diagnosis without staging only in 5 cases. There was no mortality and only one complication, ARDS ; however, the patient recovered after 5 days ventilator support. Open lung biopsy, which is the gold standard for the diagnosis and staging evaluation of interstitial lung disease can be done safely and has value in clinical decision making. Also knowledge of the involvement of the lesion is important for proper selection of the biopsy site.

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치아우식증 탐지 및 평가의 기준 체계, ICDAS에 대한 고찰 (Review on International Caries Detection and Assessment System)

  • 김희은
    • 한국치위생학회지
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    • 제14권5호
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    • pp.609-615
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    • 2014
  • Objectives : In most developed countries there has been a substantial decrease in the prevalence of dental caries in children of 12 years old over the past 40 years. This change in epidemiology highlights the importance of preventive management in dentistry. For successful management of early caries lesions, it is essential to detect and assess the pathological changes of dental caries. Therefore, the purpose of this study was to investigate the overview of International Caries Detection and Assessment System(ICDAS) criteria for the detection and assessment of early caries lesions by literature reviews. Methods : The author reviewed the MEDLINE search by the key words of 'caries assessment', 'caries detection', 'caries measurement', and 'ICDAS'. Results : This literature review provided an overview of International Caries Detection and Assessment System(ICDAS) criteria for the detection and assessment of early caries lesions. This article showed the principles, concept, and primary caries detection criteria of the ICDAS. The ICDAS can macroscopically measure the enamel surface changes and potential histological depth of caries lesions by the surface characteristics of the teeth. The ICDAS criteria allow researchers and clinicians to choose the stage of dental caries and characteristics for assessment. Conclusions : ICDAS can be an adjunct method to clinical decision making and preventive treatment planning.

부인암 전문간호사 제도 확립을 위한 기초조사 (A Fundamental Study for a System Establishment of Advanced Practice Nursing for Gynecological Cancer Patients)

  • 박재순
    • 여성건강간호학회지
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    • 제12권2호
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    • pp.87-96
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    • 2006
  • Purpose: This study was conducted to provide fundamental information for a system establishment of advanced practice nursing for gynecological cancer patients (APN-GCP). Method: Data was collected by focus group and individual interviews and analyzed in the framework of the Grounded theory method mapped by Strauss and Corbin (1990). There were 13 subjects in this study (nurses, doctors, patient and her family). Result: We identified 87 concepts, 22 sub-categories, and 10 categories. Categories for role expectation were arrangement of diagnosis and treatment process, giving information of treatment course, support of treatment process, patients' right toward making a decision of treatment, counseling and teaching after discharge from hospital, medical insurance and financial problems, counseling about sexual problems and use of family and community resources. All subjects perceived the necessity of an APN-GCP. An APN-GCP requires over 2$\sim$7 years clinical experience and a master's degree. Services would be performed from initial registration to termination of treatment or death, and accomplished on an outpatient clinic basis. Conclusion: The nursing delivery system and curriculum should be developed for a women's health nurse practitioner including APN-GCP. As a further step, cost-effectiveness and projected estimation of manpower of APN-GCP should be studied in the future.

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