• Title/Summary/Keyword: Clinical Decision-Making

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Data Mining Approach to Clinical Decision Support System for Hypertension Management (고혈압관리를 위한 의사지원결정시스템의 데이터마이닝 접근)

  • 김태수;채영문;조승연;윤진희;김도마
    • Proceedings of the Korea Inteligent Information System Society Conference
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    • 2002.11a
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    • pp.203-212
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    • 2002
  • This study examined the predictive power of data mining algorithms by comparing the performance of logistic regression and decision tree algorithm, called CHAID (Chi-squared Automatic Interaction Detection), On the contrary to the previous studies, decision tree performed better than logistic regression. We have also developed a CDSS (Clinical Decision Support System) with three modules (doctor, nurse, and patient) based on data warehouse architecture. Data warehouse collects and integrates relevant information from various databases from hospital information system (HIS ). This system can help improve decision making capability of doctors and improve accessibility of educational material for patients.

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Reducing Medical Errors : Patients' Self Protect Behaviors and Involvement in Decision Making (의료과오 감소를 위한 환자의 자기보호행동 및 의사결정 참여)

  • An Kyung-Eh;Kim Jeong-Eun;Kang Kim Min-Ah;Jung Yoen-Yi
    • Health Policy and Management
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    • v.16 no.3
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    • pp.70-85
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    • 2006
  • The purposes of this study were (1) to describe patients' behaviors to protect themselves from medical errors and their involvement in decision making on the diagnostic and treatment procedures (2) to examine whether patients' characteristics, such as age, sex, education, experience of hospitalization and/or surgery influence their self protect behaviors and involvement in decision making on the diagnostic and treatment procedures. A survey was conducted with 99 patients visited one university hospital in Seoul, Korea. A 20-item questionnaire, a 4-point Likert scale, was used to measure the degree of patients' active involvement in decision making; patients' self protect behaviors regarding medication, hospitalization, and surgery; and communication (Cronbach's alpha=0.801). SPSS 12.0 was used for the descriptive and correlation analysis. Only 6.1% of the participants were involved in the decision making process for the diagnostic tests and treatment. More patients did self-protect behaviors associated with the medication than other areas but widely varied from 18.2 to 94.3 % among various items. More people with age of 60 or older compared to people in younger age groups reported more protect behaviors particularly associated with medication. Patient education is needed to improve their active role in preventing medical errors and to promote patients' safety.

Influence of teamwork skill and decision making competency on nursing work performance (간호사의 팀워크스킬과 의사결정역량이 간호업무성과에 미치는 영향)

  • Mun, Mi Yeong;Kim, Mi Yeon
    • Journal of the Korean Data and Information Science Society
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    • v.27 no.5
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    • pp.1361-1373
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    • 2016
  • This study was undertaken to investigate the influence of teamwork skill and decision making competency on nursing work performance. A total of 170 nurses more than one years working experience were recruited from two university hospitals. Data were collected during March, 16 to 25, 2016 using a structured self-report questionnaires. Data were analyzed using the IBM SPSS/WIN 21.0 program. Teamwork skill and decision making competency for nursing work performance showed significant positive correlation. The significant predictors of nursing work performance among nurses were total clinical experience (${\beta}=.23$, p<.001), teamwork skill (${\beta}=.61$, p<.001) and decision making competency (${\beta}=.13$, p=.015). These variables explained 66% of the variance in nursing work performance among nurses. The results indicate that nurses' teamwork skill and decision making competency are factors positively influencing on nursing work performance.

Mediation effect of career self-regulation on the relation between family strength and career decision-making difficulties (대학생의 가족건강성과 진로결정 어려움 간의 관계에서 진로자기조절의 매개효과)

  • Shin, Yun-Jeong;Jun, Joo-Ram
    • Korean Journal of Family Social Work
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    • no.56
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    • pp.105-133
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    • 2017
  • The purpose of this study was to examine the relationship between family strength and career decision-making difficulties and the mediating effect or career self-regulation. The results of the present study suggested the significance of family strength and career self-regulation in understanding career decision-making difficulties. With 172 Korean college students, there were both significant direct and indirect effects from family strength to career decision-making difficulties. Specifically, the mediation roles of career self-regulation was confirmed. Comparing the partial mediation model with full mediation model, the partial mediation model fits better with the data. These results have significant clinical implication that counseling practitioners need to address the possible influence of family strength on college student's perceived difficulties in career decision-making process and to assist students develop appropriate level of competencies of regulating one's emotion, thoughts, and behavior related to career problems.

Lifting Shadows off the End-of-Life Care: Hopes and Beliefs on Video Decision Support Tools for Advance Care Planning

  • Jeong, Heon-Jae;Yoon, Hyeyeon
    • Journal of Hospice and Palliative Care
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    • v.19 no.1
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    • pp.1-4
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    • 2016
  • As advance care planning is taking center stage in the field of end-of-life care, various tools have been developed to aid in the often emotional and difficult decision-making process. Video decision support tools are one of the most promising means of assistance, of which the modus operandi is to provide more comprehensive and precise information of medical procedures to patients and their families, allowing them to make better informed decisions. Despite such value, some are concerned about its potential negative impact. For example, video footages of some procedures may be shocking and unpalatable to non-medical professionals, and patients and families may refuse the procedures. One approach to soften the sometimes unpleasant visual of medical procedures is to show less aggressive or more relaxing scenes. Yet another potential issue is that the objectivity of video decision support tools might be vulnerable to the very stakeholders who were involved in the development. Some might argue that having multiple stakeholders may function as checks and balances and provide collective wisdom, but we should provide more systematic guarantee on the objectivity of the visual decision aids. Because the decision of the modality of an individual's death is the last and most significant choice in one's life, no party should exert their influence on such a delicate decision. With carefully designed video decision support tools, our patients will live the last moments of their lives with dignity, as they deserve.

The Development and Effects of a Tailored Simulation Learning Program for New Nursing Staffs in Intensive Care Units and Emergency Rooms (중환자실과 응급실 초보간호사를 위한 맞춤형 시뮬레이션 학습프로그램 개발 및 효과)

  • Kim, Eun Jung;Kang, Hee-Young
    • The Journal of Korean Academic Society of Nursing Education
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    • v.21 no.1
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    • pp.95-107
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    • 2015
  • Purpose: The purpose of this study was to develop a tailored simulation learning (SL) program and to evaluate the effects of the program on the clinical competency, clinical decision-making competency, and communicative competency of new nursing staffs in intensive care units (ICU) and emergency rooms (ER). Methods: In this quasi-experimental study, fifteen nurses were assigned to the experimental group and fifteen to the control group. The experimental group was given the SL program of four sessions, whereas the lectures of four sessions were given to the control group. Data were analyzed using a $x^2$-test, Mann-Whitney U test, and Kruskal-Wallis test with an SPSS program. Analysis of covariance was used to treat the covariate of pre communicative competency between the experimental and control groups. Results: Based on the education needs of new nursing staffs in ICUs and ERs, three learning scenarios and one evaluating scenario were developed for the SL program. The score for clinical competency, clinical decision-making competency, and communicative competency were significantly higher in the experimental group compared with the control group. Conclusion: The SL program is an effective learning strategy for new nursing staffs in ICUs and ERs. These findings suggest that an SL program be offered as an alternative for new nurse orientation and continuing nurse education.

Nurses′ Research Activities and Barriers of Research Utilization (임상 간호사들의 연구 관련 활동 실태 및 연구결과 활용의 장애 요인)

  • 오의금;오현주;이윤정
    • Journal of Korean Academy of Nursing
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    • v.34 no.5
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    • pp.838-848
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    • 2004
  • Purpose: This study was to describe nurses' research activities, perceptions and performances of evidence-based practice and barriers to the use of research evidence in nursing practice in Korea. Method: A cross-sectional survey design was used. A questionnaire, except for Barriers Scale, was developed for the study. Data was collected from a convenient sample of 437 registered nurses working at research and education oriented university hospitals. Result: Nurses' research-related activities were relatively low compared to previous studies. Also perceptions and performances of evidence based nursing practice were low. Preferred informational resources for clinical decision making were identified as ward manuals/clinical guidelines, manager/senior nurses, and literature/research. The major barriers to research utilization were a lack of implication for practice along with inadequate facilitation to implement research evidence and difficulty understanding research written in English. Priorities of barriers factor were Administrator, Communication, Adopter, and Research. Conclusion: The findings provide directions for future training, education, and managerial policy to achieve successful evidence based nursing practice.

Clinical study on mandibular invasion by oral cancer (구강암의 하악골 침윤에 관한 임상적 연구)

  • Kim, B.Y.;Kim, H.J.;Cha, I.H.;Lee, E.W.
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.16 no.4
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    • pp.508-514
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    • 1994
  • For the complete cure of oral cancer suspected to have invaded the mandible in clinical & radiological evaluation, the mandible resection in planned. The aim of this clinical study was to help in decision making in the method & the extent of the mandibular resection surgery. This study was conducted on 46 oral cancer patients, who received cancer surgery including mandibulectomy. And we evaluated the relationship between the pathologic results of resected mandible and the location, size and clinical newk node involvement, tumor cell differentiation. The results are that ; (1) Hiher incidence of bone invasion patterns were observed in tumor of mouth floor & gingiva compared to those of tongue & tonsil, and (2) No significant relationship was found between bone invasion of tumor and tumor size, neck node involvement tumor cell differentiation. The approximation between tumor and bone seems to be the most reliable factor among the other factors in decision making of mandibular resection.

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A Case Report of Intervention Strategy applied ICF Tool about Floor to Stand and Stand to Floor for Stroke Patient (ICF Tool을 적용한 뇌졸중 환자의 바닥에 앉고 일어서기에 대한 중재전략의 증례)

  • Yun, Tae-Won;Kim, Tae-Yoon
    • Journal of Korean Physical Therapy Science
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    • v.18 no.1
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    • pp.33-49
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    • 2011
  • The process of physical therapy uses a problem-solving approach to enhance a patients's functioning status. The International Classification of Functioning, Disability and Health(ICF) is the common concept for the functioning in the world. Physical therapists require the ability to identify problems, formulate hypothesis, and plan intervention strategies through clinical reasoning. In the clinical process, physical therapists need to use standard and common languages in speech and in documentation. The purpose of this study was to suggest the process of making strategy for efficient intervention, examining and evaluating the functional problem of the person with stroke using ICF tools. For the first step in this process model, therapists could list the information relating to functional problems used by the ICF Core set and then could identify the interaction among the problems using the ICF assessment sheet. For the next step, therapist is needed to make the hypothesis and hypothesis testing, and then set a primary functional goals and therapeutic goals in detail after prioritizing the problems to be managed based on the problem list. Finally, after setting the identified problems as the purpose of intervention through the hypothesis testing, therapist could do some intervention after making a plan to solve these problems, and find out the outcomes using the ICF evaluation display. This report illustrates how to apply the process based on ICF concept into physical therapy practice. Making a decision for the most efficient intervention requires that therapists use the clinical reasoning process based on ICF concept.

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