• 제목/요약/키워드: Clinical Practice Guidelines

검색결과 453건 처리시간 0.033초

Efficiency and accuracy of artificial intelligence in the radiographic detection of periodontal bone loss: A systematic review

  • Asmhan Tariq;Fatmah Bin Nakhi;Fatema Salah;Gabass Eltayeb;Ghada Jassem Abdulla;Noor Najim;Salma Ahmed Khedr;Sara Elkerdasy;Natheer Al-Rawi;Sausan Alkawas;Marwan Mohammed;Shishir Ram Shetty
    • Imaging Science in Dentistry
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    • 제53권3호
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    • pp.193-198
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    • 2023
  • Purpose: Artificial intelligence (AI) is poised to play a major role in medical diagnostics. Periodontal disease is one of the most common oral diseases. The early diagnosis of periodontal disease is essential for effective treatment and a favorable prognosis. This study aimed to assess the effectiveness of AI in diagnosing periodontal bone loss through radiographic analysis. Materials and Methods: A literature search involving 5 databases (PubMed, ScienceDirect, Scopus, Health and Medical Collection, Dentistry and Oral Sciences) was carried out. A specific combination of keywords was used to obtain the articles. The PRISMA guidelines were used to filter eligible articles. The study design, sample size, type of AI software, and the results of each eligible study were analyzed. The CASP diagnostic study checklist was used to evaluate the evidence strength score. Results: Seven articles were eligible for review according to the PRISMA guidelines. Out of the 7 eligible studies, 4 had strong CASP evidence strength scores (7-8/9). The remaining studies had intermediate CASP evidence strength scores (3.5-6.5/9). The highest area under the curve among the reported studies was 94%, the highest F1 score was 91%, and the highest specificity and sensitivity were 98.1% and 94%, respectively. Conclusion: AI-based detection of periodontal bone loss using radiographs is an efficient method. However, more clinical studies need to be conducted before this method is introduced into routine dental practice.

족관절 인대 손상 치료 동향: 대한족부족관절학회 회원 설문조사 분석 (Current Trends in the Treatment of Ankle Ligament Injuries: Analysis of the Korean Foot and Ankle Society (KFAS) Member Survey)

  • 조병기;조재호;이명진;이준영;배서영;2021 대한족부족관절학회 학술위원회
    • 대한족부족관절학회지
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    • 제26권1호
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    • pp.22-29
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    • 2022
  • Purpose: Despite continuous updates of standard treatment guidelines for acute ankle sprain and chronic ankle instability (CAI), in practice preferred treatment protocols vary widely. Based on a Korean Foot and Ankle Society (KFAS) member survey, this study reports current trends in the management of ankle ligament injuries. Materials and Methods: A web-based questionnaire containing 34 questions was sent to all KFAS members in September 2021. Questions mainly addressed clinical experience and preferences for the diagnosis and treatment of ankle ligament injuries. Answers with a prevalence of ≥50% among respondents were considered to reflect tendencies. Results: Eighty-four of the 550 members (15.3%) responded. Answers that showed a tendency were as follows: commonest additional image study (ultrasound), conservative treatment modality (immobilization, oral medication), frequency of surgical treatment (<5 cases per annum), most important factor when deciding on surgical treatment (activity level, e.g., occupation or sport), and commonest surgical procedure (open ligament repair). Answers that showed a tendency for CAI were as follows: most important symptom (repeated sprain, giving way), radiological factors (talar tilt, osteochondral lesion, anterior talar translation), and patient factors (occupation, sports activities, recurrent instability after surgery, etc.). For decision making regarding surgical treatment and method, the most preferred surgical procedure was the modified Broström procedure, and the most common repair technique was suture anchor technique. The following were considered poor prognostic factors; generalized laxity, failed previous surgery, cavovarus, severe mechanical instability, heavy work, obesity, and dissatisfaction after surgery because of residual pain. Conclusion: This study updates information regarding current trends in the management of ankle ligament injuries in Korea, and reveals consensus opinions and variations in approaches to patients with an acute or chronic injury. The divergence of approaches identified indicates the need for further studies to determine standard guidelines and long-term results.

Characterization of food allergies in patients with atopic dermatitis

  • Kwon, Jaryoung;Kim, Jungyun;Cho, Sunheui;Noh, Geunwoong;Lee, Sang Sun
    • Nutrition Research and Practice
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    • 제7권2호
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    • pp.115-121
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    • 2013
  • We examined the characteristics of food allergy prevalence and suggested the basis of dietary guidelines for patients with food allergies and atopic dermatitis. A total of 2,417 patients were enrolled in this study. Each subject underwent a skin prick test as well as serum immunoglobulin E (IgE) measurement. A double-blind, placebo-controlled food challenge was conducted using milk, eggs, wheat, and soybeans, and an oral food challenge was performed using beef, pork, and chicken. Food allergy prevalence was found among 50.7% in patients with atopic dermatitis. Among patients with food allergies (n = 1,225), the prevalence of non-IgE-mediated food allergies, IgE-mediated food allergies, and mixed allergies was discovered in 94.9%, 2.2%, and 2.9% of the patients, respectively. Food allergy prevalence, according to food item, was as follows: eggs = 21.6%, milk = 20.9%, wheat = 11.8%, soybeans = 11.7%, chicken = 11.7%, pork = 8.9% and beef = 9.2%. The total number of reactions to different food items in each patient was also variable at 45.1%, 30.6%, 15.3%, 5.8%, 2.2%, and 1.0% for 1 to 6 reactions, respectively. The most commonly seen combination in patients with two food allergies was eggs and milk. The clinical severity of the reactions observed in the challenge test, in the order of most to least severe, were wheat, beef, soybeans, milk, pork, eggs, and chicken. The minimum and maximum onset times of food allergy reactions were 0.2-24 hrs for wheat, 0.5-48 hrs for beef, 1.0-24 hrs for soybeans, 0.7-24 hrs for milk, 3.0-24 hrs for pork, 0.01-72 hrs for eggs, and 3.0-72 hrs for chicken. In our study, we examined the characteristics of seven popular foods. It will be necessary, however, to study a broader range of foods for the establishment of a dietary guideline. Our results suggest that it may be helpful to identify food allergies in order to improve symptoms in patients with atopic dermatitis.

Impact of Cellular Immune Function on Prognosis of Lung Cancer Patients after Cytokine-induced Killer Cell Therapy

  • Jin, Congguo;Li, Jia;Wang, Yeying;Chen, Xiaoqun;Che, Yanhua;Liu, Xin;Wang, Xicai;Sriplung, Hutcha
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권15호
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    • pp.6009-6014
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    • 2014
  • Aims: To investigate changes in cellular immune function of patients with lung cancer before and after cytokine-induced killer (CIK) cell therapy and to identify variation effects on overall survival (OS) and progression-free survival (PFS). Materials and Methods:A total of 943 lung cancer patients with immune dysfunction were recruited from January 2002 to January 2010, 532 being allocated to conventional therapy and 411 to CIK therapy after a standard treatment according to the NCCN Clinical Practice Guidelines. All the patients were investigated for cellular immune function before and after therapy every three months. and clinical prognostic outcomes were analyzed. Results: After six courses of treatment, immune function was much improved in patients receiving CIK cells therapy as compared to controls. The percentages of recurrence and/or metastases for patients undergoing CIK cell therapy was 56.2% and 49.1% respectively but 78.6% and 70.3% among controls (p<0.001). The median OS times for CIK cell therapy and control groups were 48 and 36 months respectively. The OS rates at 12, 36, 60, 84 months in CIK treated patients were 97.8%, 66.9%, 27.7%, and 4.1% while they were 92.3%, 44.5%, 9.2%, and 1.5% in controls. OS and PFS were significantly different by log rank test between the two groups and across the three immune improvement classes. Conclusions: The immune function of lung cancer patients was improved by CIK cell therapy, associated with an increase in the OS rate and extension of the time to recurrence and/or metastasis.

Korean Guidelines for Diagnosis and Management of Interstitial Lung Diseases: Part 2. Idiopathic Pulmonary Fibrosis

  • Lee, Sang Hoon;Yeo, Yoomi;Kim, Tae-Hyung;Lee, Hong Lyeol;Lee, Jin Hwa;Park, Yong Bum;Park, Jong Sun;Kim, Yee Hyung;Song, Jin Woo;Jhun, Byung Woo;Kim, Hyun Jung;Park, Jinkyeong;Uh, Soo-Taek;Kim, Young Whan;Kim, Dong Soon;Park, Moo Suk;Korean Interstitial Lung Diseases Study Group
    • Tuberculosis and Respiratory Diseases
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    • 제82권2호
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    • pp.102-117
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    • 2019
  • Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial pneumonia, which presents with a progressive worsening dyspnea, and thus a poor outcome. The members of the Korean Academy of Tuberculosis and Respiratory Diseases as well as the participating members of the Korea Interstitial Lung Disease Study Group drafted this clinical practice guideline for IPF management. This guideline includes a wide range of topics, including the epidemiology, pathogenesis, risk factors, clinical features, diagnosis, treatment, prognosis, and acute exacerbation of IPF in Korea. Additionally, we suggested the PICO for the use of pirfenidone and nintendanib and for lung transplantation for the treatment of patients with IPF through a systemic literature review using experts' help in conducting a meta-analysis. We recommend this guideline to physicians, other health care professionals, and government personnel in Korea, to facilitate the treatment of patients with IPF.

Quality indicators for cervical cancer care in Japan

  • Watanabe, Tomone;Mikami, Mikio;Katabuchi, Hidetaka;Kato, Shingo;Kaneuchi, Masanori;Takahashi, Masahiro;Nakai, Hidekatsu;Nagase, Satoru;Niikura, Hitoshi;Mandai, Masaki;Hirashima, Yasuyuki;Yanai, Hiroyuki;Yamagami, Wataru;Kamitani, Satoru;Higashi, Takahiro
    • Journal of Gynecologic Oncology
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    • 제29권6호
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    • pp.83.1-83.10
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    • 2018
  • Objective: We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan. Methods: A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected. Results: In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for 'cystoscope or proctoscope for stage IVA' to 98.8% for 'chemotherapy using platinum for stage IVB'. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively. Conclusion: Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.

만성 저산소성 폐질환의 폐동맥 고혈압에 대한 심초음파 검사 (Echocardiographic Diagnosis of Pulmonary Arterial Hypertension in Chronic Lung Disease with Hypoxemia)

  • 장중현
    • Tuberculosis and Respiratory Diseases
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    • 제46권6호
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    • pp.846-855
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    • 1999
  • 연구배경 : 만성 저산소성 폐질환 환자의 폐동맥고혈압은 폐혈류 장애에 따른 악화에 이르는 주요 합병증이다. 폐동맥 고혈압과 이에 수반되는 폐성심의 임상적 진단은 때로 모호하여 폐동맥압의 비관혈적인 심초음파 검사의 중요성이 대두되고 있다. 최근 도플러 심초음파는 기존의 M모드 검사법에 비해 측정치의 정확도, 재생산성과 좋은 창을 얻을 수 있는 상대적인 장점이 있어 폐기종성 환자에서 보다 적용하기 용이한 검사법이다. 본 연구는 만성 저산소성 폐질환의 폐동맥 고혈압 예상 환자에서 도플러 검사법이 갖는 유의한 지표를 확인함에 목적이 있다. 방 법 : 대상환자는 만성 저산소성 폐질환을 보이며 임상소견상 폐동맥 고혈압이 예상되어 심초음파 검사를 시행받은 19명의 환자들을 대상으로 의의있는 폐동맥 고혈압 지표에 대해 조사하였다. 대상 환자들은 와위에서 좌흉골연이나 늑골하에 2.5MHz 진동자를 두고 도플러 및 M모드 심초음파를 시행하였고 특히, 삼첨판 역류시는 도플러 모드로 예측되는 우심실 수축기압(RVSP)이 40mmHg 이상인 군을 그 미만이거나 삼첨판 역류가 없었던 경우와 구분하여 다른 임상지표들에 대하여 비교, 분석하였다. 결 과 : 1) M모드 심초음파의 늑골하 사방관찰에서 RVSP 상승군이 대조군에 비해 수축기말 우심실 직경은 증가하였지만 그외 이완기말 우심실 직경, 수축기 및 이완기말 면적, 우심실 지유벽의 두께, 우심실 출구의 직경과 심실 중벽 두께 등은 두군간 차이가 없었다. 2) 도플러 모드에서 RVSP 상승군의 우심실 출구 수축기 가속기간(AT)은 $82{\pm}9msec$로 대조군 $96{\pm}16msec$에 비해 유의하게 단축되어 있었다. 3) 동맥혈 검사상 RVSP 상승군은 대조군에 비해 산소분압이 감소되어 있었으나 유의한 차이는 없었고 폐기능검사의 노력성 폐활량 및 1초 노력성호기량도 상승군에서 저하되었으나 두군간 유의한 차이는 없었다. 4) AT는 RVSP와 통계학적으로 유의한 역상관관계를 보여주었다. 결 론 : 만성 저산소성 폐질환에서 임상소견상 폐동맥 고혈압이 예상되는 경우 이를 규명하기 위해 심초음파 검사를 하여 컬러도플러로 삼첨판 역류가 확인되면 연속파 도플러로 RVSP를 예측할 수 있으며 이는 간헐파 도플러의 AT의 단축과 관련되어 있음을 확인하였다. 도플러 모드하의 RVSP 및 AT의 측정은 폐동맥 고혈압의 좋은 지표가 될 수 있을 것으로 예상된다.

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Clinical Features, Diagnosis, Management, and Outcomes of Idiopathic Pulmonary Fibrosis in Korea: Analysis of the Korea IPF Cohort (KICO) Registry

  • Jegal, Yangjin;Park, Jong Sun;Kim, Song Yee;Yoo, Hongseok;Jeong, Sung Hwan;Song, Jin Woo;Lee, Jae Ha;Lee, Hong Lyeol;Choi, Sun Mi;Kim, Young Whan;Kim, Yong Hyun;Choi, Hye Sook;Lee, Jongmin;Uh, Soo-Taek;Kim, Tae-Hyung;Kim, Sang-Heon;Lee, Won-Yeon;Kim, Yee Hyung;Lee, Hyun-kyung;Lee, Eun Joo;Heo, Eun Young;Yang, Sei Hoon;Kang, Hyung Koo;Chung, Man Pyo;Korea ILD Study Group,
    • Tuberculosis and Respiratory Diseases
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    • 제85권2호
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    • pp.185-194
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    • 2022
  • Background: The Korea Interstitial Lung Disease Study Group has made a new nationwide idiopathic pulmonary fibrosis (IPF) registry because the routine clinical practice has changed due to new guidelines and newly developed antifibrotic agents in the recent decade. The aim of this study was to describe recent clinical characteristics of Korean IPF patients. Methods: Both newly diagnosed and following IPF patients diagnosed after the previous registry in 2008 were enrolled. Survival analysis was only conducted for patients diagnosed with IPF after 2016 because antifibrotic agents started to be covered by medical insurance of Korea in October 2015. Results: A total of 2,139 patients were analyzed. Their mean age at diagnosis was 67.4±9.3 years. Of these patients, 76.1% were males, 71.0% were ever-smokers, 14.4% were asymptomatic at the time of diagnosis, and 56.9% were at gender-age-physiology stage I. Occupational toxic material exposure was reported in 534 patients. The mean forced vital capacity was 74.6% and the diffusing capacity for carbon monoxide was 63.6%. Treatment with pirfenidone was increased over time: 62.4% of IPF patients were treated with pirfenidone initially. And 79.2% of patients were treated with antifiboritics for more than three months during the course of the disease since 2016. Old age, acute exacerbation, treatment without antifibrotics, and exposure to wood and stone dust were associated with higher mortality. Conclusion: In the recent Korean IPF registry, the percentage of IPF patients treated with antifibrotics was increased compared to that in the previous IPF registry. Old age, acute exacerbation, treatment without antifibrotics, and exposure to wood and stone dust were associated with higher mortality.

조현병 환자의 동반 만성신체질환 현황 및 총 의료비용에 관한 연구 (Chronic Physical Comorbidities and Total Medical Costs in Patients with Schizophrenia)

  • 이상욱;이예린;오인환;유빈;구애진;김유석
    • 정신신체의학
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    • 제26권1호
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    • pp.26-34
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    • 2018
  • 연구목적 본 연구에서는 조현병 환자의 만성신체질환 유병현황을 확인하고, 총 의료비용에 미치는 영향을 제시하고자 하였다. 방 법 2014~2015년 건강보험심사평가원 자료를 활용하였으며, 자료의 정확성을 높이기 위하여 조현병 및 만성신체질환은 주/부상병으로 동일 상병을 3회이상 진단받은 경우만 해당 질환으로 분류하였다. 총 의료비용은 보건의료체계적 관점으로 보험자의 비용과 함께 본인부담비용을 포함하였다. 결 과 조현병 환자의 24.5%는 1개, 17.3%는 2개, 23.4%는 3개이상의 만성신체질환을 가지고 있는 것으로 나타났으며, 만성신체질환의 1~5순위는 만성위염/위식도역류질환이 27.3%, 알레르기가 19.5%, 고혈압이 13.2%, 만성요통이 11.0%, 당뇨병이 10.6%로 위장간질환 및 알레르기 질환, 대사성 질환뿐만 아니라 근골격계 질환의 유병률도 높게 나타났다. 2014년에 진단받은 조현병 환자의 2015년 총 의료비용은 약 1조 8백억원이었으며, 총 의료비용에 영향을 미치는 요인으로는 성별, 연령, 만성신체질환의 수, 건강보험여부로 나타났다. 결 론 조현병 환자의 만성신체질환의 문제를 해결하기 위한 접근방법은 단순히 개별 질환을 중심으로 치료하기 보다는 조현병 환자의 다양한 신체 질환을 동시에 치료 및 관리할 수 있는 새로운 형태의 진료체계에 대한 모델 개발이 필요할 것이다.

얼굴마비 환자의 의·한의 협진 의료이용 연구: 건강보험심사평가원 환자표본 데이터를 이용 (A study on the facial palsy patients' use of Western-Korean collaborative treatment: Using Health Insurance Review & Assessment Service-National Patients Sample)

  • 박효성;엄태웅;김남권
    • Journal of the Korean Data and Information Science Society
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    • 제28권1호
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    • pp.75-86
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    • 2017
  • 본 연구는 의 한의 협진 진료의 발생 빈도가 높은 질환인 얼굴마비에 대하여, 2014년도 건강보험심사평가원 환자표본 자료 (HIRA-NPS, 2014)를 이용해서 진료 에피소드 단위의 분석을 시행하였다. 건강보험 급여 청구현황에 근거한 진료 에피소드 단위 분석결과, 의 한의 협진 빈도는 남성보다 여성에서 높은 것으로 나타났으며, 연령대는 50세 이상이 높은 것으로 나타났다. 얼굴마비 환자들에서 확인된 의료이용 패턴은 의과 단독 진료 군의 경우 진단 및 검사가 다 빈도로 확인되었으며, 한의과 단독 진료와 의 한의 협진 진료 군의 경우는 치료 항목들이 다 빈도로 나타났다. 치료 행태별 요양일수는 의 한의 협진, 한의과 단독 진료, 의과 단독진료 등의 순으로 다 빈도가 확인되었으며, 내원일당 요양급여 비용은 의과 단독 진료, 의 한의 협진, 한의과 단독 진료 등의 순으로 높게 나타났다. 본 연구에서 추정된 의 한의 협진 의료이용 행태는 향후 본 질환의 임상진료지침 개발과 의료 정책의 수립에 방향성을 제시할 수 있을 것으로 사료된다.