• Journal of Periodontal and Implant Science
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• 제28권4호
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• pp.645-660
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• 1998

The purpose of this study was to make and ascertain a decision making process on the base of patient-oriented utilitarianism in the treatment of patients of chronic adult periodontitis. Fifty subjects were chosen in Yonsei Dental hospital and the other fifty were chosen in Severance dental hospital according to the selection criteria. Fifty four patients agreed in this study. NS group(N=32) was treated with scaling and root planing without any surgical intervention, the other S group(N=22) done with flap operation. During the active treatment and healing time, all patients of both groups were educated about the importance of oral hygiene and controlled every visit to the hospital. When periodontal treatment needed according to the diagnostic results, some patients were subjected to professional tooth cleaning and scaling once every 3 months according to an individually designed oral hygienic protocol. Probing depth was recorded on baseline and 18 months after treatments. A questionnaire composed of 6 kinds(hygienic easiness, hypersensitivity, post treatment comfort, complication, functional comfort, compliance) of questions was delivered to each patient to obtain the subjective evaluation regarding the results of therapy. The decision tree for the treatment of adult periodontal disease was made on the result of 2 kinds of periodontal treatment and patient's ubjective evaluation. The optimal path was calculated by using the success rate of the results as the probability and utility according to relative value and the economic value in the insurance system. The success rate to achieve the diagnostic goal of periodontal treatment as the remaining pocket depth less than 3mm and without BOP was $0.83{\pm}0.12$ by non surgical treatment and $0.82{\pm}0.14$ by surgical treatment without any statistically significant difference. The moderate success rate of more than 4mm probing pocket depth were 0.17 together. The utilities of non-surgical treatment results were 100 for a result with less than 3mm probing pocket depth, 80 for the other results with more than 4mm probing pocket depth, 0 for the extraction. Those of surgical treatment results were the same except 75 for the results with more than 4mm. The pooling results of subjective evaluation by using a questionnaire were 60% for satisfaction level and 40% for no satisfaction level in the patient group receiving nonsurgical treatment and 33% and 67% in the other group receiving surgical treatment. The utilities for 4 satisfaction levels were 100, 75, 60, 50 on the base of that the patient would express the satisfaction level with normal distribution. The optimal path of periodontal treatment was rolled back by timing the utility on terminal node and the success rate, the distributed ratio of patient's satisfaction level. Both results of the calculation was non surgical treatment. Therefore, it can be said that non-surgical treatment may be the optimal path for this decision tree of treatment protocol if the goal of the periodontal treatment is to achieve the remaining probing pocket depth of less than 3mm for adult chronic periodontitis and if the utilitarian philosophy to maximise the expected utility for the patients is advocated.

• 사상체질의학회지
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• 제13권2호
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• pp.144-155
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• 2001

By the increasing concern about Sasang Constitution Medicine, its practical use is considered very important in disease prevention and medical treatment. However, the method of constitution classification is depending on the doctor's clinical trials because of the lack of the objective test criteria. This study is trying to improve the objectiveness of diagnosis using a new statistical method, decision tree. Decision tree method-a classification technique in the statistical analysis- was used to analyze the result of QSCCII instead of using discriminant analysis. As a result, 16 among 121 QSCCII questions was selected as important questions and 21 terminal nodes was built to classify the constitution. Using only 16 questions shown in the result of decision tree, we can diagnose and interpret the constitution easily and effectively.

• Journal of Hospice and Palliative Care
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• 제26권2호
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• pp.69-79
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• 2023

Purpose: This study aimed to investigate the involvement of patients who died from hematologic neoplasms in the decision-making process surrounding the withdrawal of life-sustaining treatment (LST). Methods: A total of 255 patients diagnosed with hematologic neoplasms who ultimately died following decisions related to LST during their end-of-life period at a university hospital were included in the study. Data were retrospectively obtained from electronic medical records and analyzed utilizing the chi-square test, independent t-test, and logistic regression. Results: In total, 42.0% of patients participated in the decision-making process regarding LST for their hematologic neoplasms, while 58.0% of decisions were made with family involvement. Among these patients, 65.1% died in general wards and 34.9% in intensive care units (ICUs) as a result of decisions such as the suspension of LST. The period from the LST decision to death was longer when the decision was made by the patient (average, 27.15 days) than when it was made by the family (average, 7.48 days). Most decisions were made by doctors and family members in the ICU, where only 20.6% of patients exercised their right to make decisions regarding LST, a rate considerably lower than 79.4% observed in general wards. Decisions to withhold or withdraw LST were more commonly made by patients themselves than by their families. Conclusion: The key to discussing the decision to suspend hospice care and LST is respecting the patient's self-determination. If a patient is lucid prior to admission to the ICU, considerations about suspending LST should involve the patient input.

• 한국보건간호학회지
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• 제37권1호
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• pp.125-135
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• 2023

Purpose: The number of patients suffering from depression is rapidly increasing worldwide, and by 2030, it is expected to pose a severe social and economic burden. Reports suggest that approximately 30% of subjects with symptoms of depression do not attempt treatment. Therefore, predicting the characteristics of subjects with depressive symptoms who have not even attempted counseling treatment is essential to increase the participation rate for such treatment. This study intends to predict the participation rates for psychological counseling treatment for depression among subjects with depressive symptoms. Methods: This study used data from the 2021 Korea Community Health Survey (KCHS). Data analysis was carried out using a decision tree to design a model that predicted participation in psychological counseling for depression. Results: The results showed that subjects aged 65 to 74 had difficulty understanding the explanations of medical staff even though they did not have cognitive impairment. Only 11.1% of this group received psychological counseling, which was the lowest rate among the various age groups. Among the subjects, 62.4% of those aged 19-44 or 45-64, who had suicidal thoughts and attempted suicide, received psychological counseling and this was the highest rate among the age groups surveyed. Conclusion: The identification of people showing depressive symptoms is crucial for encouraging them to undertake treatment. Also, proper depression-oriented medical services should be developed and implemented for people with depressive symptoms who exhibit a blind spot towards attempting treatment.

• KIEE International Transaction on Systems and Control
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• 제2D권2호
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• pp.59-64
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• 2002

About two thirds of patients admitted to hospitals world-wide suffer from acute abdomen pains of varying degrees of severity. Acute abdomen pain due to appendicitis or pancreatitis usually requires urgent surgical treatment, whereas pain due to heart ischemia or enteroviral infection requires only drug treatment. In general, making an immediate decision about whether or not acute abdomen pain requires urgent surgery is very difficult. This decision becomes even more difficult when the patient is a young child who can't properly describe the abdominal pain. In this case, thermo-visual inspection can alternatively be used to decide whether urgent surgical treatment is necessary to cure the abdominal pain.

• Journal of Preventive Medicine and Public Health
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• 제43권1호
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• pp.26-34
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• 2010

Objectives: The purpose of this research is to analyze the impact of shared-decision making on patient satisfaction. The study is significant since it focuses on developing appropriate methodologies and analyzing data to identify patient preferences, with the goals of optimizing treatment selection, and substantiating the relationship between such preferences and their impact on outcomes. Methods: A thorough literature review that developed the framework illustrating key dimensions of shared decision making was followed by a quantitative assessment and regression analysis of patient-perceived satisfaction, and the degree of shared-decision making. Results: A positive association was evident between shared-decision making and patient satisfaction. The impact of shared decision making on patient satisfaction was greater than other variable including gender, education, and number of visits. Conclusions: Patients who participate in care-related decisions and who are given an explanation of their health problems are more likely to be satisfied with their care. It would benefit health care organizations to train their medical professionals in this communication method, and to include it in their practice guidelines.

• Tuberculosis and Respiratory Diseases
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• 제58권3호
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• pp.213-229
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• 2005

The first and the longest criminal indictment case of Korean medico-legal battle, so called BORAMAE Hospital Incident, was finally on its end by Korean Supreme Court's decision on June 24, 2004, after 7 years long legal dispute via Seoul District Court and Seoul Superior Appeal Court's decision. Boramae Hospital case was the first Korean legal case of Withdrawing Life-sustaining treatment of mechanical respirator on 58 years old Extradural Hematoma victim who was on Respirator under Coma after multi-organ failure postoperatively(APACHE II score: 34-39). Two physicians who have involved patient's care and had helped to make discharge the Near-death patient to home after repeated demand of patient's wife, due to economic reason, were sentenced as homicidal crime. This review article will discuss the following items with the review of US cases, Quinlan(1976), Nancy Cruzan(1990), Barber (1983), Helen Wanglie(1990), Baby K (1994) and Baby L cases, along with Official Statement of ATS and other Academic dignitaries of US and World.: [1] Details of Boramae Hospital incident, medical facts description and legal language of homicidal crime sentence. [2] The medical dispute about the legal misinterpretation of patient's clinical status, regarding the severity of the victim with multi-organs failure on Respirator under coma with least chance of recovery, less than 10% probability. [3] Case study of US, of similar situation. [4] Introduction of ATS official Statement on Withdrawing/ Withholding Life sustaining treatment. [5] Patient Autonomy as basic principle. [6] The procedural formality in Medical practise for keeping the legitimacy. [7] The definition of Medical Futility and its dispute. [8] Dying in Dignity and PAS(Physician Assisted Suicide)/and/or Euthanasia [9] The Korean version of "Dying in Dignity", based on the Supreme Court's decision of Boramae Hospital incident (2004.6.24.) [10] Summary and Author's Note for future prospects.

• Journal of Periodontal and Implant Science
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• 제52권3호
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• pp.183-193
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• 2022

Purpose: We retrospectively analysed patients' dental and periodontal status according to the presence of non-communicable diseases (NCDs) and the effects of NCDs on periodontal treatment outcomes. Factors influencing disease recurrence were investigated using decision tree analysis. Methods: We analysed the records of patients who visited the Department of Periodontology, Pusan National University Dental Hospital from June 2014 to October 2019. As baseline subjects, 1,362 patients with periodontitis and who underwent full-mouth periodontal examinations before periodontal treatment were selected. Among them, 321 patients who underwent periodontal examinations after the completion of periodontal treatment and 143 who continued to participate in regular maintenance were followed-up. Results: Forty-three percent of patients had a NCD. Patients without NCDs had more residual teeth and lower sum of the number of total decayed, missing, filled teeths (DMFT) scores. There was no difference in periodontal status according to NCD status. Patients with a NCD showed significant changes in the plaque index after periodontal treatment. The decision tree model analysis demonstrated that osteoporosis affected the recurrence of periodontitis. Conclusions: The number of residual teeth and DMFT index differed according to the presence of NCDs. Patients with osteoporosis require particular attention to prevent periodontitis recurrence.

• International Journal of Computer Science & Network Security
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• 제23권9호
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• pp.150-156
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• 2023

For a doctor, diagnosing a patient's heart disease is not easy. It takes the ability and experience with high flying hours to be able to accurately diagnose the type of patient's heart disease based on the existing factors in the patient. Several studies have been carried out to develop tools to identify types of heart disease in patients. However, most only focus on the results of patient answers and lab results, the rest use only echocardiography data or electrocardiogram results. This research was conducted to test how accurate the results of the classification of heart disease by using two medical data, namely echocardiography and electrocardiogram. Three treatments were applied to the two medical data and analyzed using the decision tree approach. The first treatment was to build a classification model for types of heart disease based on echocardiography and electrocardiogram data, the second treatment only used echocardiography data and the third treatment only used electrocardiogram data. The results showed that the classification of types of heart disease in the first treatment had a higher level of accuracy than the second and third treatments. The accuracy level for the first, second and third treatment were 78.95%, 73.69% and 50%, respectively. This shows that in order to diagnose the type of patient's heart disease, it is advisable to look at the records of both the patient's medical data (echocardiography and electrocardiogram) to get an accurate level of diagnosis results that can be accounted for.

• Journal of Construction Engineering and Project Management
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• 제7권1호
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• pp.30-36
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• 2017

Most local agencies such as counties and small cities continuously express difficulties in making technically and financially defensible decisions on their pavement infrastructure maintenance and rehabilitation. Unlike pavement systems managed by state highway agencies, the total lane-miles of many local pavements are significantly short and they are managed by a limited number of staff who typically have multiple responsibilities. Most local agencies also do not have historical pavement performance data and the lack of a systematic decision making framework exacerbates the problem. A structured framework and an easily accessible decision support tool that reflects their local requirements, practices and operational conditions would greatly assist them in making consistent and defensible decisions. This study fills this gap by developing a systematic pavement treatment selection framework and a spreadsheet based tool for local agencies. It is expected that the proposed framework will significantly help local agencies to improve their pavement asset management practices at the project level.