• Title/Summary/Keyword: standard of diagnosis

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A Survey of the Recognition on the Practice Pattern, Diagnosis, and Treatment of Korean Medicine of Dementia and Mild Cognitive Impairment - Focusing on the Differences between Neuropsychiatrists of Korean Medicine and General Physicians - (치매, 경도인지장애의 한의진료 현황, 진단 및 치료에 대한 한의사의 인식도 조사 연구 - 한방신경정신과 전문의와 일반의의 차이를 중심으로 -)

  • Seo, Young Kyung;You, Dong Keun;Kim, Hwan;Kim, Siyeon;Lee, Go eun;Kim, Sang-Ho;Kang, Hyung-Won;Jung, In Chul
    • Journal of Oriental Neuropsychiatry
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    • v.28 no.3
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    • pp.263-274
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    • 2017
  • Objectives: To identify the current status of Korean medical practice pattern, diagnosis and treatment of dementia through recognition survey, and to use it as a preliminary data for various dementia research. Methods: Questionnaires were developed through expert meetings. The disease was defined as dementia and mild cognitive impairment, and areas were designated to practice pattern, diagnosis and treatment. From December 18, 2016-January 18, 2017, 221 respondents, including 36 neuropsychiatrists of Korean Medicine and 185 general physicians (including other medical specialists) were included. Results: 1. In both groups, the most commonly used KCD (Korean standard classification of disease and cause of death) were in the order of Unspecified Alzheimer's Dementia (F00.9), Mild Cognitive Impairment (F06.7), and Unspecified Dementia (F03). 2. The most commonly used pattern identification were zang-fu and qi-blood-yin-yang in both groups. 3. Diagnostic evaluation tools were mainly conducted by MMSE, radiologic examination, K-DRS, GDS and CDR in both groups. 4. Both groups reported using acupuncture and herbal medicine mainly. 5. In both groups, the acupuncture method was used extensively in the order of Body, Scalp, and Sa-Am. 6. Neuropsychiatrists used a variety of herbal medicines such as Wonjiseokchangpo-san (Yuanzhushichangpu-san), Yukmijihwang-tang (Liuweidihuang-tang), Palmijihwang-won (Baweidihuang-won), Sunghyangjungki-san (Xingxiang Zhengqi-san) and Ondam-tanggami (Wendan-tangjiawei). General physicians used a variety of herbal medicines such as Ondam-tanggami (Wendan-tangjiawei), Bojungikgi-tang (Buzhongyiqi-tang), Yukmijihwang-tang (Liuweidihuang-tang). 7. Neuropsychiatrists used a variety of Korean herbal preparation products (benefit and non-benefit) such as Ekgan-sangajinpibanha (Yigan-sanjiachenpibanxia), Yukmijihwang-tang (Liuweidihuang-tang), Jodeung-san (houteng-san), Palmijihwang-won (Baweidihuang-won). General physicians used a variety of Korean herbal preparation products such as Bojungikgi-tang (Buzhongyiqi-tang), Banhabaegchulcheonma-tang (banxiabaizhutianma-tang), Yukmijihwang-tang (Liuweidihuang-tang), Ekgan-sangajinpibanha (Yigan-sanjiachenpibanxia), Palmijihwang-won (Baweidihuang-won). Conclusions: By confirming awareness of Korean medical doctors treating dementia in clinical fields and understanding differences between neuropsychiatrists of Korean medicine and general physicians, it can be used to understand guideline users' needs and confirm clinical questions during development of future clinical practice guidelines for dementia.

Quantitative assessment of Endorectal Ultrasonography by using GLCM Algorithm (GLCM알고리즘을 이용한 경직장 초음파 영상의 정량적 평가)

  • Nho, Da-Jung;Kang, Min-Ji;Kim, Yoo-Kyeong;Seo, Ah-Reum;Lee, In-Ho;Jeong, Hee-Seong;Jo, Jin-Yeong;Ko, Seong-Jin
    • Proceedings of the Korean Institute of Information and Commucation Sciences Conference
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    • 2015.05a
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    • pp.383-387
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    • 2015
  • Bowel and rectal diseases are on the increase by irregular life and westernized eating habits of modern people, especially rectal cancer, which accounts for 50% of the entire colon cancer. For the initial rectal cancer, because there is no portion projecting on the surface, if not see inside the tissue with ultrasound, you make an errors that misdiagnosis as rectal abscess. However there is a need for more accurate diagnosis, because it is sometimes difficult to distinguish abscess from rectal cancer depending on staging, in spite of the ultrasonic diagnosis. Therefore, this study was performed quantitative analysis by using a computer algorithm for rectal cancer and abscess image. Each of 20 cases about normal, abscess and cancer by setting analysis region ($50{\times}50$ pixels) applies to GLCM algorithm and Autocorrelation, Max probability, Sum average, Sum variance in each image were analyzed by comparing the 4 single parameter. Consequently, The high lesion detection efficiency was presented 100% by the 3 parameter of Autocorrelation, Max probability, Sum variance and the parameter of Sum average presents 95% in cancer, more than 90% in abscess. Those parameters are valuable in distinction standard about normal, cancer and abscess in rectum. It is sufficient availability as a computer assisted diagnosis system depended on clinical using.

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Diagnostic efficacy of specialized MRI & clinical results of arthroscopic treatment in ankle soft tissue impingement syndrome (족근 관절 연부조직 충돌 증후군에서 MRI의 진단적 의의 및 관절경적 치료 결과)

  • Lee, Jin-Woo;Moon, Eun-Su;Kim, Sung-Jae;Hahn, Soo-Bong;Kang, Eung-Shick
    • Journal of Korean Foot and Ankle Society
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    • v.7 no.2
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    • pp.208-217
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    • 2003
  • Introduction: Soft-tissue impingement syndrome is now increasingly recognized as a significant cause of the chronic ankle pain. As a method to detect soft-tissue ankle impingement, a characteristic history and physical examination, routine MR imaging, and direct MR arthrography were used. The efficacy of routine MR imaging has been controversial for usefulness because of low sensitivity and specificity. Direct MR artrhography was recommaned for diagnosis because of the highest sensitivity, specificity and accuracy, but it requires an invasive procedure. The purpose of this study is to investigate the diagnostic accuracy of Fat suppressed, contrast enhanced, three-dimensional fast gradient recalled acquisition in the steady state with rediofrequency spoiling magnetic resonance imaging(CE 3D-FSPGR MRI) and to evaluate the clinical outcome of the arthroscopic treatment in assessing soft-tissue impingement associated with trauma of the ankle. Materials and Methods: We reviewed 38 patients who had arthroscopic evaluations and preoperative magnetic resonance imaging studies(3D-FSPGR MRI) for post-traumatic chronic ankle pain between January 2000 and August 2002. Among them, 24 patients had osteochondral lesion, lateral instability, loose body, malunion of lateral malleoli, and peroneal tendon dislocation. The patient group consisted of 23 men and 15 women with the average age of 34 years(16-81 years). The mean time interval from the initial trauma to the operation was 15.5 months(3 to 40 months), The mean follow-up duration of the assessment was 15.6months(12-48 months). MRI was simultaneously reviewed by two radiologists blinded to the clinical diagnosis. The sensitivity, specificity and accuracy of MRI was obtained from radiologic and arthroscopic finding. Arthroscopic debridement and additional operation for associated disease were performed. We used a standard protocol to evaluate patients before the operation and at follow-up which includes American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. Results: For the assessment of the synovitis and soft tissue impingement, fat suppressed CE 3D-FSPGR MR imaging had the sensitivity of 91.9%, the specificity of 84.4 and the accuracy of 87.5%. AOFAS Ankle-Hindfoot Score of preoperative state was 69.2, and the mean score of the last follow-up was 89.1. These were assessed as having 50% excellent(90-100) and 50% good(75-89). The presence of other associated disease didn't show the statistically significant difference(>0.05). Conclusion: Fat suppressed CE 3D-FSPGR MR imaging is useful method comparable to MR arthrography for diagnosis of synovitis or soft-tissue impingement, and arthroscopic debridement results in good clinical outcome.

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Diagnostic Accuracy, Sensitivity, Specificity and Positive Predictive Value of Fine Needle Aspiration Cytology (FNAC) in Intra Oral Tumors

  • Gillani, Munazza;Akhtar, Farhan;Ali, Zafar;Naz, Irum;Atique, Muhammad;Khadim, Muhammad Tahir
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.8
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    • pp.3611-3615
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    • 2012
  • Objective: The objective of this study was to establish the diagnostic accuracy, specificity and sensitivity of fine needle aspiration cytology(FNAC) for intra-oral tumors, comparing with histopathology as the gold standard. Materials and methods: Forty cases of FNA cytology from intraoral tumors was performed in AFID along with the demographic data and clinical information and then diagnosed at AFIP, Rawalpindi. Then the cytology results obtained per FNAC were compared with the histopathological biopsy results of the same lesions. The following variables were recorded for each patient: Age, gender, site of biopsy, diagnosis. The data were entered and analyzed using Open-epi version 2.0. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Cohen Kappa was further applied to compare the agreement between the biopsy and FNAC diagnoses. A p-value of < 0.05 was considered as statistically significant. Results: Among the total patients included in the study there were 24 males and 16 females, with a ratio of 1.5:1. Age of the patients ranged from 24 to 80 years with a mean of 52 years. A total of six sites were aspirated from the oral cavity with maximum (11) aspirates taken from alveolar ridge. The results of FNAC revealed that there were 32 malignant and 8 benign aspirates. Confirmation through histopathological analysis came for 31/32 malignant cases while one was falsely given positive for malignancy on FNAC. Among a total of 40 cases, 31(77%) cases diagnosed were found to be malignant and remaining 9(23%) were benign. The FNAC results revealed 32 malignant and 8 benign lesions. Histopathology of the subsequent surgically excised specimen showed malignant lesions in 31(77%) and benign in 9(23%) patients. As a whole, it was found that the absolute sensitivity for introral FNAC was 100% and specificity 89% with positive predictive value of 97% and negative predictive value of 100%. Conclusion: Cytological diagnosis was almost corroborative with final histopathological diagnosis in all cases, with very few exceptions, exhibiting high diagnostic accuracy.

Study II of Diagnosis Criteria for Qi deficiency in Stroke (중풍 기허증 진단 기준에 관한 연구 II)

  • Kang, Byoung Kab;Heo, Tae Young;Yun, Kyung Jin;Park, Tae Yong;Lee, Ju Ah;You, Soo Seong;Park, Geon Hee;Lee, Myeong Soo
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.28 no.1
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    • pp.76-81
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    • 2014
  • The aim of this study was to build the diagnosis criteria of Qi deficiency using distribution of sum of 11 items for Qi deficiency in stroke patients. Between September 2006 and December 2010, 2,994 patients from 11 Korean medical hospitals were asked to complete the Korean Standard Pattern Identification for Stroke (K-SPI-Stroke) questionnaire as a part of project 'Fundamental study for the standardization and objectification of pattern identification in traditional Korean medicine for stroke (SOPI-Stroke). Each patient was independently diagnosed by two experts (traditional Korean medicine physicians) from the same site according to one of five patterns. 2,994 patients were divided modeling and testing in 70:30 ratio by stratification of pattern identification. We calculated the sensitivity, specificity, accuracy and odds ratio (OR) using distribution of sum of 11 items (signs and symptoms) for Qi deficiency. More than four from 11 items of Qi deficiency in modeling dataset, sensitivity, specificity, accuracy and OR was 70.07%, 74.94%, 73.92% and 7.00, respectively. In testing dataset, 78.31%, 73.45%, 74.47% and 9.98, respectively. Although this values are not high, after values of sensitivity, specificity, accuracy and OR should be more than current value, and then we should be able to suggest as objective diagnosing criteria.

Feasibility of Photodynamic Diagnosis for Challenging TUR-Bt Cases Including Muscle Invasive Bladder Cancer, BCG Failure or 2nd-TUR

  • Takai, Tomoaki;Inamoto, Teruo;Komura, Kazumasa;Yoshikawa, Yuki;Uchimoto, Taizo;Saito, Kenkichi;Tanda, Naoki;Kouno, Junko;Minami, Koichiro;Uehara, Hirofumi;Takahara, Kiyoshi;Hirano, Hajime;Nomi, Hayahito;Kiyama, Satoshi;Azuma, Haruhito
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.6
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    • pp.2297-2301
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    • 2015
  • Background: Despite widely adopted standard methods for follow-up including cystoscopy plus cytology, recurrence rates of non muscle-invasive bladder cancer (NMIBC) have not improved over the past decades, still ranging from 60% through 70%. Hence, widely acceptable surveillance strategies with excellent sensitivity are needed. Early recurrence has led to the development of a novel cystoscopy technique utilizing photodynamic diagnosis (PDD). Although, no studies have evaluated the efficacy of PDD for patients of MIBC, BCG failure or 2nd-transurethelial resection (TUR). Materials and Methods: The present study was performed from October 2012 through May 2013. IRB approved 25 patients initially underwent a cystoscopy examination of white light and blue light followed by the resection of tumors identified. Resections were performed from bladder mucosa areas considered suspicious at PDD, along with PDD negative normal bladder mucosa area resected by random biopsy. Specimens were divided into two groups, PDD positive and negative. Primary endpoints were sensitivity and specificity. Results: A total of 147 specimens extracted from 25 patients were included in the analysis. Some 45 out of 92 PDD-positive specimens were confirmed to have bladder cancer, and 51 out of PDD-negative 55 specimens were confirmed to be cancer negative. The sensitivity of PDD was 91.8% (45/49) and specificity was 52.0% (51/98). The sensitivity:specificity was 89.5% (17/19) : 47.6% (30/63) in 12 2nd-TUR patients, 90.5% (19/21) : 61.1% (11/18) in seven MIBC patients, and 95.0% (19/20) : 48.5% (16/33) in eight failed BCG cases. Conclusions: PDD-TURBT has high sensitivity to diagnose BC even for 2nd-TUR, MIBC or BCG failure cases.

Study on Diagnosis by Facial Shapes and Signs as a Disease-Prediction Data for a Construction of the Ante-disease Pattern Diagno-Therapeutic System - Focusing on Gallbladder's versus Bladder's Body and Masculine versus Feminine Shape - (미병학(未病學) 체계구축을 위한 질병예측자(疾病豫側子)로서의 형상진단연구 - 담방광체(膽膀胱體)와 남녀형상(男女形象)을 중심으로 -)

  • Kim, Jong-Wan;Kim, Kyung-Chul;Lee, Yang-Tae;Lee, In-Seon;Kim, Kyu-Kon;Chi, Gyoo-Yang
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.23 no.3
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    • pp.540-547
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    • 2009
  • There needs disease-predictable signs in order to enable preventive diagnosis and therapy. Then traditional Chinese medicine applies various medical diagnostic equipments used in western medicine to diagnosing sub-healthy state. But such data are not originated from inherent oriental medicine, and not obtained easily in ordinary clinical practice. This paper is to provide synopsis of the ante-disease diagno-therapeutics partly and to show predictable data based on the facial shapes and signs, especially of gall bladder's versus bladder's body and masculine versus feminine shape. Ante-disease means not only the complete healthy state, but also the state unseen any symptoms in macrographically in the course of outbreak of disease. It contains two stages, first one is the former state of disease and second one is untransmitted state of disease. The patterns of ante-disease consist of latent disease, pre-disease, transmission type like senescent syndrome, abnormal reactive syndrome(變證), syndrome of transmission and transmutation. The classification with gall bladder and bladder type manifests the differences of shape, color and size of each organ in comparison of the universal and standard figures of the human being. On the other hand, the classification with masculine and feminine shape contrasts the innate sexual difference and the shape, characteristics originated from in itself. These two classification theories have their own pathologic types and syndrome types with each disease so that disease-predictable data can be constructed based on such a relationship. In addition, this diagnostic method by facial shapes and signs is able to be applied to whole stages from prenatal to present state of disease even if the cause and inducement are not clear. Ante-disease diagno-theraputic system by Gall Bladder's versus Bladder's Body and Masculine versus Feminine Shape is getting more important in the chronic and internal disease in comparison of the acute and traumatic disease. So this study is able to make up for the limit of diagnosis on ante-disease in the field of oriental medicine clinic.

Study of Deficiency of Qi Pattern Identification Diagnosis Criteria in Stroke (중풍환자의 기허변증 진단 기준에 관한 연구)

  • Kang, Byoung-Kab;Sun, Seung-Ho;Kang, Kyung-Won;Cho, Ki-Ho;Lee, In;Seol, In-Chan;Choi, Sun-Mi
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.21 no.6
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    • pp.1581-1585
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    • 2007
  • To report Sensitivity and specificity about utility as diagnosis criteria for deficiency of Qi in stroke. Korean medicine doctor surveyed deficiency of Qi of the symptoms for the Stroke case report form in stroke patients within 1 month of onset. We analyzed 643 patients have diagnosed stroke, neurological deficit continued over twenty-four hours and within one month of onset, except traumatic cerebrovascular attack (EDH, SDH) using the result by medical specialist and residents diagnosed differentiation and written CRF(Case Report Forms) which based on 'Korean Standard Differentiation of the Symptoms and Signs II' in twenty multi centers. The sensitivity of "more 1/5 in major sings and 1/5 in helpful signs", "more 1/5 in major signs and 2/5 in helpful signs", "more 2/5 in major signs and 1/5 in helpful signs", "more 2/5 in major signs and 2/5 in helpful signs""more 3/5 in major signs and 1/5 in helpful signs""more 3/5 in major signs and 2/5 in helpful signs" are respectively 83%, 50%, 72%, 46%, 47%, 32%. The specificity are respectively 28%, 59%, 55%, 74%, 80%, 89%. The sensitivity(72%) and specificity(55%) of "more 2/5 in major signs and 1/5 in helpful signs" that to be implanted. Although this values are not high, after values of sensitivity and specificity should be more than current value, and then we should be able to suggest as objective diagnosing criteria.

Characteristics of Korean Poisoning Patients: Retrospective Analysis by National Emergency Department Information System (한국 중독환자의 경향: 국가응급진료 정보망을 이용한 후향적 연구)

  • Kim, Woongki;Kim, Kyung Hwan;Shin, Dong Wun;Park, Junseok;Kim, Hoon;Jeon, Woochan;Park, Joon Min;Kim, Jung Eon;Kim, Hyunjong
    • Journal of The Korean Society of Clinical Toxicology
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    • v.17 no.2
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    • pp.108-117
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    • 2019
  • Purpose: The study examined the poisoned patients' characteristics nationwide in Korea by using data from the National Emergency Department Information System (NEDIS). Methods: Among the patients' information sent to NEDIS from January 1, 2013 to December 31, 2015, the included subjects' main diagnosis in ED showed poisoning according to the 7th edition of the Korean Standard Disease Classification (KCD-7). We analyzed the patients' gender, age, initial vital signs, visit time, stay time of staying in ED, results of ED care, main diagnosis in ED, length of hospitalization, and results of hospitalization. Results: A total of 106,779 ED visits were included in the analysis. There were 55,878 males (52.3%), which was more than the number of females. The number of intentional poisoning was 49,805 (59.6%). 75,499 cases (70.8%) were discharged, and 25,858 cases (24.2%) were hospitalized. The numbers of poisoning patients per 1,000 ED visits were 14 in Chungnam and 11.9 in Jeonbuk. The most common cause of poisoning, according to the main diagnosis, was venomous animals. It was the same for hospitalized patients, and pesticide was next. Pesticide was the most common cause of mortality in ED (228 cases, 46.1%) and after hospitalization (584 cases, 54.9%). The incidence of poisoning by age group was frequent for patients in their 30s to 50s, and mortality in ED and post-hospitalization were frequent for patients in their 60s to 80s. Conclusion: This study investigated the characteristics of poisoning patients reported in the past 3 years. Pesticide poisoning had a high mortality rate for patients in ED and in-hospital. For mortality, there was a high proportion of elderly people over 60. Thus, policy and medical measures are needed to reduce this problem. Since it is difficult to identify the poison substance in detail due to nature of this study, it is necessary to build a database and monitoring system for monitoring the causative substance and enacting countermeasures.

Development of Protein Chip for Diagnosis of Chlamydophia Pneumoniae (단백질 칩을 이용한 클라미디아 폐렴의 진단)

  • Kim, Woo Jin;Lee, Hui Young;Lee, Seung-Joon;Jung, Se-Hui;Yuk, Jong Seol;Ha, Kwon-Soo;Jung, Ki-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.60 no.4
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    • pp.412-418
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    • 2006
  • Background; The diagnosis of chlamydial infection is based on serology. The current gold standard of diagnosis is MIF(microimmunofluorescence), but this modality is subjective and time-consuming. Protein microarray with using a SPR(surface plasmon resonance) sensor has recently been suggested as a method for detecting infection. For developing a protein chip to diagnose chlamydial infection, EBs(elementary bodies) were immobilized on a gold chip and the interaction between an antibody for Chlamydophila pneumoniae and the EBs(elementary bodies) immobilized on the surface of the gold chip was measured by using an SPR sensor. Methods; For the surface antigen, the EBs of Chlamydophila pneumoniae LKK1 were purified. Charged arrays were prepared by using PDDA(polydiallyldimethylammonium chloride) which has a positive charge. After immobilization of the chlamydial EBs on the PDDA surface, the investigation of the surface was done with using atomic force microscopy. After the antibody for C. pneumoniae was applied on chip, we monitored the SPR wavelength-shift to detect any antigen-antibody interaction with using a self-assembled SPR sensor. Results; The chlamydial EBs on the positively charged PDDA were visible on the surface with using atomic force microscopy. The SPR wavelength increased after interaction of antibody for C. pneumoniae with the EBs immobilized on charged gold surface. The wavelength-shift was correlated with the concentration of antigens. Conclusion; The surface immobilization of EBs on the gold surface with the charged arrays was identified and the antigen-antibody interaction on the gold chip was detected via the SPR sensor. Further investigations are needed to apply this technique to the clinical field.