• Korean Journal of Radiology
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• v.24 no.2
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• pp.155-165
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• 2023

Objective: Little is known about the effects of using different expert-determined reference standards when evaluating the performance of deep learning-based automatic detection (DLAD) models and their added value to radiologists. We assessed the concordance of expert-determined standards with a clinical gold standard (herein, pathological confirmation) and the effects of different expert-determined reference standards on the estimates of radiologists' diagnostic performance to detect malignant pulmonary nodules on chest radiographs with and without the assistance of a DLAD model. Materials and Methods: This study included chest radiographs from 50 patients with pathologically proven lung cancer and 50 controls. Five expert-determined standards were constructed using the interpretations of 10 experts: individual judgment by the most experienced expert, majority vote, consensus judgments of two and three experts, and a latent class analysis (LCA) model. In separate reader tests, additional 10 radiologists independently interpreted the radiographs and then assisted with the DLAD model. Their diagnostic performance was estimated using the clinical gold standard and various expert-determined standards as the reference standard, and the results were compared using the t test with Bonferroni correction. Results: The LCA model (sensitivity, 72.6%; specificity, 100%) was most similar to the clinical gold standard. When expert-determined standards were used, the sensitivities of radiologists and DLAD model alone were overestimated, and their specificities were underestimated (all p-values < 0.05). DLAD assistance diminished the overestimation of sensitivity but exaggerated the underestimation of specificity (all p-values < 0.001). The DLAD model improved sensitivity and specificity to a greater extent when using the clinical gold standard than when using the expert-determined standards (all p-values < 0.001), except for sensitivity with the LCA model (p = 0.094). Conclusion: The LCA model was most similar to the clinical gold standard for malignant pulmonary nodule detection on chest radiographs. Expert-determined standards caused bias in measuring the diagnostic performance of the artificial intelligence model.

• Journal of Nutrition and Health
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• v.36 no.6
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• pp.589-602
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• 2003

This study was designed to investigate the effects of weight reduction and changes in serum lipid composition using a commercial uncooked powdered food (UPF) diet on 27 obese hyperlipidemic women over a period of 12 weeks. We replaced the standard breakfast and dinner of each of the subjects with UPF. Their dietary intake status was evaluated by 24-hour recall method. Their body compositions were measured using a body fat analyzer. Also, we conducted hematological, clinical and lipid profile analyses of their blood. Their intake of energy, lipid and protein significantly decreased as the subjects started to take UPF, but their intake of vitamins and minerals, other than iron, increased. Due to the energy intake decrease, the subjects' weight, body fat and waist circumference significantly decreased. Among the lost weight the percentage of the body fat was high. We judged that this process of losing weight was successful in obese hyperlipidemic women. Serum HDL-cholesterol gradually increased and serum total-cholesterol, LDL-cholesterol, triglyceride levels showed gradual decreases. When obese hyperlipidemic women replaced two of three meals with UPF for 3 months, we were able to see useful changes like decreased body fat and serum lipid. Complete judgment on the usefulness of UPF may be difficult but if people take a standard meal once a day and replenish their iron by taking UPF twice a day, we assume that replacing UPF with balanced regular meal not be a problem in nutritional status. Our results show that UPF is effective in the diet therapy of obese hyperlipidemic women.

• The Journal of Korean Academic Society of Nursing Education
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• v.15 no.2
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• pp.183-193
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• 2009

Purpose: The purpose of this study was to explore experiences among undergraduate nursing students in a high-fidelity simulation education course for a semester. Method: The participants in this study were 10 nursing students in the senior classes and volunteers. Data collection was conducted using a focus group interview for 100 minutes, which was recorded on video tape. Transcribed data was analyzed through qualitative content analysis. Result: The results of this study were deduced as 4 codes and 22 themes. Study participants reported experiences due to the simulation method itself, interaction among peer group and personal experiences during high-fidelity simulation education. Additionally, experiences related to clinical application were examined. The participants indicated positive outcomes such as developing clinical judgment skills and confidence. Conclusion: Overall, the results of this study supported the usability and effectiveness of a high-fidelity simulation education method in undergraduate nursing curriculum. Further studies are needed to provide more reliable and valid educational information.

• Korean Journal of Veterinary Service
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• v.35 no.1
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• pp.53-57
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• 2012

This is a case report about rape poisoning in a Hanwoo. Non-protein nitrogen (NPN) compound in rape may cause poisoning in domestic animals. Rape poisoned cattle may show big and rapid breath with opening its mouth, edema and erosion of skin with itching, drooling, dyspnea and indigestion. Besides there can be shown neurological (blindness) and urological (red water) symptoms in some cases. There is no effective therapy for rape poisoning, therefore stopping the rape supplying is basically important. Clinical symptoms and history taking are very important factors in diagnosis of rape poisoning, due to the absence of diagnostic standard of judgment for rape poisoning. A Hanwoo 38 months old cow, in a farm located in Gyeoungbuk province showed typical rape poisoning symptoms such as breath with opening its mouth, drooling, dyspnea and hyperphotosensitivity, and dramatical recovery were occurred after stopping supplying of rape. The cow were diagnosed as the rape poisoning based on observation of clinical symptoms and history taking.

• Journal of Gastric Cancer
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• v.23 no.3
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• pp.400-409
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• 2023

Artificial intelligence (AI) has made significant progress in recent years, and many medical fields are attempting to introduce AI technology into clinical practice. Currently, much research is being conducted to evaluate that AI can be incorporated into surgical procedures to make them safer and more efficient, subsequently to obtain better outcomes for patients. In this paper, we review basic AI research regarding surgery and discuss the potential for implementing AI technology in gastric cancer surgery. At present, research and development is focused on AI technologies that assist the surgeon's understandings and judgment during surgery, such as anatomical navigation. AI systems are also being developed to recognize in which the surgical phase is ongoing. Such a surgical phase recognition systems is considered for effective storage of surgical videos and education, in the future, for use in systems to objectively evaluate the skill of surgeons. At this time, it is not considered practical to let AI make intraoperative decisions or move forceps automatically from an ethical standpoint, too. At present, AI research on surgery has various limitations, and it is desirable to develop practical systems that will truly benefit clinical practice in the future.

• Journal of Korean Medicine for Obesity Research
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• v.7 no.2
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• pp.27-37
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• 2007

Background Clinical practice guidelines (CPG) are systematically developed statements to assist practitioners and patients on healthcare decisions. They provide recommendations for the average patient, which should take into account individual clinical judgment and the patient's values and expectations. Ephedra has sympathomimetic effect and has been used for weight loss worldwide. However, its safety is controversial especially in autonomic and cardiovascular systems. Therefore, the need of appropriate CPG for ephedra prescription in obesity was advocated in Korean Traditional Medicine. Methods The committee comprised of specialists of obesity, oriental herbology, oriental cardiology, constitutional medicine. The committee collected all relevant references about adverse effect and safety of ephedra in the forms of meta-analysis, systematic review, randomized controlled trial, case-control study and observational study from international and domestic databases and paper journals. 11 English- and 5 Korean-language references were gathered and categorized by PICO (Patient, Intervention, Comparison, Outcome) method. We could not complete strength of recommendation which should be clarified according to the evidence grade estimation. Result The first version of CPG for ephedra prescription in obesity was issued by Korean Oriental Association for Study of Obesity. It includes topics of introduction, pharmacokinetics, side effects and adverse events, constitutional aspect and recommendations for dose, indication and contraindication. Conclusion There should be periodic upgrade of this CPG from now on. Although there are some drawbacks in this version of CPG, it has significance as the first CPG in Korean Traditional Medicine.

• The Journal of Internal Korean Medicine
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• v.27 no.3
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• pp.784-790
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• 2006

Most of the atrial flutter occurs in patients who have an organic disease of the heart. The symptoms of atrial flutter include anxiety with palpitation. sleep disorder and fatigue. For a long time, oriental medicine has clinically treated these symptoms, and the diagnosis has been usually based on the doctor's judgment on the subjective clinical symptoms. However, if oriental medicine includes new diagnostic aids like electrocardiogram or other various methods or combinations of techniques, the accuracy and objectivity of diagnosis and clinical data can be improved. In this case, a 65 year-old male patient who had anxiety with palpitation and abnormal P wave (atrial flutter) on the EKG was treated with Xiaofengbusindaotantang (疎風補心導痰湯) and Shengmaisan (生脈散). Significant improvement in the clinical symptoms and EKG results was observed. This result suggests that oriental medical treatment can be used for treatment of organic heart disease like an atrial flutter. In addition, subsequent studies should be followed to ensure the appropriateness of new diagnostic aids, such as EKG, and other various modalities.

• Journal of Acupuncture Research
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• v.41 no.2
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• pp.107-114
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• 2024

Background: Low back pain (LBP) is a common musculoskeletal disorder worldwide, with a lifetime prevalence of up to 80%. Among nonsurgical treatments for chronic LBP, Korean medicine treatments are highly preferred, and pharmacopuncture therapy combining acupuncture and herbal medicine is widely used. However, no evidence-based study has focused on the use of various types of pharmacopuncture. Methods: The pragmatic randomized controlled clinical trial will include 44 participants; recruitment will start in July 2023. All participants will receive integrated Korean medicine treatment including acupuncture, cupping, and infrared therapy, and the intervention group will also receive pharmacopuncture. After 16 treatment sessions, twice a week for 8 weeks, follow-up assessments will be performed at week 9. As a pragmatic randomized controlled clinical protocol, the type, dose, and acupoints of acupuncture and pharmacopuncture are not determined in advance but are selected and recorded according to the clinical judgment of the Korean medicine doctor. Results: The primary outcome will be measured using a visual analog scale score, and the secondary outcomes include the Oswestry disability index, patient global impression of change, no worse than mild pain, and range of motion. Safety will be assessed by examining participants' self-reported adverse events and vital signs and conducting blood tests before and after the test. Conclusion: This study aims to provide clinical evidence of the effectiveness and safety of pharmacopuncture for chronic LBP.

• Journal of Korean Critical Care Nursing
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• v.17 no.2
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• pp.42-54
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• 2024

Purpose : This study aimed to assess the effectiveness of an advanced practice nurse (APN)-driven ventilator weaning protocol for patients undergoing cardiac surgeries. Methods : A retrospective analysis was conducted on 226 patients admitted to the intensive care unit (ICU) of a tertiary hospital between January and June 2020, following a cardiac surgery. Patients were divided into an APN protocol-applied group (experimental group, n=152) and a control group managed based on doctors' judgment (n=74). Ventilator weaning criteria and clinical outcomes, including duration of ventilation, length of ICU stay, and rate of reintubation, were compared between the two groups. Results : Patients in the control group were older and had a higher incidence of massive bleeding from chest tube drainage (>100 cc/hr) at baseline. The average duration of ventilation was significantly shorter in the experimental group compared to the control group (7.44 vs. 21.61 hours, p <.001). Furthermore, the mean length of ICU stay was shorter in the experimental group compared to the control group (47.96 vs. 77.97 hours, p <.001). There was no difference in the rate of reintubation between the two groups. Conclusion : These findings suggest that an APN-driven ventilator weaning protocol can improve clinical outcomes without significant complications. These results support the adoption of APN-driven mechanical ventilator weaning protocols in clinical practice.

• The Journal of the Korean life insurance medical association
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• v.27 no.1
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• pp.37-38
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• 2008

The concept of Chiari malformations emerged toward the end of $19^{th}$ century from Chiari's initial descriptions of "alterations in the cerebellum resulting from cerebral hydrocephalus." In 1891, Hans Chiari(1851-1916) suggested cerebellar ectopia in which he classified Type I as "elongation of the tonsils and medial parts of the inferior lobes of the cerebellum into cone-shaped projections, which accompany the medulla oblongata into the spinal canal. The incidence of Chiari malformation has been found to be between 0.56% and 0.77% on MR imaging studies, as well as 0.62% in brain dissection studies. the definition of the adult Chiari malformation has varied with the evolution of neurodiagnositic capabilities and knowledge of physiopathology. This disorder can be associated with significant symptomatology, risk of secondary injury due to trauma, and the risk of progression and damage of the spinal cord due to associated Syringomyelia. Syringomyelia is found in 50 to 70% of Chiari I malformation. It is the clinical judgment of the physicians evaluating this disorder that is of the importance to avoid the therapeutic extremes of pursuing unnecessary surgery or withholding necessary treatment from patients.