• 의료법학
• /
• 제9권2호
• /
• pp.181-207
• /
• 2008

With recent emphasis on evidence based medicine, clinical practice guidelines are seen as a potential mechanism by which unify various managerial and professional approaches to improving the quality of care. The development process of guidelines has been the subject of much research. and it is need translating the medical evidence of research into a clinical practice guidelines. the gathered evidence needs to be interpreted into a clinical, public health, policy, or payment context. The term 'clinical practice guidelines' can evoke a diverse range of responses from healthcare personnel. Clinical practice guidelines are increasingly used in patient management but some clinicians are not familiar with their origin or appropriate applications. Understanding the limitations as well as benefits of CPG could enable clinicians to have clearer view of the place of guidelines in every practice. In the context of increasing complaints and litigation in healthcare, the legal implications of clinical practice guidelines are of increasing importance. Clinical practice guidelines could, in theory, influence the manner in which the courts establish negligence by suggesting the doctor breached the duty of care by failing to provide the required standard of medical care. In several studies, the CPGs were relevent to and played a pivotal role in the proof of negligence. Much depends on the quality of guidelines and the tools developed and the authoritativeness of a guideline. Recently, there are several opinions the court also should review the validity and reliability of expert testimony including medical evidence. and widespread use of guidelines in malpractice lawsuit could lead the physicians to greater compliance with guidelines in the long term. In conclusion, Health care reformers, physicians as well as guidelines developers should understand that guidelines have both medical and legal aspects as a double-edges sword. so clinicians, legal representatives and decision-makers should not defer unduly to guidelines.

• 한국임상수의학회지
• /
• 제25권3호
• /
• pp.146-151
• /
• 2008

During the clinical decision making practitioners are often faced with performing diagnostic tests to solve the presenting problems seen in the patients. The diagnostic utility of a test has traditionally been described by technical terms such as sensitivity, specificity, and positive (PPV) and negative predictive value (NPV). Although well known, clinicians are frequently unclear about the concept and application of these terms in everyday evidence-based clinical decision making. Sensitivity and specificity, which are intrinsic properties of diagnostic tests, summarizes the characteristics of the test over a population. The PPV and NPV are greatly dependent on the population prevalence of disease, and thus they do not transferable to different patients or clinical settings. Besides, considering the fact that clinicians more often interested in knowing the extent to which a test result could confirm or exclude of a condition under consideration (posttest probability), these measures do not provide answers on this question. The likelihood ratios (LR) using the information contained in sensitivity and specificity are becoming increasingly popular for reporting the usefulness of diagnostic tests because this term provide an indication of posttest probability as a function of the pretest probability. In this article, clinical applications of LR are illustrated with some practical examples. Discussion is also included of the inherent limitations regarding diagnostic test characteristics.

• 대한한의진단학회지
• /
• 제19권1호
• /
• pp.1-10
• /
• 2015

Objectives The purpose of this study was to survey the status of clinical use of a computerized tongue diagnosis system (CTDS) Methods We searched domestic/international articles using the CTDS from online medical databases including OASIS, NDSL and pubmed. We selected articles on clinical application or reliability of CTDS but excluded articles on mechanical design or software programming for developing a new CTDS. Finally we found 15 articles and classified the articles according to the study purpose. Results Out of the 15 articles, 8 were focused on the clinical application including halitosis, cold/heat syndrome, lung cancer, xerostomia etc. Other 5 articles were aimed at evaluating and improving reliability of CTDS. The other 2 articles were studied for development of differential diagnostic criteria on tongue coating thickness. Conclusion We found out that until now the researches on clinical application of CTDS mainly had been performed for producing a variety of CTDSs. Considering the importance of the tongue color in the traditional Korean medicine, we suggest that at first standard operating procedure for CTDS be developed and researches to develop differential diagnostic criteria on tongue body/coating color be performed and then explore its applications.

• Journal of Information Processing Systems
• /
• 제8권1호
• /
• pp.67-84
• /
• 2012

An important amount of clinical data concerning the medical history of a patient is in the form of clinical reports that are written by doctors. They describe patients, their pathologies, their personal and medical histories, findings made during interviews or during procedures, and so forth. They represent a source of precious information that can be used in several applications such as research information to diagnose new patients, epidemiological studies, decision support, statistical analysis, and data mining. But this information is difficult to access, as it is often in unstructured text form. To make access to patient data easy, our research aims to develop a system for extracting information from unstructured text. In a previous work, a rule-based approach is applied to a clinical reports corpus of infectious diseases to extract structured data in the form of named entities and properties. In this paper, we propose the use of a Boolean inference engine, which is based on a cellular automaton, to do extraction. Our motivation to adopt this Boolean modeling approach is twofold: first optimize storage, and second reduce the response time of the entities extraction.

• 약학회지
• /
• 제57권6호
• /
• pp.412-419
• /
• 2013

Drug discovery and development processes are time consuming and costly endeavors. It has been reported that on average it takes 10 to 15 years and costs more than $ 1billion to bring a molecule from discovery to market. Compounds fail for various reasons but one of the significant reasons that accounts for failures in clinical trials is poor prediction/understanding of pharmacokinetics and drug metabolism in human. In an effort to improve the number of compounds that exhibit optimal absorption, distribution, metabolism, elimination (ADME), and pharmacokinetic properties in human, drug metabolism, pharmacokinetic scientists have been continually developing new technologies and compound screening strategies. Over the last few years, accelerator mass spectrometry (AMS) and its applications to preclinical/clinical pharmacokinetics and ADME studies have significantly increased, particularly for new chemical/biological entities that are difficult to support with conventional radiolabel studies. In this review, the application of AMS for micro-dosing, micro-tracer absolute bioavailability, mass balance and metabolite profiling studies will be discussed.

• 대한한방부인과학회지
• /
• 제35권1호
• /
• pp.75-90
• /
• 2022

Objectives: The purpose of this study protocol is firstly to investigate the status of Korean medical treatment of dysmenorrhea, and secondly to investigate effectiveness of the Clinical Pathway (CP) of dysmenorrhea and review the applicability. Methods: This is a multi-center observational study. The data will be prospectively collected from 14 Korean medicine clinics. 45 patients for each of the CP-applied and non-applied groups will be recruited to compare the degree of improvement in menstrual pain. All the diagnosis records, treatment methods, treatment results, adverse events, and medical expenses of patients with dysmenorrhea will be collected. We will investigate the proportion of patients who could be applied with CP, and the actual number of CP applications, and CP completion rate to evaluate the applicability. Additionally, the satisfaction survey will be used to collect feedback from medical staff members and patients. Results: The results of this study will be disseminated through peer-reviewed publications and scientific presentations. Conclusions: This study is expected to provide valuable data for application of standard Korean medicine clinical pathway for dysmenorrhea.

• Mass Spectrometry Letters
• /
• 제6권4호
• /
• pp.85-90
• /
• 2015

This article reviews recent analytical techniques using inductively coupled plasma-mass spectrometry (ICP-MS) immunoassay for clinical and bio analysis. We classified the techniques into two categories, direct and indirect analysis, which depend upon a guideline of whether tagging materials are used or not. Direct analysis is well known, and generally used in conjunction with various other techniques, such as laser ablation, chromatographic separations, etc. Recently, indirect analysis using tagging elements has intensively been discussed because of its importance in future applications to bio and clinical analysis, including environmental and food industries. The method has shown advantages of multiplex detection, excellent sensitivity, and short analysis time owing to signal amplification and magnetic separation. Now, it expands the application field from small biomolecules to large cells.

• Communications for Statistical Applications and Methods
• /
• 제6권2호
• /
• pp.543-564
• /
• 1999

The principal aim of a sequential phase I clinical trial in which the toxicity reponses of a group of patient(s) determine the dose level of the next patient(s) group is to estimate the maximal tolerated dose(MTD) of a new drug, In this paper we compared with a simulation study the performance of the MTD estimates that are determined by a stopping rule in a design and also those that are determined by analyzing the data after a clinical trial is terminated. To the latter belong the mean median mode and maximum likelihood estimates. For the Standard Methods the stopping rule MTD is quite inefficient but the median MTD has a best efficiency and is robust with respect to the three different toxicity curves. The problem of non-convergence of MLE MTD is severe. A more improved MTD estimate is produced by combining the advantages of the various MTD estimates and its efficiency is better than the single median MTD estimate especially for the toxicity curve of an unlucky choice of dose levels. The simulation results suggest that simple types of phase I designs can be combined with relatively standard analytic techniques to provide a more efficient MTD estimate.

• Nuclear Medicine and Molecular Imaging
• /
• 제42권sup1호
• /
• pp.113-115
• /
• 2008

Clinical experience on FDG PET in urothelial tumors, vulva and vaginal carcinoma is still limited. The main interest of this review is to study a bibliographic review and applications of PET for urothelial tumors, vulva and vaginal carcinoma. The role of positron emission tomography (PET) is still evolving but is likely to be most important in determining early spread of disease in patients with aggressive tumors and for monitoring response to therapy. More extensive clinical investigations are necessary to support this indications.

• Journal of Yeungnam Medical Science
• /
• 제24권2호
• /
• pp.97-106
• /
• 2007

Functional electrical stimulation (FES) has developed over the last 35 years to become a scientifically, technologically and clinically recognized field of interest in clinical medicine. FES has been applied to locomotion, grasping, ventilation, incontinence, and decubitus healing. However, all of these achievements illustrate the initial applications of FES; its true potential has not yet been realized. Recently, FES systems, which are miniaturized stimulation devices, have been utilized in the clinical setting. However, because the stimulating electrodes of the current FES devices are percutaneous electrodes, which are susceptible to wire breakage, and skin infection an implantable FES stimulating electrode has been introduced in the U.S. and Japan. In the present study, an external power supply method using radio frequency (RF) coupling and data transmission was developed for the control of the implantable FES device. In addition, we review the current understanding of FES devices and their application in clinical medicine.