• 제목/요약/키워드: Clinical decision making

검색결과 391건 처리시간 0.027초

Endoscopic Ultrasonography in Pediatric Patients with Pancreatobiliary Disease: Single-Center Trial

  • Demirbas, Fatma;Kaymazli, Mustafa;Caltepe, Gonul;Abbasguliyev, Hasan;Kalayci, Ayhan Gazi;Bektas, Ahmet
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제24권2호
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    • pp.164-172
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    • 2021
  • Purpose: The use of Endoscopic ultrasonography (EUS) in pediatric patients is not as common as in adults. The aim of this study is to evaluate the role of EUS in the diagnosis of pancreatobiliary disease in childhood. Methods: Between December 2016 and January 2018, the findings of patients who underwent EUS were evaluated retrospectively. Results: Of the 41 patients included in the study 25 were girls (61.0%), mean age was 12.2±4.2 years. EUS was performed for biliary colic in 21 (51.2%), for recurrent pancreatitis in 12 (29.2%), for cholecystitis/cholangitis in 5 (12.2%), and for acute pancreatitis in 3 (7.4%) patients. EUS had a significant clinical effect in the decision of treatment and follow-up of 6/21 biliary colic cases, in diagnosis and follow-up of 6/12 recurrent pancreatitis cases, in decision-making and monitoring of invasive procedures (ERCP/surgery) of 3/5 acute cholecystitis/cholangitis and 2/3 of acute pancreatitis cases as well as in follow-up of the other cases. The effectiveness of EUS in determining direct treatment and invasive intervention was 43.9%. None of the patients had complications related to the EUS procedure. Conclusion: Although current guidelines show that EUS can be used in pediatric patients, this is limited to a few published studies. In this study, it is shown that EUS is a safe method for the diagnosis, follow-up and treatment of common pancreatobiliary pathologies in childhood.

Deep-learning performance in identifying and classifying dental implant systems from dental imaging: a systematic review and meta-analysis

  • Akhilanand Chaurasia;Arunkumar Namachivayam;Revan Birke Koca-Unsal;Jae-Hong Lee
    • Journal of Periodontal and Implant Science
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    • 제54권1호
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    • pp.3-12
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    • 2024
  • Deep learning (DL) offers promising performance in computer vision tasks and is highly suitable for dental image recognition and analysis. We evaluated the accuracy of DL algorithms in identifying and classifying dental implant systems (DISs) using dental imaging. In this systematic review and meta-analysis, we explored the MEDLINE/PubMed, Scopus, Embase, and Google Scholar databases and identified studies published between January 2011 and March 2022. Studies conducted on DL approaches for DIS identification or classification were included, and the accuracy of the DL models was evaluated using panoramic and periapical radiographic images. The quality of the selected studies was assessed using QUADAS-2. This review was registered with PROSPERO (CRDCRD42022309624). From 1,293 identified records, 9 studies were included in this systematic review and meta-analysis. The DL-based implant classification accuracy was no less than 70.75% (95% confidence interval [CI], 65.6%-75.9%) and no higher than 98.19 (95% CI, 97.8%-98.5%). The weighted accuracy was calculated, and the pooled sample size was 46,645, with an overall accuracy of 92.16% (95% CI, 90.8%-93.5%). The risk of bias and applicability concerns were judged as high for most studies, mainly regarding data selection and reference standards. DL models showed high accuracy in identifying and classifying DISs using panoramic and periapical radiographic images. Therefore, DL models are promising prospects for use as decision aids and decision-making tools; however, there are limitations with respect to their application in actual clinical practice.

전통적 원가계산과 활동기준 원가계산의 비교연구 (A Case Study on Activity-Based Costing for a hospital)

  • 정용모;양동현;이용철;임복희
    • 한국병원경영학회지
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    • 제10권1호
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    • pp.25-47
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    • 2005
  • This study was purposed to find out the difference of the accounting of practical cost between the ABC system and the traditional costing system applied in a hospital, to verified general effect of ABC. Methods: This case study deals with the method of calculation, the cost information that is produced at K hospital in Busan. To examine ABC system and traditional costing system, applying them to the clinical pathology, radiology, physics in K hospital. Results: As a result of costing analysis, it is showed maximum difference of 50% between ABC and traditional cost. compared in revenue center, it occurs the difference of 15% of them. considering the result, it is confirmed that ABC could be used as a means to offer more precise information. therefore, ABC makes possible to produce precise costing information and grasp the driver of cost, and it is possible to reduce cost effectively. Conclusion: ABC provide six benefits: (1) more accurate of service delivered (2) inproved pricing and contracting strategies (3) improved management decision making capability (4) greater ease of determining relevant costs (5) reduced nonvalue added costs.

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간호실무현장에서 요구하는 간호대학 졸업생들의 간호핵심역량 (Nursing Core Competencies Needed in the Fields of Nursing Practice for Graduates in Nursing)

  • 이선경;박선남;정석희
    • 간호행정학회지
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    • 제18권4호
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    • pp.460-473
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    • 2012
  • Purpose: This study was done to provide information on issues of nursing core competencies needed in the fields of nursing practice for graduates in nursing, from the perspective of nursing managers, and to make suggestion for improving nursing education programs. Methods: Ten nursing managers participated in this study. They were in charge of clinical nursing education in the fields of nursing practice. Data were collected using focus group interviews and analyzed with the content analysis methodology of Downe - Wamboldt's. Results: Six types of nursing core competency - therapeutic nursing competency, professional nursing competency, administrative nursing competency, humanistic nursing competency, relational nursing competency, and personal nursing competency - were identified as nursing core competencies needed in the fields of nursing practice for graduates in nursing. Conclusion: Results of the study show important evidence for decision-making about nursing curriculum revision based on nursing core competency, both in the classroom and in nursing practice areas. These results should contribute to the development of evaluation indicators for nursing students or new nurses. Further research is required to measure degree of nursing core competency in graduates of nursing and to identify the effect of competency-based education for improving nursing core competency.

레이저 우식진단기기 'DIAGNODent$^{(R)}$'의 활용 (Use of laser fluorescence device 'DIAGNODent$^{(R)}$' for detecting caries)

  • 이병진
    • 대한치과의사협회지
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    • 제49권8호
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    • pp.461-471
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    • 2011
  • The detection of carious lesions is a key point to apply appropriate preventive measures or operative treatment of dental caries. A laser fluorescence device DIAGNOdent$^{(R)}$ (KaVo, Biberach, Germany) has also been shown to be of additional clinical value in the detection of initial caries. This report focus on the DIAGNOdent$^{(R)}$ for caries detection. DIAGNOdent$^{(R)}$ irradiate visible red light at a wavelength of 655 nm to elicit near-infrared fluorescence from caries lesion. This device is known as a reproducible method for caries detection, with good sensitivity and specificity especially for caries detection on occlusal and accessible smooth surfaces. DIAGNOdent$^{(R)}$ tended to be more sensitive method of detecting occlusal dentinal caries, however, showed more false-positive diagnoses than the visual inspection. So Clinician should not use the device as a clinician's primary diagnostic method and it is recommended that the device should be used in the decision-making process in relation to the diagnosis of caries as a second opinion in cases of doubt after visual inspection. The trend of modern dentistry would be a preventive approach rather than invasive treatment of the disease. This is possible only with early detection and respective preventive measures, DIAGNOdent$^{(R)}$ can help the changes.

미만성 간질성 폐질환의 개흉 폐 생검 (Open Lung Biopsy for Diffuse Interstitial Lung Disease)

  • 성숙환;서필원
    • Journal of Chest Surgery
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    • 제27권10호
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    • pp.850-853
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    • 1994
  • Open lung biopsy was performed in thirty patients for the diagnosis and staging evaluation of interstitial lung disease during the period from January 1987 until December 1992. The age of the patients ranged from 14 to 71 years [mean 48 years], and the patients consisted of 14 males and 16 females. Preoperative FEV1`s were from 0.80 liter to 3.88 liters [mean 1.66]. Other non-invasive diagnostic studies such as PCNA, bronchoalveolar lavage, TBLB, and gallium scan were also done in addition to X-ray and high-resolution chest CT. Tweaty-eight were correctly diagnosed and 2 cases were not [diagnostic yield rate 93.3%]. Among the 28 cases,pathologic diagnosis influenced further treatment regimens and prognostic expectations in 23 cases [82.1%]. The diagnostic non-invasive studies other than open lung biopsy yielded a correct diagnosis without staging only in 5 cases. There was no mortality and only one complication, ARDS ; however, the patient recovered after 5 days ventilator support. Open lung biopsy, which is the gold standard for the diagnosis and staging evaluation of interstitial lung disease can be done safely and has value in clinical decision making. Also knowledge of the involvement of the lesion is important for proper selection of the biopsy site.

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치아우식증 탐지 및 평가의 기준 체계, ICDAS에 대한 고찰 (Review on International Caries Detection and Assessment System)

  • 김희은
    • 한국치위생학회지
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    • 제14권5호
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    • pp.609-615
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    • 2014
  • Objectives : In most developed countries there has been a substantial decrease in the prevalence of dental caries in children of 12 years old over the past 40 years. This change in epidemiology highlights the importance of preventive management in dentistry. For successful management of early caries lesions, it is essential to detect and assess the pathological changes of dental caries. Therefore, the purpose of this study was to investigate the overview of International Caries Detection and Assessment System(ICDAS) criteria for the detection and assessment of early caries lesions by literature reviews. Methods : The author reviewed the MEDLINE search by the key words of 'caries assessment', 'caries detection', 'caries measurement', and 'ICDAS'. Results : This literature review provided an overview of International Caries Detection and Assessment System(ICDAS) criteria for the detection and assessment of early caries lesions. This article showed the principles, concept, and primary caries detection criteria of the ICDAS. The ICDAS can macroscopically measure the enamel surface changes and potential histological depth of caries lesions by the surface characteristics of the teeth. The ICDAS criteria allow researchers and clinicians to choose the stage of dental caries and characteristics for assessment. Conclusions : ICDAS can be an adjunct method to clinical decision making and preventive treatment planning.

부인암 전문간호사 제도 확립을 위한 기초조사 (A Fundamental Study for a System Establishment of Advanced Practice Nursing for Gynecological Cancer Patients)

  • 박재순
    • 여성건강간호학회지
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    • 제12권2호
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    • pp.87-96
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    • 2006
  • Purpose: This study was conducted to provide fundamental information for a system establishment of advanced practice nursing for gynecological cancer patients (APN-GCP). Method: Data was collected by focus group and individual interviews and analyzed in the framework of the Grounded theory method mapped by Strauss and Corbin (1990). There were 13 subjects in this study (nurses, doctors, patient and her family). Result: We identified 87 concepts, 22 sub-categories, and 10 categories. Categories for role expectation were arrangement of diagnosis and treatment process, giving information of treatment course, support of treatment process, patients' right toward making a decision of treatment, counseling and teaching after discharge from hospital, medical insurance and financial problems, counseling about sexual problems and use of family and community resources. All subjects perceived the necessity of an APN-GCP. An APN-GCP requires over 2$\sim$7 years clinical experience and a master's degree. Services would be performed from initial registration to termination of treatment or death, and accomplished on an outpatient clinic basis. Conclusion: The nursing delivery system and curriculum should be developed for a women's health nurse practitioner including APN-GCP. As a further step, cost-effectiveness and projected estimation of manpower of APN-GCP should be studied in the future.

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TRL을 이용한 R&D 프로젝트 성과 평가지표 개발: 의료기기 사업을 중심으로 (Development of Performance Measure Indices using TRL: Focused on the National Medical Device R&D Projects)

  • 이만표;정미진;최경현
    • 대한의용생체공학회:의공학회지
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    • 제38권3호
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    • pp.89-94
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    • 2017
  • In order to improve national competitiveness through technological research and development, the government puts in R&D budget every year and manages to improve the R&D results. Accordingly, various R&D project management methods have applied for successful advancement of technology and product. TRL is a measurement system developed by NASA to assess the maturity of technology since the 1970s. To apply medical device, the characteristics such as regulation, clinical trials are considered as a significant influence. In this study, we would like to derive PMI(performance measures index) for medical device R&D projects by using TRL and stage-gate model. As a result of this study, it is possible to use the PMI for decision making and evaluation in the R&D projects and believed that the objectivity can be ensured by the approval or certification of regulatory authority.

A Case Study of English Teacher Development through Online Supervision

  • Chang, Kyungsuk;Jung, Kyutae
    • 영어어문교육
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    • 제17권4호
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    • pp.1-22
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    • 2011
  • Little has been known about the process of the language teacher professional development. The present study aims to investigate an assumption that anybody who has subject matter knowledge will be a good language teacher. A teacher with rich linguistic knowledge started to question the effectiveness of his online class. The teacher, in collaboration with a teacher trainer, became involved in the critical examination of his online class, seeking for more effective ways of teaching. The trainer provided the teacher with clinical supervision, which is characterized as developmental, collaborative, non-judgemental, interactive, and teacher-centered. The data collected at the multi-facets of the online teaching shows how the process of the teacher's decision-making became principled on the basis of recent developments in English language teaching, and how the teacher has gained pedagogical knowledge through reflection upon his teaching. The feedback from the students reveals that such teacher professional development is beneficial to student learning. These findings suggest that language teacher's professional development can take place when they are engaged in reflective teaching and classroom investigation. It is also suggested that the process of teacher development can be enhanced through collaborative supervision with trust, openness and congeniality between parties involved.

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