• 제목/요약/키워드: Clinical decision making

검색결과 391건 처리시간 0.028초

Motor Learning in Elderly: Effects of Decision Making Time for Self-Regulated Knowledge of Results During a Dynamic Balance Task

  • Jeon, Min-jae;Jeon, Hye-seon
    • 한국전문물리치료학회지
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    • 제23권4호
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    • pp.16-26
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    • 2016
  • Background: Deficiencies in the ability to maintain balance are common in elderly. Augmented feedback such as knowledge of results (KR) can accelerate learning and mastering a motor skill in older people. Objects: We designed this study to examine whether one session of Wii-Fit game with self-regulated KR is effective for elderly people, and to compare the effect of two different timings of self-regulated KR conditions. Methods: Thirty-nine community-dwelling elders, not living in hospice care or a nursing home, participated in this study. During acquisition, two groups of volunteers were trained in 10 blocks of a dynamic balancing task under the following 2 conditions, respectively: (a) a pre-trial self-regulated KR ($n_1=18$), or (b) a post-trial self-regulated KR ($n_2=21$). Immediate retention tests and delayed retention tests of balancing performance were administered in 15 minutes and 24 hours following acquisition period, respectively. Results: In both groups, significant improvements of balancing performances scores were observed during the acquisition period. Regardless of the group, mean of balancing performance scores on retention tests were well-maintained from the final session. There were no significant differences between groups in balancing performance scores during the acquisition period (p>.05); however, the post-trial self-regulated KR group exhibited significantly higher balancing performance scores in both the immediate retention test and delayed retention test than that of the pre-trial self-regulated KR group (p<.05). Conclusion: Therefore, subjects who regulated their feedback after a dynamic balancing task, during the acquisition period, experienced more efficient motor learning during the retention period than did subjects who regulated their feedback before a dynamic balancing task. Accordingly, in case of presenting the KR of motor learning in clinical settings to elders who reduced dynamic balance abilities, the requesting time of KR is imperative according to self-estimation processes as well as types of KR and practice.

수술 동영상의 비식별화를 위한 개인식별정보 자동 검출 시스템 설계 및 구현 (Design and Implementation of Automated Detection System of Personal Identification Information for Surgical Video De-Identification)

  • 조영탁;안기옥
    • 융합보안논문지
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    • 제19권5호
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    • pp.75-84
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    • 2019
  • 최근 의료정보기술 분야에서 비디오는 풍부한 임상정보를 포함하는 특징으로 인하여 새로운 서비스 창출 및 연구개발을 위한 중요한 데이터로서 그 가치를 새롭게 평가받고 있다. 그러나 임상정보는 개인정보를 포함하고 있어, 생명윤리 혹은 연구 윤리에 대한 고려가 필요하다. 따라서 비디오 또한 의료영상으로서 비식별화가 요구되지만 기존 방법은 주로 정형데이터와 정지영상에 특화되어 기존의 방법을 그대로 적용하기 어려운 문제가 있다. 본 논문에서는 개인정보 비식별화 처리 시스템과의 연동을 고려하여 비디오 내에서 개인식별정보를 검출하는 자동화 시스템을 제안한다. 제안 시스템은 장면분할과 체내외 영역 검출의 전처리 후에 텍스트 및 사람검출을 통한 인덱싱과정을 수행한다. 검출된 개인식별 인덱스 정보는 비식별화를 수행하는 외부 시스템 및 시각화를 위한 메타데이터로 제공된다. 제안 시스템의 효용성을 검증하기 위하여 프로토타입을 구현하고 실제 수술비디오를 대상으로 인덱싱 속도를 측정하였다. 그 결과 입력 비디오의 재생시간 대비 2배 이상의 빠른 작업속도를 보였으며, 수술교육콘텐츠 제작 및 학술용 반자동 편집시스템의 사례를 통해 빠른 의사결정을 보조할 수 있음을 확인하였다.

Class III 악간관계와 교합평면 부조화를 보이는 환자의 전악수복증례 (Full mouth rehabilitation of class III patient with disharmonious occlusal plane: A case report)

  • 김하영;백장현;권긍록;배아란
    • 대한치과보철학회지
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    • 제54권4호
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    • pp.451-457
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    • 2016
  • 보철 치료계획 결정과정은 임상정보에 대한 치과의사의 분석과 환자와의 상호소통을 통하여 이루어진다. 치아의 상실이나 치관부 결손으로 인해 발생한 공간으로 반대악 치아가 정출된 경우, 구강기능을 회복시키는데 있어 적절한 치료방법 선택 및 예후를 예측하는데 혼란이 야기될 수 있다. 치아의 정출로 인한 교합평면의 심한 부조화가 나타난 경우, 신중한 평가가 필요하며, 필요 시 교합평면을 재설정 해야 한다. 본 증례는 심한 정출에 의한 불균일한 교합평면과 class III 악간관계로 인한 비심미성 및 저작불편을 주소로 내원한 환자로, 체계적인 진단과정을 통한 치료계획의 수립으로 교합평면 재설정을 통한 전악수복으로 심미적이고 기능적인 결과를 얻었기에 보고하는 바이다.

국내 응급전문간호사의 업무 수행빈도, 중요성, 자율성 및 지각된 수행능력 (Task Analysis of Emergency Nurse Practitioners: Frequency, Importance, Autonomy, and Perceived Competence to Perform)

  • 안숙희;이은남;송라윤;박진희;김복자;성미혜;이은자;김민주;김성숙
    • 중환자간호학회지
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    • 제8권1호
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    • pp.25-40
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    • 2015
  • Purpose: The purpose of the study was to identify the frequency and importance of task performance and the perceived competence to perform of the emergency nurse practitioners (ENPs) certified in Korea. Method: This cross-sectional study was conducted with 41 ENPs certified by March 2012. The questionnaire to identify frequency, importance, autonomy, and perceived competence to perform 131 typical ENP task elements was developed on the basis of the standardized role of an ENP defined by the Korean Accreditation Board of Nursing Education. The data were analyzed using descriptive statistics. Results: The professional nursing practice showed the highest scores for performance frequency, task importance, autonomy, and perceived competence to perform as compared to other job categories. Clinical decision making was the most frequently performed duty. Data collection was the duty with highest levels of importance, autonomy, and perceived competence for the ENPs. However, the ENPs reported that research was the duty with the lowest levels of frequency, importance, autonomy, and perceived competence Conclusion: ENPs in Korea perform various tasks. In order to improve their position in the field, it is necessary to clarify their job description and enhance their competence to perform evidencebased professional nursing practices.

Mutation Spectra of BRCA Genes in Iranian Women with Early Onset Breast Cancer - 15 Years Experience

  • Yassaee, Vahid Reza;Ravesh, Zeinab;Soltani, Ziba;Hashemi-Gorji, Feyzollah;Poorhosseini, Seyed Mohammad;Anbiaee, Robab;Joulaee, Azadeh
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권sup3호
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    • pp.149-153
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    • 2016
  • Breast cancer is the most common cancer in Iran. In the recent years an upward trend has been observed in the Iranian population. Early detection by molecular approaches may reduce breast cancer morbidity and mortality. We provided consultation to 3,782 women diagnosed with early onset breast cancer during the past 15 years (1999-2014). To establish a data set for BRCA gene alterations of the Iranian families at risk, two hundred and fifty four women who met our criteria were analyzed. A total number of 46 alterations including 18 variants with unknown clinical significance (39.1%), 18 missense mutations (39.1%), 7 Indels (15.2%) and 3 large rearrangement sequences (6%) were identified. Further scanning of affected families revealed that 49% of healthy relatives harbor identical causative mutations. This is the first report of comprehensive BRCA analysis in Iranian women with early onset breast cancer. Our findings provide valuable molecular data to support physicians as well as patients for the best decision making on disease management.

Breaking Bad News: Patient Preferences and the Role of Family Members when Delivering a Cancer Diagnosis

  • Rao, Abha;Sunil, Bhuvana;Ekstrand, Maria;Heylen, Elsa;Raju, Girish;Shet, Arun
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권4호
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    • pp.1779-1784
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    • 2016
  • Background: Western physicians tend to favour complete disclosure of a cancer diagnosis to the patient, while non-Western physicians tend to limit disclosure and include families in the process; the latter approach is prevalent in clinical oncology practice in India. Few studies, however, have examined patient preferences with respect to disclosure or the role of family members in the process. Materials and Methods: Structured interviews were conducted with patients (N=127) in the medical oncology clinic of a tertiary referral hospital in Bangalore, India. Results: Patients ranged in age from 18-88 (M=52) and were mostly male (59%). Most patients (72%) wanted disclosure of the diagnosis cancer, a preference significantly associated with higher education and English proficiency. A majority wanted their families to be involved in the process. Patients who had wanted and not wanted disclosure differed with respect to their preferences regarding the particulars of disclosure (timing, approach, individuals involved, role of family members). Almost all patients wanted more information concerning their condition, about immediate medical issues such as treatments or side effects, rather than long-term or non-medical issues. Conclusions: While most cancer patients wanted disclosure of their disease, a smaller group wished that their cancer diagnosis had not been disclosed to them. Regardless of this difference in desire for disclosure, both groups sought similar specific information regarding their cancer and largely favoured involvement of close family in decision making. Additional studies evaluating the influence of factors such as disease stage or family relationships could help guide physicians when breaking bad news.

Artificial Neural Network for Prediction of Distant Metastasis in Colorectal Cancer

  • Biglarian, Akbar;Bakhshi, Enayatollah;Gohari, Mahmood Reza;Khodabakhshi, Reza
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권3호
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    • pp.927-930
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    • 2012
  • Background and Objectives: Artificial neural networks (ANNs) are flexible and nonlinear models which can be used by clinical oncologists in medical research as decision making tools. This study aimed to predict distant metastasis (DM) of colorectal cancer (CRC) patients using an ANN model. Methods: The data of this study were gathered from 1219 registered CRC patients at the Research Center for Gastroenterology and Liver Disease of Shahid Beheshti University of Medical Sciences, Tehran, Iran (January 2002 and October 2007). For prediction of DM in CRC patients, neural network (NN) and logistic regression (LR) models were used. Then, the concordance index (C index) and the area under receiver operating characteristic curve (AUROC) were used for comparison of neural network and logistic regression models. Data analysis was performed with R 2.14.1 software. Results: The C indices of ANN and LR models for colon cancer data were calculated to be 0.812 and 0.779, respectively. Based on testing dataset, the AUROC for ANN and LR models were 0.82 and 0.77, respectively. This means that the accuracy of ANN prediction was better than for LR prediction. Conclusion: The ANN model is a suitable method for predicting DM and in that case is suggested as a good classifier that usefulness to treatment goals.

Evaluation of KRAS Gene Mutations in Metastatic Colorectal Cancer Patients in Kermanshah Province

  • Amirifard, Nasrin;Sadeghi, Edris;Farshchian, Negin;Haghparast, Abbas;Choubsaz, Mansour
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권7호
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    • pp.3085-3088
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    • 2016
  • Background: Worldwide, colorectal cancer (CRC) is reported to be the fourth most common cancer in men and the third most common in women. KRAS is a proto-oncogene located on the short arm of chromosome 12. The aim of this study was to evaluate the KRAS oncogene and its relationship it with clinicopathologic features in 33 Kurdish patients. Materials and Methods: Metastatic CRC between 2012 and 2016 that came to Imam Reza hospital, Kermanshah province, Iran, were analysed for KRAS mutations using allele specific PCR primers and pyrosequencing. Correlations between variables was analyzed in PASW SPSS and overall survival curves were plotted in Graph Pad prism 5. Results: The mean age for them at diagnosis was $51.5{\pm}12.6$ years (range, 22-76 years). Among the 33 patients that were sequenced, 12 samples in the KRAS gene had a nucleotide change, 11 in codon 12 and 1 in codon 13.There was no significant relationship between the mutation and clinical and pathological aspects of the disease. Conclusions: Knowledge of the KRAS status can help in decision-making to treat metastatic colorectal cancer patients more efficiently and increase survival. However, many Kurdish people due to economic problems are not able to do this valuable genetic test. In addition, we need more careful research of KRAS oncogene at the molecular level in young populations with more patients.

Gastric Cancer in Asian American Populations: a Neglected Health Disparity

  • Taylor, Victoria M.;Ko, Linda K.;Hwang, Joo Ha;Sin, Mo-Kyung;Inadomi, John M.
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권24호
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    • pp.10565-10571
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    • 2015
  • Gastric cancer incidence rates vary dramatically by world region with East Asia having the highest rate. The Asian population of the United States (US) is growing rapidly and over 17 million Americans are of Asian descent. A majority of Chinese, Korean and Vietnamese Americans are immigrants. Americans of East and Southeast Asian descent experience marked gastric cancer disparities and the incidence rate among Korean men in the US is over five times higher than the incidence rate among non-Hispanic white men. Randomized controlled trials have provided evidence for the effectiveness of helicobacter pylori identification and eradication in preventing gastric cancer. Additionally, Japan and South Korea have both experienced improvements in gastric cancer mortality following the implementation of programs to detect early stage gastric cancers. There are currently no clear US guidelines regarding the primary and secondary prevention of gastric cancer in high-risk immigrant populations. However, it is likely that a proportion of US physicians are already recommending gastric cancer screening for Asian patients and some Asian immigrants to the US may be completing screening for gastric cancer in their native countries. Surveys of US primary care physicians and Asian American communities should be conducted to assess current provider practices and patient uptake with respect to gastric cancer prevention and control. In the absence of clinical guidelines, US health care providers who serve high-risk Asian groups could consider a shared decision-making approach to helicobacter pylori identification and eradication, as well as gastric endoscopy.

조현병 환자의 신경과학적 근거에 대한 고찰 (Review of the Neuroscientific Evidences for the People With Schizophrenia)

  • 신은식
    • 재활치료과학
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    • 제2권1호
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    • pp.5-12
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    • 2013
  • 본 연구는 조현병의 신경과학적 연구에 대한 흐름을 알아봄으로써 임상가들에게 조현병 환자 치료의 토대를 제공하고, 보다 효과적인 치료를 선정하는데 도움이 되고자 하였다. 현재까지 조현병 환자의 신경과학적 연구는 매우 활발히 이루어지고 있는데, 본 고찰에서는 조현병의 발생에 대한 연구와 조현병으로 인한 신경해부학적 기능 이상에 초점을 두고 살펴보았다. 조현병의 발생과 관련된 연구는 신경생화학적 이상, 신경발달적 모델, 뇌단백물질, 뇌유래신경영양인자에 대한 근거들을 다루었으며, 조현병의 신경해부학적 기능 이상에 대해서는 주로 신경영상학적 특징들에 근거하였다. 결론적으로, 조현병은 광범위한 기능적 손실을 가져오는 정신과적 질환으로 이제까지 원인과 치료에 대한 많은 연구들이 실행되고 있지만 아직 명백한 결과를 가져오지는 못하고 있다. 그러나 이제까지 밝혀진 많은 근거들은 임상가들이 조현병 환자를 치료하고 재활함에 있어서 충분한 도움이 될 것으로 생각된다. 앞으로도 조현병의 원인 규명과 치료에 대한 다양한 신경과학적 연구가 진행될 것으로 보인다.