• Neurospine
• /
• 제15권4호
• /
• pp.329-337
• /
• 2018

Objective: Machine learning algorithms excel at leveraging big data to identify complex patterns that can be used to aid in clinical decision-making. The objective of this study is to demonstrate the performance of machine learning models in predicting postoperative complications following anterior cervical discectomy and fusion (ACDF). Methods: Artificial neural network (ANN), logistic regression (LR), support vector machine (SVM), and random forest decision tree (RF) models were trained on a multicenter data set of patients undergoing ACDF to predict surgical complications based on readily available patient data. Following training, these models were compared to the predictive capability of American Society of Anesthesiologists (ASA) physical status classification. Results: A total of 20,879 patients were identified as having undergone ACDF. Following exclusion criteria, patients were divided into 14,615 patients for training and 6,264 for testing data sets. ANN and LR consistently outperformed ASA physical status classification in predicting every complication (p < 0.05). The ANN outperformed LR in predicting venous thromboembolism, wound complication, and mortality (p < 0.05). The SVM and RF models were no better than random chance at predicting any of the postoperative complications (p < 0.05). Conclusion: ANN and LR algorithms outperform ASA physical status classification for predicting individual postoperative complications. Additionally, neural networks have greater sensitivity than LR when predicting mortality and wound complications. With the growing size of medical data, the training of machine learning on these large datasets promises to improve risk prognostication, with the ability of continuously learning making them excellent tools in complex clinical scenarios.

• 통합자연과학논문집
• /
• 제12권2호
• /
• pp.58-68
• /
• 2019

Critical thinking is essential to implementing the nursing process requiring timely decision making. The study examined the effects of a critical thinking course for nurses in the RN-BSN program. The study used a pre- and post-test design with a control group. The experimental group was a convenience sample of 24 working nurses attending a health college. The control group was 24 fellow nurses. The nursing process-based critical thinking course was provided to the experimental group two and half hours a week for 8 weeks. Teaching methods included lectures followed by a summary and quiz, brainstorming and action learning, and lecturer feedback. A pamphlet about views of professional occupation was provided to the control group. The data were collected using self-report questionnaires and analyzed to examine differences in the test scores before and after the intervention. The scores of critical thinking disposition, problem-solving process, and clinical competence increased significantly in the experimental group but did not in the control group. The difference between the two groups was also statistically significant in critical thinking disposition, problem-solving process, and clinical competence. It is necessary that a robust educational program or training to enhance critical thinking ability of nurses are provided in clinical settings and that nurses keep going on thinking critically in their practice.

• 한국간호교육학회지
• /
• 제13권1호
• /
• pp.32-40
• /
• 2007

Purpose: The purpose of this study was to develop and evaluate an integrated clinical evaluation program to increase the competency of senior nursing students. Method: A cross-sectional one group test design was utilized. Based on a framework derived from the prior studies, an integrated clinical evaluation program was developed. In order to assess the effect of the developed program, the senior students' experience with the program was measured. The participants were senior nursing students and the program was performed on November, 2005 after their semester was all finished. Result: The evaluation score for ability in application of nursing process was 83.87 and nursing skill was 85.69 by evaluators. The students reported that the program provided a chance to relearn and practice basic nursing skills and it was helpful in increasing decision making competency and their ability to apply the nursing process. Conclusion: This study suggests that the integrated clinical evaluation program contributes to cultivating a nurse with comprehensive nursing competencies and to improve the nursing students' knowledge, attitude, and skill.

• The Korean Journal of Physiology and Pharmacology
• /
• 제18권6호
• /
• pp.447-456
• /
• 2014

Until now, a disease-modifying therapy (DMT) that has an ability to slow or arrest Alzheimer's disease (AD) progression has not been developed, and all clinical trials involving AD patients enrolled by clinical assessment alone also have not been successful. Given the growing consensus that the DMT is likely to require treatment initiation well before full-blown dementia emerges, the early detection of AD will provide opportunities to successfully identify new drugs that slow the course of AD pathology. Recent advances in early detection of AD and prediction of progression of the disease using various biomarkers, including cerebrospinal fluid (CSF) $A{\beta}_{1-42}$, total tau and p-tau181 levels, and imagining biomarkers, are now being actively integrated into the designs of AD clinical trials. In terms of therapeutic mechanisms, monitoring these markers may be helpful for go/no-go decision making as well as surrogate markers for disease severity or progression. Furthermore, CSF biomarkers can be used as a tool to enrich patients for clinical trials with prospect of increasing statistical power and reducing costs in drug development. However, the standardization of technical aspects of analysis of these biomarkers is an essential prerequisite to the clinical uses. To accomplish this, global efforts are underway to standardize CSF biomarker measurements and a quality control program supported by the Alzheimer's Association. The current review summarizes therapeutic targets of developing drugs in AD pathophysiology, and provides the most recent advances in the clinical utility of CSF biomarkers and the integration of CSF biomarkers in current clinical trials.

• 대한간호학회지
• /
• 제24권2호
• /
• pp.206-215
• /
• 1994

Intuition is an abstract concept which is most often thought of as a nonrational, nonscientific mode of thought. However, since there are so many amorphous definitions of intuition that it seems important to clarify the meaning of this concept. Therefore, this study use the process of Walker & Avant’s concept analysis to define of the concept of intuition Attributes of intuition were defined as 1) Knowledge of truth that is difficult to explicate ; 2) A type of immediate knowing ; 3) Knowlwdge without reasining analysis ; 4) Knowledge that is attained based on virtue character which integrates all matter and is not attained through individual experience. Antecedents of intuition consists of 1) as ground for knowledge or truth that is not availables to trace through the analytic procedures ; & 2) the flow of Ki which unites human beings and the universe. Consequences of intuition events or incidents occuring as a result of the concept consist of verification of the truth though analytic procedures and application of knowledge in both theoretical and practical ways. To develop intuitive ability, as an educator should not only make studies in recognizine, analysing and teaching concepts related to logical, rational decision making but should also recognize and teach concepts related to intuitive components of making decisions in clinical practice and classroom learning as well.

• 한국간호교육학회지
• /
• 제26권4호
• /
• pp.402-411
• /
• 2020

Purpose: The purpose of this study is to explore the trends of research related to ethical topics in Korean nursing students. Methods: A total of 131 articles that were published from 2000 to 2020 were analyzed and summarized according to publishing type, research design, subject, data analysis method, main research topic, research variables and instrument. Results: Most studies were journal articles (93.9%) and their most frequent research design was survey (75.7%). The research subjects covered all grades (35.1%) or they were divided between clinical nursing practicum (29.8%) or not (21.4%). The main research topics were biomedical ethics, ethical values, moral judgment and ethics education. Recently, ethical decision making and practical ability in nursing practice were reported. The instruments for measuring variables were limited and the same tools were used several times. Conclusion: Based on the findings of this study, it is suggested that the selection of various research topics and the application of research methods related to ethics for nursing students will continue in response to rapidly changing social phenomena in the future. In particular, it is necessary that research related to ethical and practical ability as well as ethical attitudes and perceptions of nursing students be actively carried out.

• 한국융합학회논문지
• /
• 제11권9호
• /
• pp.65-72
• /
• 2020

치위생학교육평가·인증체계 정립을 위한 학습성과기반 치위생 핵심역량을 파악하고자 치위생(학)과 전임교수 207명을 대상으로 설문 조사를 실시하였다. 핵심역량별 세부영역에서 전문가적 행동 및 윤리적 의사결정 능력(1영역)과 과학적이고 전문적인 임상치위생과 임상치과업무의 지식과 기술을 적용할 수 있는 능력(2영역)의 전체 점수가 가장 높게 나타났고, 의사소통 능력 정도(3영역)는 4.48점, 근거중심의 통합적 사고와 문제해결 능력 정도(5영역)는 4.35점으로 나타났다. 핵심역량 세부영역들은 강한 상관관계가 있는 것을 확인하여 보건의료서비스 직종간의 핵심역량 파악과 임상 실무현장에 근무하고 있는 치과위생사들의 핵심역량에 대한 질적 연구가 필요하다고 사료된다.

• 대한통합의학회지
• /
• 제11권2호
• /
• pp.231-242
• /
• 2023

Purpose : This study aimed to identify ways to improve the quality of physical therapy research and ultimately review the current situation to improve evidence-based decision-making in physical therapy. Methods : For better evidence-based decision-making in physical therapy, researchers should review the quality assessment of articles in more detail and report their findings for valid and appropriate level of evidence and strength of recommendations. The level of evidence affects how well the findings are derived from well-designed literature. The evaluation of the evidence focuses primarily on the study design and the degree of bias that may compromise the validity of the findings. The final recommendation is based on a combination of the study design and literature quality. To uncover gems of information in each paper, a risk of bias assessment should be performed after the literature has been initially selected. Results : Researchers should consider the complexity of the intervention, appropriate grouping, and calculation of effect sizes for the intervention. Researchers conducting systematic reviews should provide a detailed description of the quality assessment performed and present a detailed analysis of their interpretation of the results. The results of systematic reviews and meta-analyses should be interpreted with caution and include a risk of bias assessment. Guidelines for the level of evidence and strength of recommendations should be developed and utilized more broadly to improve reporting practices in physical therapy. Conclusion : Researchers should be knowledgeable about the strengths and limitations of each study design and methodology. In the future, researchers will also need to improve their ability to critically evaluate their findings, given the potential for their results to influence clinical practice.

• 치위생과학회지
• /
• 제20권1호
• /
• pp.16-24
• /
• 2020

Background: Dental treatment has shifted to the center of the community, and the public policy of the country has expanded to support the vulnerable classes such as the disabled. The dental profession needs education regarding oral health services for persons with disabilities, and it is necessary to derive the competencies for this. Therefore, we conducted this study to derive the normative ability to understand the role of a dental hygienist in the oral health service for persons with disabilities and improvement plans for education. Methods: We conducted a qualitative analysis for deriving competencies by analyzing the data collected through in-depth interviews with experts in order to obtain abilities through practical experience. Based on the competency criterion, relevant competency in the interview response was derived using the priori method, and it was confirmed whether the derived ability matched the ability determined by the respondent. Results: The professional conduct competencies of dental hygienists, devised by the Korean Association of Dental Hygiene, consists of professional behavior, ethical decision-making, self-assessment skills, lifelong learning, and accumulated evidence. Also, core competencies of the American Dental Education Association competencies for dental hygienist classification such as ethics, responsibility for professional actions, and critical thinking skills were used as the criterion. The dental hygienist's abilities needed for oral health care for people with disabilities, especially in the detailed abilities to fulfill these social needs, were clarified. Conclusion: To activate oral health care for people with disabilities, it is necessary for dental hygienists to fulfill their appropriate roles, and for this purpose, competency-based curriculum restructuring is indispensable. A social safety net for improving the oral health of people with disabilities can be secured by improving the required skills-based education system of dental hygienists and strengthening the related infrastructure.

• Experimental and Molecular Medicine
• /
• 제50권12호
• /
• pp.10.1-10.11
• /
• 2018

Cancer growth and progression are associated with immune suppression. Cancer cells have the ability to activate different immune checkpoint pathways that harbor immunosuppressive functions. Monoclonal antibodies that target immune checkpoints provided an immense breakthrough in cancer therapeutics. Among the immune checkpoint inhibitors, PD-1/PD-L1 and CTLA-4 inhibitors showed promising therapeutic outcomes, and some have been approved for certain cancer treatments, while others are under clinical trials. Recent reports have shown that patients with various malignancies benefit from immune checkpoint inhibitor treatment. However, mainstream initiation of immune checkpoint therapy to treat cancers is obstructed by the low response rate and immune-related adverse events in some cancer patients. This has given rise to the need for developing sets of biomarkers that predict the response to immune checkpoint blockade and immune-related adverse events. In this review, we discuss different predictive biomarkers for anti-PD-1/PD-L1 and anti-CTLA-4 inhibitors, including immune cells, PD-L1 overexpression, neoantigens, and genetic and epigenetic signatures. Potential approaches for further developing highly reliable predictive biomarkers should facilitate patient selection for and decision-making related to immune checkpoint inhibitor-based therapies.