• 제목/요약/키워드: Clinical evidence

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Radiomics and Deep Learning from Research to Clinical Workflow: Neuro-Oncologic Imaging

  • Ji Eun Park;Philipp Kickingereder;Ho Sung Kim
    • Korean Journal of Radiology
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    • 제21권10호
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    • pp.1126-1137
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    • 2020
  • Imaging plays a key role in the management of brain tumors, including the diagnosis, prognosis, and treatment response assessment. Radiomics and deep learning approaches, along with various advanced physiologic imaging parameters, hold great potential for aiding radiological assessments in neuro-oncology. The ongoing development of new technology needs to be validated in clinical trials and incorporated into the clinical workflow. However, none of the potential neuro-oncological applications for radiomics and deep learning has yet been realized in clinical practice. In this review, we summarize the current applications of radiomics and deep learning in neuro-oncology and discuss challenges in relation to evidence-based medicine and reporting guidelines, as well as potential applications in clinical workflows and routine clinical practice.

Evaluating the Efficacy of Anti-wrinkle Products in USA

  • Kang Sewon
    • 대한화장품학회지
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    • 제29권2호
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    • pp.79-104
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    • 2003
  • Introducing to the market place, safe and effective product is an important responsibility of clinical investigators as well as regulatory agencies in all developed countries. Products claiming to improve skin wrinkles are no exceptions. To date, Renova(R) (all-trans retinoic acid), Avage(R) (tazarotene), and Botox(R) (botulinum toxin) are the only agents FDA approved to ameliorate wrinkles associated with photoaged skin in the USA. For all three, clinical evaluation of wrinkle severity was the primary endpoint required for the approval process. No sophisticated instrument measurements of wrinkles were required, nor used in the pivotal studies. The Division of Dermatologic & Dental Products of the US FDA (Director, Jonathan Wilkin, MD) is not against the use of mechanical instruments in assessing wrinkle severity. Its position on this issue however, remains that any such device must be grounded in patients' or product users' perspective, which means that the evaluation instrument must be clinically relevant and clinically perceptible. Sophisticated devices that can detect minimal improvement, but imperceptible to the users are considered useless in the eyes of the US FDA. Two instruments that have been tried in some antiwrinkle studies in the USA are silicone replicas and Primos. Despite their sophistications, they have clear limitations; thus have never replaced clinical evaluations in these studies. At most, they have served as secondary measures to provide corroborative data on the clinical efficacy of antiwrinkle products. For the foreseeable future, at least in the USA, careful clinical assessment of wrinkles will continue to serve as the critical benchmark to determine whether an antiwrinkle product has enough efficacy to benefit its users. We must not lose sight of the fact that sophisticated devices are only to serve in generating supportive evidence, and not the primary evidence, in any clinical studies.

The prevalence, clinical and radiographic characteristics of cemento-osseous dysplasia in Korea

  • Cho, Bong-Hae;Jung, Yun-Hoa;Nah, Kyung-Soo
    • Imaging Science in Dentistry
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    • 제37권4호
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    • pp.185-189
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    • 2007
  • Purpose: This study was intended to estimate the prevalence of cemento-osseous dysplasia (COD) in the Korean population and to assess the clinical and radiographic characteristics of this condition. Materials and Methods: Panoramic radiographs from 10,646 patients (4,982 males and 5,664 females, age range from 6 to 91 years) were reviewed for evidence of COD. Their demographics, clinical characteristics, and radiographic features were retrospectively assessed. Results: Of 10,646 panoramic radiographs, 33 radiographs (0.31 %) exhibited evidence of COD. The prevalence of COD increased to over 1 % in women over 40-years old. Of these 33 patients, 16 had florid cemento-osseous dysplasia (FCOD) and 17 had focal COD. Due to the multiplicity of FCOD, a total of 63 COD lesions were assessed. These lesions were most common in the mandibular molar area. Most of the COD lesions examined (61.9%) were less than 10 mm and the majority (82.5%) showed radiopacity. Conclusion : COD has a predilection for the mandibular molar area of middle-aged and older women.

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운동 신경원 질환에서의 상부 운동 신경원 침범: 운동 유발 전위 연구 (Upper Motor Neuron Involvement in Motor Neuron Disease: Motor Evoked Potentials Study)

  • 김성훈;박경석;김주용;이광우
    • Annals of Clinical Neurophysiology
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    • 제2권2호
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    • pp.107-113
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    • 2000
  • Background & Objectives : Motor evoked potentials(MEPs) to magnetic trans cranial stimulation were performed to evaluate upper motor neuron involvement and relationship to lower motor neuron involvement in motor neuron disease patients. Method : MEPs were obtained in the 17 consecutive patients with motor neuron disease. These patients were divided into three group based on clinical evidence of upper and lower motor neuron involvement, bulbar symptom; amyotrophic lateral sclerosis(ALS), progressive muscular atrophy(PMA), progressive bulbar palsy(PBP). MEPs were recorded from abductor pollicis brevis and abductor hallucis muscles. Abnormal MEPs were defined by delayed central motor conduction time or absent MEP. Results : MEPs were abnormal in 64%(11/17) of patients; 100%(7/7) in ALS, 64%(4/7) in PMA, 0%(0/3) in PBP respectively. In 68 total recording muscles, 34 muscles had evidence of motor weakness and showed abnormal responses in 59%(20/34). Whereas 34 muscles with normal strength, only 3%(1/34) of muscles showed abnormal response. Conclusion : MEPs are well correlated with upper motor neuron signs in ALS and may detect masking upper motor neuron signs in PMA. The muscles with lower motor neuron sign(weakness) usually relate with abnormal MEPs reponses.

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보건의료 빅데이터를 활용한 연구방법 및 한의학 레지스트리의 필요성 (Application of Health Care Big data and Necessity of Traditional Korean Medicine Data Registry)

  • 한경선;하인혁;이준환
    • 한방비만학회지
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    • 제17권1호
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    • pp.46-53
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    • 2017
  • Health care big data is thought to be a promising field of interest for disease prediction, providing the basis of medical treatment and comparing effectiveness of different treatments. Korean government has begun an effort on releasing public health big data to improve the quality and safety of medical care and to provide information to health care professionals. By studying population based big data, interesting outcomes are expected in many aspects. To initiate research using health care big data, it is crucial to understand the characteristics of the data. In this review, we analyzed cases from inside and outside the country using clinical data registry. Based on successful cases, we suggest research method for evidence-based Korean medicine. This will provide better understanding about health care big data and necessity of Korean medicine data registry network.

임상의사결정 향상을 위한 근거 기반 간호과정 시스템 개발-대장암 간호진단을 중심으로- (Development of an Evidence-based Nursing Process System to Improve Clinical Decision Making with Colorectal Cancer Nursing Diagnosis)

  • 박현상;조훈;김화선
    • 한국멀티미디어학회논문지
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    • 제19권7호
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    • pp.1197-1207
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    • 2016
  • The purpose of this study was to develop an evidence-based Nursing Process System on Nursing Diagnosis, Nursing Outcomes, and Nursing Interventions Classification targeting nurse students. We use standard classification-focused research data on the basis of Nursing Diagnosis Classification established by NANDA (North American Nursing Diagnosis Association), NOC (Nursing Outcomes Classification) and NIC (Nursing Interventions Classification) mainly developed by Iowa Sate University. The existing research methods are difficult to be applied the consistent nursing process, since such methods need to repeatedly enter the same nursing process without systematic guidelines. But, this study was coded data of standardized nursing process in accordance with the 10 clinical condition in order to implement the nursing process macro, and developed a system that reflects the needs of nursing educators. Therefore, nurse students can improve clinical decision-making ability, and naturally learn the nursing process through a system developed.

Traditional Korean Medicine Therapy for Treating Carpal Tunnel Syndrome in Patients with Wrist Pain: A Systematic Review

  • Kim, Jung Hyun;Song, Ho Sueb
    • Journal of Acupuncture Research
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    • 제32권2호
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    • pp.59-64
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    • 2015
  • Objectives : This study aims to evaluate current clinical evidence of traditional Korean medicine treatment on wrist pain with carpal tunnel syndrome. Methods : Ten Korean databases were searched for prospective clinical trials of traditional Korean medicine therapy on wrist pain with carpal tunnel syndrome from the time of their inception to February, 2015. Studies conducted in Korean, Chinese and English were searched. Risk of bias in included non-randomized controlled trials was assessed by the Cochrane handbook procedure. Results : Four non-randomized controlled trials were included. A high risk of bias was observed in all trials. All of the included studies reported favorable effects being experienced by an intervention group compared to a baseline or control group. Included studies never described any occurrence of adverse events. Conclusions : There is no evidence that traditional Korean medicine treatments are effective for treating wrist pain associated with carpal tunnel syndrome. All of the included studies lacked appropriate methodological qualities and internal validity. Future well-designed clinical trials that evaluate the effects and safety of traditional Korean medicine treatment for patients with carpal tunnel syndrome are needed.

비만치료 및 체중 감량에서 방풍통성산과 방기황기탕 사용에 대한 임상 권고안 (Clinical practice recommendations for Bangpungtongseong-san (Bofutsusho-san) and Bangkihwangki-tang(Boiogito) in obesity)

  • 박정현;김호준
    • 한방비만학회지
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    • 제12권1호
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    • pp.48-58
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    • 2012
  • Objectives These prescribing recommendations have been written to guide clinicians on the appropriate use of Bangpungtongseong-san(BT) and Bangkihwangki-tang(BH) in the treatment of obesity. These recommendation are aimed at providing evidence based information concerning diagnosis and management of obesity. Methods We collected all relevant references about treatment effect of BT and BH on obesity in the forms of meta-analysis, systematic review, randomized controlled trial, case-control study, observational study and practice guideline from international and domestic databases and paper journals. We examined treatment effect, side effects, recommendations for dose, indication and contraindication of BT and BH. Results The treatment effect of BT and BH on obesity has been proved through clinical trial. BT is indicated for obese patients (Body mass index, $BMI{\geq}25$) with strong abdomen and a tendency to constipation, BH is indicated for obese patients ($BMI{\geq}25$) with a fair skinned, soft muscled, edematous and sweat easily. Conclusion We wish the information contained in theses recommendations will help clinicians reach a reasonable and beneficial decision with evidence-based results. Further studies are strongly needed to develop better treatment strategies for herbal medicines on obesity.

순목반사검사를 응용한 안면근육 공동반사운동 평가 (Evaluation of Facial Synkinesis With Applied Blink Reflex Test)

  • 김정미;한영수;조정선;박상은;하상원;한정호;조은경;김두응
    • Annals of Clinical Neurophysiology
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    • 제7권2호
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    • pp.88-92
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    • 2005
  • Blink reflex could be a useful tool to differentiate facial synkinesis as one of complications of facial neuropathy, from volitional associated movements. We had performed applied blink reflex test for 23 patients with objective evidence of hemifacial weakness in which orbicularis oculi muscle(zygomatic branch) and mentalis muscle(mandibular branch) are electrophysiologically evaluated in response to supraorbital stimulation of trigeminal nerve. For an unaffected side of face there is no evidence of positive blink reflex from the mentalis muscle. We concluded that a positive blink reflex from mentalis muscle is almost always suggestive of chronic facial neuropathy even in clinical silence of facial synkinesis, or an aberrant reinnervation after peripheral facial neuropathy, and does not electrophysiologically correlate with the severity of facial palsy.

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Clinical characteristics of trigeminal neuralgia in a dental hospital

  • Noguchi, Tomoyasu;Shimamoto, Yoshinori;Fukuda, Ken-ichi
    • Journal of Dental Anesthesia and Pain Medicine
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    • 제21권5호
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    • pp.431-440
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    • 2021
  • Background: Neurovascular compression (NVC) is a well-known cause of trigeminal neuralgia (TN). However, patients with idiopathic TN (ITN) do not have evidence of NVC on magnetic resonance imaging (MRI), and other patients may remain asymptomatic despite evidence of NVC on MRI. This suggests that there may be additional risk factors for TN development other than NVC. Although epidemiological factors, such as age and sex differences, are useful for understanding the pathophysiology of TN, detailed statistics for each TN subtype are currently unavailable. Therefore, this study aimed to classify patients with TN into the following groups based on data extracted from past medical records: classical TN (CTN), secondary TN, and ITN. Methods: The characteristics of the groups and their differences were explored. Results: CTN was more common in women than in men, as previously reported, whereas ITN was more common in men than in women. The ratio of pain sites located on the right side of the face was high in all groups. Patients with CTN were also prone to NVC on the asymptomatic side. Conclusion: By investigating TN subtype, it may be possible to elucidate the pathophysiology of TN. This would greatly improve treatment outcomes.