• 제목/요약/키워드: Clinical practice pattern

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임상가를 위한 특집 3 - NAT/NFR 교합의 임상적용 (The clinical application of NAT/NFR occlusal concept)

  • 정승미
    • 대한치과의사협회지
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    • 제51권5호
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    • pp.255-264
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    • 2013
  • Many concept of occlusion have been introduced in the past, but there isn't any generally accepted unified theory since a single occlusion theory cannot represent the natural perfection, especially considering the difference in clinical experience, the dynamic occlusion, and individual diversity in mastication pattern. NAT(Naturgemasse Aufwachstechnik)/NFR((Natur Funktionsgerechte Rekonstruktion) occlusion is not just a theory on occlusion, but a clinical occlusion that can be practically applied to clinical practice by providing dynamic occlusion adjusted to the individual mastication pattern and biomechanics. This report aims to provide a guide to a clinically biomechanical occlusion through the teamwork of both the dentist and the lab technician by introducing the NAT occlusion through following: reviewing the concept of occlusion in terms of morphology, its correlation with NAT/NFR occlusion, reviewing the limitation of conventional occlusion theories, and introducing the clinical application of NAT/NFR.

과민대장증후군(Irritable Bowel Syndrome)의 한의임상 진료현황에 대한 설문조사 연구 (A Survey on the Clinical Practice Patterns of Irritable Bowel Syndrome in Korean Medicine)

  • 전혜진;김금지;고석재;박재우
    • 대한한방내과학회지
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    • 제42권4호
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    • pp.532-546
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    • 2021
  • Objective: This study investigated the perception, diagnosis, and treatment of irritable bowel syndrome (IBS) in the general population, in patients, and in Korean medicine doctors (KMDs) in order to provide basic information for the development of Korean medicine clinical practice guidelines for IBS. Methods: A questionnaire was developed in two versions, one for the general population/patients and one for KMDs. The questions were about the general perception, diagnosis, and treatment of IBS. Both online and offline surveys were conducted using these questionnaires. Results: In total, 213 general population/patients and 435 KMDs responded to the survey. The results of the analysis were as follows. Most of the KMDs diagnosed IBS based on clinical aspects. Acupuncture was the most common treatment, followed by prescription herbal medicine, moxibustion, and manufactured herbal medicine. 34.3% of KMDs used clinical practice guidelines for IBS patient treatment. 57.8% of patients were diagnosed with IBS by doctors at primary medical institutions, and 53.1% were diagnosed with colonoscopy. More than half of the IBS patients who have been treated with Korean medicine said they experienced improvement of symptoms and prevention of recurrence, but more than 70% of the respondents said future safety and effectiveness studies of Korean medicine were needed. Conclusions: In spite of the positive perception of IBS treatment with Korean medicine, actual utilization was relatively low. The development and promotion of, as well as education about, appropriate and reasonable Korean medicine practice guidelines for IBS is necessary.

ICHD 분류에 따른 원발 두통의 한의학적 변증 연구 (The Study on Pattern Differentiations of Primary Headache in Korean Medicine according to the International Classification of Headache Disorders)

  • 이정소;박미선;김영목
    • 동의생리병리학회지
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    • 제31권4호
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    • pp.201-212
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    • 2017
  • This study draws pattern differentiations of headache disorders on the ground of modern clinical applications and Korean medical literature. Categorization and symptoms of headache disorders are based on International Classification of Headache Disorders 3rd edition(beta version). And clinical papers are searched in China Academic Journals(CAJ) of China National Knowledge Infrastructure(CNKI). In the aspect of eight principle pattern identification, primary headache occurs due to lots of yang qi and has more inner pattern rather than exterior pattern, heat pattern rather than cold pattern, excess pattern rather than deficiency pattern. And primary headache is related with liver in the aspect of visceral pattern identification and blood stasis, wind and phlegm are relevant mechanisms. Migraine without aura is associated with ascendant hyperactivity of liver yang, phlegm turbidity, sunken spleen qi, wind-heat, blood deficiency or yin deficiency. Migraine with aura is mainly related with wind and it's major mechanisms are ascendant hyperactivity of liver yang, liver fire, yin deficiency of liver and kidney, blood deficiency or liver depression and qi stagnation. High repetition rate of tension-type headache can be identified as heat pattern or excess pattern. And trigeminal autonomic cephalalgias can also be accepted as heat pattern or excess pattern when the occurrence frequency is high and is relevant to combined pattern with excess pattern of external contraction and deficiency pattern of internal damage based on facial symptoms by external contraction and nervous and anxious status by liver deficiency. This study can be expected to be Korean medical basis of clinical practice guidelines on headache by proposing pattern identifications corresponding to the western classifications of headache disorders.

관절낭 패턴의 임상적 적용과 한계 (Clinical Application and Limitations of the Capsular Pattern)

  • 임우택
    • 한국전문물리치료학회지
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    • 제28권1호
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    • pp.13-17
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    • 2021
  • A normal range of motion is essential for performing activities of daily living. The capsular pattern is the proportional motion restriction in range of motion during passive exercises due to tightness of the joint capsule. Although the capsular pattern is widely referred to in clinical practice, there is no scientific evidence to support the concept. In this review, the appropriateness of the capsular pattern for evaluation of joint pathology was assessed. In the Textbook of Orthopaedic Medicine written by Cyriax, the capsular pattern did not specify how much reduction in angular motion is considered motion restriction. As the definition proposed initially was unclear, different methods have been used in previous studies investigating capsular pattern. In addition, the capsular pattern described all the major joints of the human body, but only the hip joint, knee joint, and shoulder joint were studied in experimental studies. Sensitivity and specificity were reported in one study and were meaningful in specific pathologies (loss of extension to loss of flexion). There was no consensus on the reliability and validity. In summary, the capsular pattern suggested by Cyriax or Kaltenborn is not supported or applies only to certain conditions. Various components around a joint complement each other and provide stability to the joint. It is recommended that the therapist perform multiple assessments rather than rely on a single assessment when evaluating joints.

갱년기장애 및 폐경기후증후군 한의표준임상진료지침 개발을 위한 한의사의 인식과 치료에 관한 실태조사 (A survey on Korean Medicine Doctors' Recognition and Treatment for Developing Korean Medicine Clinical Practice Guideline of Climacteric and Postmenopausal Syndrome)

  • 최수지;김동일
    • 대한한방부인과학회지
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    • 제30권4호
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    • pp.135-148
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    • 2017
  • Objectives: This study was aimed to develop a Korean medicine clinical practice guidelines (CPG) of Climacteric and Postmenopausal Syndrome Methods: We conducted a questionnaire survey targeting Korean medicine doctors belonging to the Association of Korean Obstetrics and gynecology by e-mail and analyzed the answers. On October 18, 2016, we sent questionnaires to 583 people, and on October 31, 2016, we sent questionnaires to 581 people again. A survey ended on November 15, 2016. A total of 56 responded. Results: 1. 91.07% of respondents knew the concepts and contents of CPG, and all respondents agreed about the necessity of CPG. 2. Most common symptom of climacteric and postmenopausal syndrome that 65.75% of the respondents answered was the hot flush 3. To diagnosis a climacteric and postmenopausal syndrome, 69.64% of the respondents used pattern identification diagnosis mainly. 4. 36.84% of the respondents answered that herbal medicine and acupuncture are the most effective treatments for climacteric and postmenopausal syndrome. The most commonly used herb medicine was Kamisoyo-san. Conclusions: We figured out Korean Medicine doctors' recognition of Korean medicine clinical practice guideline, clinical diagnosis, treatment on climacteric and postmenopausal syndrome to make the contents of the CPG reflecting the clinical situation. Further research will be needed in the future.

Comparison of Attention-Deficit/Hyperactivity Disorder Practice in Adults According to a Training Background in Child Psychiatry

  • Hong, Minha;Lee, Seung-Yup;Lee, Young Sik;Kim, Bongseog;Joung, Yoo Sook;Yoo, Hanik K;Kim, Eui-Jung;Lee, Soyoung Irene;Park, Su-Bin;Bhang, Soo-Young;Han, Doughyun;Bahn, Geon Ho
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제30권3호
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    • pp.121-126
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    • 2019
  • Objectives: Awareness of attention-deficit/hyperactivity disorder (ADHD) in adults has significantly increased; however, clinical data specific to the Korean population are insufficient. Clinical experience of ADHD may differ based on whether psychiatrists have received pediatric psychiatry-specific training. In order to prepare a practice parameter for adult ADHD patients in Korea, we examined questionnaire data to observe how pediatric psychiatry training could affect clinical practice for adults with ADHD. Methods: A questionnaire about the diagnosis and treatment process was distributed to both general psychiatrists (GPsy) and child and adolescent psychiatrists (CAP) at the summer and winter workshop meetings of Korean Academy of Child and Adolescent Psychiatry. Results: In total, 142 psychiatrists participated in the survey (86 GPsy, 56 CAP). GPsy and CAP preferred pharmacotherapy (GPsy 82.40%, CAP 64.30%) as the primary treatment option and answered that the clinical psychiatric interview is the most necessary step in diagnostic assessment (GPsy 22.16%, CAP 19.00%). The GPsy responded with an optimal and average treatment duration that was shorter than that reported by CAP. Conclusion: Identification of the initial presenting symptom as the correct diagnosis and the optimal duration of pharmacotherapy differed between GPsy and CAP in practice, whereas concepts in diagnosis and treatment of ADHD in adults were similar for both groups. These results suggest the urgent need for the Continuing Medical Education program for psychiatrists treating adults with ADHD.

Capecitabine Pattern of Usage, Rate of Febrile Neutropaenia and Treatment Related Death in Asian Cancer Patients in Clinical Practice

  • Phua, Vincent Chee Ee;Wong, Wei Quan;Tan, Pei Lin;Bustam, Anita Zarina;Saad, Marniza;Alip, Adlinda;Ishak, Wan Zamaniah Wan
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권4호
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    • pp.1449-1453
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    • 2015
  • Background: Oral capecitabine is increasingly replacing intravenous 5-fluorouracil in many chemotherapy regimens. However, data on the risk of febrile neutropaenia (FN) and treatment related death (TRD) with the drug remain sparse outside of clinical trial settings despite its widespread usage. This study aimed to determine these rates in a large cohort of patients treated in the University of Malaya Medical Centre (UMMC). Materials and Methods: We reviewed the clinical notes of all patients prescribed with oral capecitabine chemotherapy for any tumour sites in University Malaya Medical Centre (UMMC) from $1^{st}$ January 2009 till $31^{st}$ June 2010. Information collected included patient demographics, histopathological features, treatment received including the different chemotherapy regimens and intent of treatment whether the chemotherapy was given for neoadjuvant, concurrent with radiation, adjuvant or palliative intent. The aim of this study is to establish the pattern of usage, FN and TRD rates with capecitabine in clinical practice outside of clinical trial setting. FN is defined as an oral temperature > $38.5^{\circ}C$ or two consecutive readings of > $38.0^{\circ}C$ for 2 hours and an absolute neutrophil count < $0.5{\times}10^9/L$, or expected to fall below $0.5{\times}10^9/L$ (de Naurois et al., 2010). Treatment related death was defined as death occurring during or within 30 days of last chemotherapy treatment. Results: Between $1^{st}$ January 2009 and $30^{th}$ June 2010, 274 patients were treated with capecitabine chemotherapy in UMMC. The mean age was 58 years (range 22 to 82 years). Capecitabine was used in 14 different tumour sites with the colorectal site predominating with a total of 128 cases (46.7%), followed by breast cancer (35.8%). Capecitabine was most commonly used in the palliative setting accounting for 63.9% of the cases, followed by the adjuvant setting (19.7%). The most common regimen was single agent capecitabine with 129 cases (47.1%). The other common regimens were XELOX (21.5%) and ECX (10.2%). The main result of this study showed an overall FN rate of 2.2% (6/274). The overall TRD rate was 5.1% (14/274). The FN rate for the single agent capecitabine regimen was 1.6% (2/129) and the TRD rate was 5.4% (7/129). All the TRDs were with single agent capecitabine regimen were used for palliative intent. Conclusions: Oral capecitabine is used widely in clinical practice in a myriad of tumour sites and bears a low risk of febrile neutropaenia. However, capecitabine like any other intravenous chemotherapeutic agent carries a significant risk of treatment related death.

기능성소화불량 환자의 BMI에 따른 변증 유형 분포 및 다빈도 처방 분석 : 후향적 차트 리뷰 (Distribution of Pattern Identification According to BMI in Functional Dyspepsia Patients and Analysis of Frequently Used Herbal Medicines: A Retrospective Chart Review)

  • 윤채림;금창열;한아람;최수현;최수현;정다희;정해인;하나연;김진성
    • 대한한방내과학회지
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    • 제44권4호
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    • pp.645-660
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    • 2023
  • Objectives: This study analyzed the clinical characteristics of patients with functional dyspepsia (FD) who received Korean medicine treatment. Methods: A retrospective chart review was conducted to investigate sociodemographic characteristics, clinical characteristics, and prescribed treatments. The clinical records of 192 patients who visited Kyung Hee University Korean Medicine Hospital for FD from May 1, 2022, to May 31, 2023, were analyzed. In addition, the distribution of pattern identification and symptom type according to body mass index (BMI), as well as prescription history, were analyzed. Results: As the degree of obesity increased, the proportion of Spleen-Qi deficiency pattern patients decreased (p=0.012), and the proportion of damp-phlegm pattern patients increased (p=0.000). Additionally, as the degree of obesity increased, the proportion of patients with excess differentiation increased (p=0.002). The PDS (Postprandial distress syndrome) symptom type was significantly more frequent in the underweight and normal groups than in the overweight and obese groups, and the EPS (Epigastric pain syndrome) symptom type was more frequent in the overweight and obese groups. Regardless of the type of pattern identification, the most frequently used prescriptions were Naesowhajung-tang, Hanshin Naeso-san, and Sojeokgunbi-hwan granule. Conclusion: This study analyzed the medical records of patients with FD to elucidate the use of Korean medicine treatments. Our study is meaningful in that we found that the distribution of pattern identification and symptom patterns are linked to the degree of obesity in FD patients and identified the tendency for herbal medicine treatments to be prescribed in clinical practice.

생명정보학과 유전체의학 (Bioinformatics and Genomic Medicine)

  • 김주한
    • Journal of Preventive Medicine and Public Health
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    • 제35권2호
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    • pp.83-91
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    • 2002
  • Bioinformatics is a rapidly emerging field of biomedical research. A flood of large-scale genomic and postgenomic data means that many of the challenges in biomedical research are now challenges in computational sciences. Clinical informatics has long developed methodologies to improve biomedical research and clinical care by integrating experimental and clinical information systems. The informatics revolutions both in bioinformatics and clinical informatics will eventually change the current practice of medicine, including diagnostics, therapeutics, and prognostics. Postgenome informatics, powered by high throughput technologies and genomic-scale databases, is likely to transform our biomedical understanding forever much the same way that biochemistry did a generation ago. The paper describes how these technologies will impact biomedical research and clinical care, emphasizing recent advances in biochip-based functional genomics and proteomics. Basic data preprocessing with normalization, primary pattern analysis, and machine learning algorithms will be presented. Use of integrated biochip informatics technologies, text mining of factual and literature databases, and integrated management of biomolecular databases will be discussed. Each step will be given with real examples in the context of clinical relevance. Issues of linking molecular genotype and clinical phenotype information will be discussed.

간호대학 실습생들의 성격/행동유형과 임상실습 스트레스 양상 및 대처 방식간의 관계 (Levels of Clinical Practice Stress and Coping Strategies according to Nursing Students' Personality/Behavior Types)

  • 장수연;김소정;김영지;서인영;송채림;오홍금;이인재;이지연;이지은;홍다혜;김정은
    • Perspectives in Nursing Science
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    • 제14권2호
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    • pp.81-89
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    • 2017
  • Purpose: This study was performed to identify levels of clinical practice stress and coping strategies according to the personality/behavior types of nursing students. Methods: The subjects of this study were 143 third- and fourth-grade nursing students in 14 nursing colleges who had experienced clinical practice. The questionnaire consisted of instruments to identify Dominance, Influence, Steadiness, and Conscientiousness (DISC) personality/behavior types, clinical stress, and stress coping strategies. The data were analyzed using Cronbach's ${\alpha}$, descriptive statistics, and ANOVA, using the SPSS 24.0 program. Results: The DISC pattern showed high priority in Steadiness (48.3%), followed by Conscientiousness (21.0%), Influence (16.1%), and Dominance (14.7%), in that order. The steadiness type showed the lowest level of stress among four patterns. Conclusion: This study found that the personality/behavior types of nursing students differ. Additionally, different personality/behavior types can be attributed to stress levels and stress coping behaviors. Based on these results, different personality and behavior types of nursing students should be considered to manage their stress levels related to the clinical practicum experience.