Factors affecting the rate of antibiotic prescription in dental practices / 대한구강보건학회지

OBJECTIVES: Resistance to antibiotics is getting worse every day. Antibiotics are commonly prescribed medicines for the prevention and treatment of bacterial infections in dental clinics. Nationally, we are attempting to reduce the use of antibiotics, but this cannot be easily achieved. As a precedent study, we investigated factors affecting antibiotic prescription in dental clinics. METHODS: We analyzed electronic patient records of S dental hospital located in a big city. A total of 12,711 medical records were analyzed. The type of prescribed antibiotic, the prescription rate, and the number of prescription days were analyzed by chi-square test and t-test. Factors associated with the rate of antibiotic prescription were analyzed using logistic regression by dividing the independent variables into four groups: patient characteristics, dentist characteristics, treatment characteristics, and time characteristics. RESULTS: The rate of antibiotic prescription was 91.7% for the first implant surgery and 60.0% for minor operations including incision and drainage. The duration of antibiotic prescription differed according to the sex of the dentist and the type of treatment. The logistic regression analysis showed that the rate of antibiotic prescription was higher in male patients, in older patients, and in female dentists, and decreased with increasing age of the dentist. Compared with basic treatment, the odds ratio of first implant surgery was highest at 102.166 times, minor operation at 18.997, and extraction of impacted tooth at 14.429. CONCLUSIONS: This is the first study to analyze the factors affecting prescription rate of antibiotics in dental clinics. We found that the antibiotic prescription rate was significantly different for each dental treatment. It was necessary to analyze the prescription rate of antibiotics according to the type of treatment. The fact that prescribing antibiotics differed according to dentist characteristics indicated that consistent guidelines need to be established and promoted.

The Improvement and Completion of Outcome index: A new assessment system for quality of orthodontic treatment / 대한치과교정학회지

OBJECTIVE: Given the considerable disagreement between the Peer Assessment Rating (PAR) index and the American Board of Orthodontics Cast-Radiograph Evaluation, we aimed to develop a novel assessment system-the Improvement and Completion of Outcome (ICO) index-to evaluate the outcome of orthodontic treatment. METHODS: Sixteen criteria from 4 major categories were established to represent the pretreatment malocclusion status, as well as the degree of improvement and level of completion of outcome during/after treatment: dental relationship (arch length discrepancy, irregularity, U1-SN, and IMPA); anteroposterior relationship (overjet, right and left molar position, ANB); vertical relationship (anterior overbite, anterior open-bite, lateral open-bite, SN-MP); and transverse relationship (dental midline discrepancy, chin point deviation, posterior cross-bite, occlusal plane cant). The score for each criterion was defined from 0 or −1 (worst) to 5 (ideal value or normal occlusion) in gradations of 1. The sum of the scores in each category indicates the area and extent of the problems. Improvement and completion percentages were estimated based on the pre- and post-treatment total scores and the maximum total score. If the completion percentage exceeded 80%, treatment outcome was considered successful. RESULTS: Two cases, Class I malocclusion and skeletal Class III malocclusion, are presented to represent the assessment procedure using the ICO index. The difference in the level of improvement and completion of treatment outcome can be clearly explained by using 2 percentage values. CONCLUSIONS: Thus, the ICO index enables the evaluation of the quality of orthodontic treatment objectively and consecutively throughout the entire treatment process.

Factors Associated with Dental Revenue and Income of Self-Employed Dentist by Using a Quantile Regression Method / 보건행정학회지

BACKGROUND: Dentist's income is quite variable. We investigate the factors underlying the distribution of dental revenue and dentist income. METHODS: Financial and structural variables of private dental practices(N=13,967) were examined with 2010 Economic Census microdata which include non-insurance revenue. We conducted quantile regression method(QRM) and ordinary least square(OLS) in treating skewness and heteroskedasticity of distributions. The effective estimation for the upper and lower range of distribution becomes possible by QRM. RESULTS: Mid-career dentists are shown to have higher revenue and income. Male dentists achieve the higher revenue and income than female dentists in all quantiles. Group practices show lower income per owner than solo practices significantly. The revenue and income are increased with increasing size of clinics. The high cost in renting the clinic office is found to have a big positive effect on the revenue but a little positive effect on the income. Interestingly the density of dentists shows negative effect on the lowest quantile of the revenue but positive effect on the highest quantile. The lowest quantile of the revenue in the capital areas have the relatively high revenue. The lowest quantile of the income in metropolitan city show higher income than those in other areas significantly. CONCLUSION: The suggested QRM is shown to have more effective and efficient tool in finding out determinants of dentists' revenue and income of our concern. The results of this study are expected to be employed for dentists preparing for the opening practices in their organizational settings and locational selections. The distributional efficiency of dental human resources could be accomplished if policy makers guide dentists with this knowledge.

How to Deal with Medical Narratives based on Controlled Natural Language Operated by an Ontology / 대한의료정보학회지

OBJECTIVE: Medical narratives entry is a major issue to be solved in developing an electronic medical record system operating in practice, as they are, in large part, described in a free-text format. The issue can be dealt with in three aspects: to improve the reusability by structuring medical narratives, to support clinical pragmatics in medical fields, and to reduce the burden of data entry. With the aspects having in mind, this paper purports to present an ontological method for better way of medical narratives entry. METHODS: We developed an ontology for which medical knowledge is structurally represented. Then we can enter medical narrative texts with commands of the controlled natural language operable on the ontology model. RESULTS: Many theoretical studies on free-text entry were reviewed, based on which an authoring and editing tool for natural language description operable on the ontology model has been developed and tested. The performance of the tool is satisfactory within the limit of the domain models we developed here. CONCLUSION: The results of this paper are contributive for clinicians to make an easy entry of medical narratives as far as the ontology model covers their knowledge domain. It is also expected that the cost in recording medical narratives might be considerably reduced and data quality can be improved.

Development of a Medical Ontology Library: Analysis of the Clinical Terms in the Medical Records of a COPD Patient / 대한의료정보학회지

OBJECTIVE: The medical records of a patient with chronic obstructive pulmonary disease(COPD) were analyzed to extract medical concepts and their relationships in order to construct a basic medical ontology. METHODS: The medical records included the admission note, vital signs record, doctors' order sheets, progress notes, emergency notes, discharge summary, surgical record, and anesthesia record. RESULTS: A total of 396 concepts, 16 relationships, and 460 connections were created. Fourteen top-level concepts, such as body, sign, and procedure, were found. The most common relationship was 'isA' and the second was 'isPartOf'. All the relationships between the concepts were displayed using the graphic tool GraphViz. CONCLUSION: A pilot ontology on COPD was constructed through a medical record analysis. The asynchronous cooperation using a web interface for the ontology construction was helpful.

Classification and Conceptualization of Clinical Documents using Formal Concept Analysis / 대한의료정보학회지

OBJECTIVE: Ontology is becoming a core research field in the realm of medical informatics. The objective of our ongoing research is to explore the potential role of Formal Concept Analysis(FCA) in a context-based ontology building support in a medical domain. The concept hierarchy plays an important role as the backbone of ontology, but its construction is a complex and time-consuming process. We present a novel approach to the automatic acquisition of taxonomies or concept hierarchies from clinical documents. METHODS: Our approach is based on FCA, a mathematical tool used in data analysis and knowledge engineering. It provides methods to group objects and attributes into concepts, pairs of object-sets(clinical documents) and attribute-sets(fields contained in the clinical documents), such that the binary relation can be presented in a concept lattice. Based on the FCA, we have applied out approach for 8 clinical documents used in a university hospital. As a result of our experiments, we can extract 15 concepts with 7 common fields that can be shared with 8 clinical documents. RESULTS: We show how FCA can be used to classify clinical documents and acquire a concept hierarchy for the medical domain out of the clinical documents with maximal property factorization. CONCLUSION: The whole of our work is based on the concept lattice of which allows to construct a "well defined" ontological concept hierarchy. As an application of this approach, we presented some results of classification of clinical documents with maximally factorized common fields. We have shown that FCA can be useful method to classify and analyze various medical data by constructing concept hierarchy. From that concept hierarchy, we can acquire well-structured facts and knowledges in medical domain.

Ontology Technology in Medical Informatics / 대한의료정보학회지

The main purpose of this paper is to overview the current issues in the area of medical ontology. Ontology technology in Medical Informatics is evolved from the three different research areas: namely, web application for the Semantic Web, Knowledge Representation in Artificial Intelligence, and medical terminology system. In this paper we provide possible research agenda concerning medical ontology development from the above three perspectives at the same time.

Medical Informatics as a New Entry to Health-related School: Some Approaches for Organizational Setting / 대한의료정보학회지

Medical Informatics (MI) as an area of the science is relatively new, expanding its application domains, gaining more attention on its practical capability from people in the health field, and thus raising the issue of establishing a proper educational setting in schools. To provide some guiding information for those who intend or plan to have an educational body in their school, this paper attempts to explore a general framework where MI roots and the contents that MI deals with, while referencing historical backgrounds and establishments related to MI education in other countries. Having in mind those exploration, it tries to devise several organizational alternatives for MI education with consideration of Korea's given reality of school environments. for each alternative, some pros and cons are discussed, but no choice or preference to any of those alternatives is suggested, because the author believes the reality keeps varying and changing in our society.

Accuracy Tests of 3D Rapid Prototyping (RP) Medical Models: Its Potential and Clinical Applications

Presented in this paper are the experimental results that measure rapid prototyping (RP) errors in 3D medical models. We identified various factors that can cause dimensional errors when producing RP models, specifically in maxillofacial areas. For the experiment, we used a human dry skull. A number of linear measurements based on landmarks were first obtained on the skull. This was followed by CT scanning, 3D model reconstruction, and RP model fabrication. The landmarks were measured again on both the reconstructed models and the physical RP models, and these were compared with those on dry skull. We focused on major sources of errors, such as CT scanning, conversion from CT data to STL models, and RP model fabrication. The results show that the overall error from skull to RP is 0.64+/-0.36mm(0.71+/-0.66%) in absolute value. This indicates that the RP technology can be acceptable in the real clinical applications. A clinical case that has applied RP models successfully for treatment planning and surgical rehearsal is presented. Although the use of RP models is rare in the medical area yet, we believe RP is promising in that it has a great potential in developing new tools which can aid diagnosis, treatment planning, surgical rehearsal, education, and so on.

Development of Oral Pathology Learning Support System based on MMDB / 대한의료정보학회지

Collecting, managing and processing course material requires of much costs and efforts while they include a variety of data types particularly in the health field. Some engineering work on the material may help reduce the workload and costs to some extent. With such benefits having in mind, this paper tries to develop multimedial database for the course material of Oral Pathology in dental schools. It provides structured analysis of data for the course material, in which a unit of disease is a central class with relation to many other classes. It also achieved data independence from server applications by using the method concept of object-oriented database(OODB), which will increase reusability of the course data. Using another important concept of OODB, the system devised many functional utilities on an Internet web server including lecture notes, case studies, disease search, and question and answer, and shows how they are operated. But the effectiveness for the part of student users may remain to be evaluated.

LAN-based Hospital Information System: A Case Study for Objective-Oriented Database for Medical Order Communication System / 대한의료정보학회지

Hospitals are increasingly concerned with the construction of computer-based medical order communication system (MOCS), despite the fact that they are financially being pressed. With limited budget, management in hospitals ought to be pursuing both methodologically effective and technically sound way of constructing MOCS. This paper intends to contribute itself toward better design of database for MOCS with reference to a university hospital. Some structural characteristics pertaining to MOCS are identified in ways of systems approach. Based on those findings, construction methodologies are reviewed and put forward with flexibility to differing requirements of hospitals. Suggestions include the followings. (1) Designing step has to be distinguished among conceptual, logical, and physical design while prototyping for user interface is utilized only for the logical design. (2) Many modeling tools including entity life cycle diagram can be effective for system integration with other units. (3) 3 different types of distributed database servers are recommended.

LAN-based Hospital Information System: A Case Study for Objective-Oriented Database for Medical Order Communication System / 대한의료정보학회지

Hospitals are increasingly concerned with the construction of computer-based medical order communication system (MOCS), despite the fact that they are financially being pressed. With limited budget, management in hospitals ought to be pursuing both methodologically effective and technically sound way of constructing MOCS. This paper intends to contribute itself toward better design of database for MOCS with reference to a university hospital. Some structural characteristics pertaining to MOCS are identified in ways of systems approach. Based on those findings, construction methodologies are reviewed and put forward with flexibility to differing requirements of hospitals. Suggestions include the followings. (1) Designing step has to be distinguished among conceptual, logical, and physical design while prototyping for user interface is utilized only for the logical design. (2) Many modeling tools including entity life cycle diagram can be effective for system integration with other units. (3) 3 different types of distributed database servers are recommended.