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Objective:To study the practical efficacy of the clinical decision support system for diagnosis and treatment of thyroid cancer (CDSS-TC) in assisting doctors to complete several diagnosis and treatment tasks, and to make a preliminary evaluation of its clinical practicability according to the test results.Methods:From Jan. 2022 to Mar. 2022, 90 patients with thyroid cancer who were admitted to the Head and Neck Surgery Department of Shaw Hospital affiliated to Zhejiang University were prospectively analyzed, and the average time spent in reading the pre-operative B-ultrasound report, as well as the individual fitness of the dose adjustment of eugenol in 70 patients with thyroid cancer after surgery. A retrospective analysis was made of the compliance of the basis of the "recommended scheme" and the deviation of the basis of the doctor’s "final scheme" for the preoperative surgery of 120 patients with thyroid cancer who were treated for the first time in the head and neck surgery of Shaw Hospital affiliated to Zhejiang University from Mar. 2021 to May. 2021. All cases were treated by pure artificial (group A) and CDSS-TC assisted (group B) , and the differences in organization were compared.Results:The average time for disposal of a single B-ultrasound report in Group B was much shorter than that in Group A ( P=5.600E-04) ; The number of patients with excellent grade and the total number of patients with excellent grade and qualified grade recommended by the doctor in group B were significantly higher than those in group A ( P=7.819E-20 and P=1.335E-18) ; The conformity rate of the basis of CDSS-TC "Recommended Scheme" ≥ 98%; The deviation rate of the basis for "final protocol" of doctors in group B was lower than that in group A ( P=0.059 for total resection or not, P=0.075 for lateral neck dissection or not) . Conclusions:CDSS-TC can accurately extract the disease-related source information in all the original examination/laboratory reports, and provide accurate decision-making suggestions through efficient correlation analysis. In view of the accurate and objective conclusions of its analysis, it can provide high-quality and all-link decision support for doctors’ clinical diagnosis and treatment, and is an ideal information work platform.
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Resumen: Se desarrolló un sistema basado en árboles de decisión con factores de peso heurísticos orientados al diagnóstico mediante termografía mamaria. El sistema de apoyo a la toma de decisiones clínicas propuesto incluye árboles de decisión binarios para la clasificación estadística de algunas patologías de la glándula mamaria. Dentro de ellos, se incluyen factores de peso constantes encontrados a través de la correlación de las variables involucradas en el desarrollo de los padecimientos mamarios de acuerdo al apego estadístico de las características termográficas, así como de la información clínica complementaria (historial clínico, parámetros físicos, carga genética y hábitos, entre otros), con respecto a su incidencia diagnóstica. La certeza del sistema para los trastornos inflamatorios es de 96 %, para mastopatía fibroquística de 78 %, para necrosis grasa de 62 % y para cáncer de seno de 86 %. El 14 % de error se asocia a microcalcificaciones mismas que con la técnica termográfica reportada no es posible diferenciar. Por lo tanto, es posible catalogar el riesgo de una paciente a padecer alguna afección según los resultados arrojados después de llevar a cabo el examen térmico. Con este sistema de apoyo a la decisión se mejora la posibilidad de aplicación de pruebas de detección temprana en la población que sufre de contraindicaciones para realizarse los exámenes con otros métodos, además permite un diagnóstico integral para las demás pacientes.
Abstract: A decision tree based system with heuristic weight factors oriented to diagnosis by thermography was developed. The proposed clinical decision support system (CDSS) includes binary decision trees for statistical classification of some diseases of the mammary gland. These include weight constant factors found by the correlation of the variables involved in the development of breast disorders according to the statistical attachment of the thermal features, as well as complementary clinical information (medical history, physical parameters, genetic load and habits, among others), regarding its diagnostic incidence. The certainty of the system for inflammatory disorders is 96%, for fibrocystic mastopathy is 78 %, for fat necrosis is 62% and for breast cancer is 86%. The 14% error is associated to microcalcifications that with the reported thermographic technique it is not possible to differentiate. Thus, it is possible to catalog the risk of a patient having a condition according to the results obtained after conducting a thermal test. Then, with the CDSS the possibility of applying early detection tests in the population suffering from contraindications to perform the others is improved, in addition it allows a comprehensive diagnosis for other patients.
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The paper introduces the basic situation of research on interoperability of the Clinical Decision Support System (CDSS),based on the types of standards for semantic interoperability and functional requirements for the development and arrangement of the CDSS,classifies the standards in the CDSS,and discusses the application of various standards in the CDSS.
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〔Abstract〕 Taking Wuxi People′s Hospital Affiliated to Nanjing Medical University as an example, the paper introduces the constitu-tion, software architecture and main functions of Clinical Decision Support System ( CDSS) .The system is integrated with Electronic Medical Records ( EMR) system, providing scientific and acurate information support for clinicians in the whole diagnosis process.It has positive significance to improve the work quality and reduce medical errors.
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PURPOSE: The influence of dietary composition on blood pressure is an important subject in healthcare. Interactions between antihypertensive drugs and diet (IBADD) is the most important factor in the management of hypertension. It is therefore essential to support healthcare providers' decision making role in active and continuous interaction control in hypertension management. The aim of this study was to implement an ontology-based clinical decision support system (CDSS) for IBADD management (IBADDM). We considered the concepts of antihypertensive drugs and foods, and focused on the interchangeability between the database and the CDSS when providing tailored information. METHODS: An ontology-based CDSS for IBADDM was implemented in eight phases: (1) determining the domain and scope of ontology, (2) reviewing existing ontology, (3) extracting and defining the concepts, (4) assigning relationships between concepts, (5) creating a conceptual map with CmapTools, (6) selecting upper ontology, (7) formally representing the ontology with Protege (ver.4.3), (8) implementing an ontology-based CDSS as a JAVA prototype application. RESULTS: We extracted 5,926 concepts, 15 properties, and formally represented them using Protege. An ontology-based CDSS for IBADDM was implemented and the evaluation score was 4.60 out of 5. CONCLUSION: We endeavored to map functions of a CDSS and implement an ontology-based CDSS for IBADDM.
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Humans , Antihypertensive Agents/therapeutic use , Biological Ontologies , Databases, Factual , Decision Support Systems, Clinical , Diet , Drug Interactions , Hypertension/drug therapy , SoftwareABSTRACT
Tras más de tres años de trabajo, la Comisión de Determinantes Sociales de la Salud de la Organización Mundial de la Salud, presentó a finales de agosto de 2008 su informe final traducido en su versión castellana como "Subsanar las desigualdades en una generación: alcanzar la equidad sanitaria actuando sobre los determinantes sociales de la salud". El informe, muy probablemente uno de los textos de mayor interés en el campo de la salud pública de las últimas décadas, no ha dejado indiferente. Ha recibido notables alabanzas, desaforadas críticas y algunas -las menos hasta el momento- críticas con un carácter más equilibrado y razonable. El objetivo de este texto es apreciar críticamente dicho informe y valorar su impacto cuatro años después de su publicación. Para ello, en primer lugar, se revisa el origen y objetivos de la Comisión resumiendo la visión y difusión del informe; segundo, se valoran las características y contenidos del informe desde distintos puntos de vista ideológicos y políticos: neoliberal y conservador, desde la epidemiología social y desde una visión radical de salud pública; y tercero, se evalua el impacto global del informe cuatro años después de su publicación. El texto concluye con algunas reflexiones finales.
After more than three years of work, the WHO Commission on Social Determinants of Health launched its final Report "Closing the gap in a generation: Health equity through action on the social determinants of health" at the end of August 2008. This report, which is probably one of the most interesting texts in the field of public health in recent decades, has attracted a lot of attention. It has been the object of remarkable praises, of ardent criticism, and to lesser extent, of more balanced and reasonable critiques. The aim of this paper was to critically evaluate the report and to assess its impact four years after its publication. Firstly, the origins and objectives of the Commission was reviewed, outlining the vision and dissemination of the report; secondly, the characteristics and contents of the report were assessed from different ideological and political points of view including neoliberal, conservative, social epidemiology and radical view of public health; and finally, the overall impact of the Report four years after publication was evaluated. The paper concluded with some final reflections.
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OBJECTIVES: To assess clinical improvement and change in plasma brain-derived neurotrophic factor(BDNF) level after repetitive transcranial magnetic stimulation(rTMS) in patients with treatment-resistant schizophrenia. METHODS: Seven patients with DSM-IV schizophrenia, who were proven to be treatment-resistant, were treated with 15 sessions of rTMS for three weeks as an adjuvant therapy to antipsychotic treatment. Clinical improvement and change in plasma BDNF level were measured after the treatment period. The symptom severity was assessed with the Positive and Negative Syndrome Scale(PANSS) and the Korean Version of Calgary Depression Scale for Schizophrenia(K-CDSS) at baseline and 7 days after the treatment. Plasma BDNF level was measured by enzyme-linked immunosorbent assay(ELISA) at baseline and 7 days after the treatment. RESULTS: After the rTMS treatment, there was no significant improvement in PANSS total score(Z=-1.693, p=0.090) and no significant change in plasma BDNF was found(Z=-1.183, p=0.237). Negative correlations were found between percentage change in PANSS positive subscale score and duration of illness(rho=-0.991, N=7, p<0.0005, two-tailed), and PANSS negative subscale score at baseline and percentage change in plasma BDNF level(rho=-0.821, N=7, p=0.023, two-tailed). CONCLUSION: This preliminary study suggests that rTMS didn't make a significant change in clinical symptoms nor in plasma BDNF level in treatment-resistant schizophrenia. Percentage change in plasma BDNF, however, might be correlated with treatment resistance in schizophrenic patients. This is a pilot study with a small sample size, therefore, a further study with a larger sample size is needed.
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Humans , Brain-Derived Neurotrophic Factor , Depression , Diagnostic and Statistical Manual of Mental Disorders , Magnetics , Magnets , Pilot Projects , Plasma , Sample Size , SchizophreniaABSTRACT
OBJECTIVES: This study was performed to standardize the Korean Version of Calgary Depression Scale for Schizophrenia (K-CDSS), a semi-structured interview scale to assess depression in schizophrenia patients and to determine the psychometric properties and clinical utility of the K-CDSS. METHODS: Sixty-one patients diagnosed as schizophrenia by DSM-IV criteria were recruited in this study. Then, the patients were interviewed using the Structure Clinical Interview for DSM-IV (SCID) by a trained psychologist. Subsequently, the KCDSS, Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale (MADRS) and Simpson Angus Rating Scale (SAS) were administered by a psychiatrist. Lastly, the K-CDSS was re-assessed by a second independent rater without any previous information of patients to confirm the inter-rater reliability. RESULTS: The internal consistency using Cronbach's alpha was 0.852. Inter-rater reliability using Intraclass Correlation Coefficient (ICC) for single items and for sum score were 0.659-0.889 and 0.963, respectively. K-CDSS was assessed by a second Factor analysis and ROC (receiver operating characteristic) curve analysis were conducted. The factor analysis revealed a single factor that accounted for 53.7% of the total variance, suggesting that the uni-dimensional structure of the K-CDSS may be retained. In addition, K-CDSS showed a good convergent validity with very strong correlations with HDRS (r=0.75) and MADRS (r=0.81), respectively. However, K-CDSS was not correlated with PANSS-positive, PANSS-negative and SAS, demonstrating its satisfactory discriminant validity. The area under the ROC curve was 0.968 (standard error=0.036, p<.001). With a cut-off point of 8, the K-CDSS had a sensitivity 83.3%, specificity 97.9%, positive predictive value 90.9% and negative predictive value 95.8%. CONCLUSION: K-CDSS is considered as a short and valid tool to identify depressive symptoms in schizophrenia.
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Humans , Depression , Diagnostic and Statistical Manual of Mental Disorders , Psychiatry , Psychology , Psychometrics , Reproducibility of Results , ROC Curve , Schizophrenia , Sensitivity and SpecificityABSTRACT
The adverse drug events (ADE) is not only common but also expensive. Although it was expected that ADE could be prevented by using computer-based clinical decision support system (CDSS), it is not widely accepted in the clinical field. Therefore the purpose of this study was to verify whether CDSS can reduce ADE by meta-analysis. We searched literatures by Medline from 1975 to 2002 with key words of clinical decision support system, medication error, and adverse drug event. We also searched references of review articles as well as textbooks on medical informatics. The criteria for quality evaluation were as follows: 1) the objec t were physician, nurse, pharmacist, 2) case design for CDSS analysis was pe rformed random c linical te st of experimental-control group, 3) deal with a adverse drug event organization whether or not. Among 290 retrieved articles five studies were selected for quantitative meta-analysis. The overall effect size of the risk of adverse drug event due to CDSS was calculated by common odds ratio using MetaKorea (http://www.metakorea.or.kr). Before the integration of each effect sized into common eff ect sizes the homogene ity test were conducted. All studies were ca se control design and cases were ADEs. Homogenity of studies were conducted by Mantel-Haenszel method. The chi-square is 10.78 (p<0.05). For evaluation of odds ratio, random effec t model was used. The overall odds ratio of CDSS associated with ADE was 0.315201 (95% confidence interval = 0.191411-0.519049). Our result suggested a negative association between use of CDSS and the development of serious ADE. So we concluded that the development of serious ADE was reduced using CDSS.