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題 名 | Use of a Medical Decision Support System to Improve the Preoperative Diagnosis of Prostate Cancer with Pelvic Lymph Node Metastases=利用醫療決策支援系統增進攝護腺癌合併骨盆腔淋巴轉移的術前診斷 |
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作 者 | 張慧朗; 王大民; 黃世聰; 謝明里; 崔克宏; 賴榮豪; | 書刊名 | 長庚醫學 |
卷 期 | 22:4 1999.12[民88.12] |
頁 次 | 頁556-564 |
分類號 | 415.863 |
關鍵詞 | 醫療決策支援系統; 攝護腺癌; 骨盆腔淋巴腺切除手術; Medical decision support system; Prostate cancer; Pelvic lymphadenectomy; |
語 文 | 英文(English) |
中文摘要 | 背景:評估醫療決策支援系統(PCES)對於攝護腺癌合併骨盆腔淋巴轉移術前診斷 的影響。同時評估使用PCES系統後,這種病人減少不必要手術的可行性。 方法:一共有43位病人因攝護腺癌住院,接受骨盆腔淋巴腺切除手術。我們比較PCES、2 位主治醫師及5位住院醫師的術前診斷,以確定醫療決策支援系統的診斷能力。同時我們評 估醫師諮詢PCES系統後的影響。 結果:PCES診斷攝護腺癌合併骨盆腔淋巴轉移的準確率比2位主治醬師好(p=0.042;p= 0.008)。所有的住院醫師其診斷的準確率都比PCES低,而經過PCES諮詢後,5位住院醫師 的術前診斷率都明顯的提高。關於PCES系統的使用,大部份的住院醫師都是主治醫師或部門 主管要求後才諮詢。 結論:由於PCES診斷攝護腺癌合併骨盆腔淋巴科移的準確率高,我們認為如果手術前使用 PCES系統幫助醫師,使手術前診斷的準確率提高,則這些病人將可以避免不必要的手術。 |
英文摘要 | Background: We evaluated the effects of a medical decision support system on the pre- operative diagnosis of prostate cancer with pelvic lymph node metastases. Methods: The preoperative accuracy of staging prostate cancer with pelvic lymph node metastasis by the prostate cancer expert system (PCES) for 43 patients was compared to the accuracy of staging performed by 2 urological attending physicians and S residents, to test the validity of the PCES. The effect of PCES consultation on physicians' staging for prostate cancer with pelvic lymph node involvement was evaluated. Results: In the diagnosis of prostate cancer with pelvic lymph node metastasis, PCES was significantly more accurate than the two attending physicians alone (p = 0.042; p = 0.008). All the urological residents' diagnoses were significantly less accurate than those of the PCES. After PCES consultation, all the urological residents increased diagnostic specificity significantly. Most residents usually used PCES for consultation only after the attending physician or department asked for the results. Conclusion: Owing to an increased ability for preoperative diagnosis of prostate cancer with pelvic lymph node metastasis, as supported by the PCES, some unnecessary pelvic lymphadenectomies may be avoided. |
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