The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment in Women Estimated with the Model of Decision Tree
The purpose of the work is to investigate the effectiveness of different methods of treatment women with pain syndrome originated from pelvis and lower part of abdomen on the basis of retrospective analysis of 1092 histories of diseases during 2013–2017 р.р., Results. It was established that the pro...
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irk-123456789-1420922018-09-26T01:22:56Z The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment in Women Estimated with the Model of Decision Tree Buzynovsky, А.B. Kоvalenko, О.S. Bayazitov, N.R. Godlevsky, L.S. Медицинская и биологическая кибернетика The purpose of the work is to investigate the effectiveness of different methods of treatment women with pain syndrome originated from pelvis and lower part of abdomen on the basis of retrospective analysis of 1092 histories of diseases during 2013–2017 р.р., Results. It was established that the probability of complete health restoration was 0,83 after surgical treatment and 0,62 after drug treatment. In case of initial inefficiency of drug treatment the probability of restoration of health as a result of surgical intervention was 0,40. The EPT in surgically treated patients was less than EPT in patients with therapeutic treatment by 3,29 times at the moment of making decision on the method of treatment. Мета роботи полягає у порівнянні ефективності різних методів лікування жінок з больовим синдромом мискового походження на основі ретроспективного аналізу 1092 історій хвороб пацієнтів, яким лікування було надано в період 2013–2017 р.р. Результати дослідження. Встановлено, що імовірність повного відновлення здоров’я склала 0,83 після хірургічного і 0,62 після консервативного лікування. У випадку, коли первинне консервативне лікування не приводило до одужання, імовірність одужання після проведення хірургічного втручання дорівнювала 0,40. Ефективність періоду лікування, розрахована для пацієнтів з первинним хірургічним лікуванням, була менша в 3,29 разу у порівнянні з ефективністю, розрахованої для пацієнтів з первинним консервативним лікуванням. Проведены ретроспективные исследования эффективности принятия решений при диагностике и лечении пациентов хирургического профиля — женщин, страдаючих хроническим болевым синдромом. Результаты анализа историй болезни 1092 пациенток, которым была оказана врачебная помощь в период 2013–2017 г.г., проведенного на основе построения дерева решений, показали, что вероятность выздоровления при проведении хирургического вмешательства составила 0,83, в то время как при проведении медикаментозного лечения — 0,62. В случае неэффективности медикаментозного лечения вероятность выздоровления уменьшалась до 0,40. Определены ключевые моменты применения системы поддержки решений хирурга, позволяющие повысить эффективность лечения данной категории пациентов. 2018 Article The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment in Women Estimated with the Model of Decision Tree / А.B. Buzynovsky, О.S. Kоvalenko, N.R. Bayazitov, L.S. Godlevsky // Кибернетика и .вычислительная техника. — 2018. — № 2 (192). — С. 61-71. — Бібліогр.: 10 назв. — англ. 0454-9910 DOI: https://doi.org/10.15407/kvt192.02.061 http://dspace.nbuv.gov.ua/handle/123456789/142092 519.71+ 004.652.4+004.827 en Кибернетика и вычислительная техника Міжнародний науково-навчальний центр інформаційних технологій і систем НАН України та МОН України |
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Медицинская и биологическая кибернетика Медицинская и биологическая кибернетика |
| spellingShingle |
Медицинская и биологическая кибернетика Медицинская и биологическая кибернетика Buzynovsky, А.B. Kоvalenko, О.S. Bayazitov, N.R. Godlevsky, L.S. The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment in Women Estimated with the Model of Decision Tree Кибернетика и вычислительная техника |
| description |
The purpose of the work is to investigate the effectiveness of different methods of treatment women with pain syndrome originated from pelvis and lower part of abdomen on the basis of retrospective analysis of 1092 histories of diseases during 2013–2017 р.р., Results. It was established that the probability of complete health restoration was 0,83 after surgical treatment and 0,62 after drug treatment. In case of initial inefficiency of drug treatment the probability of restoration of health as a result of surgical intervention was 0,40. The EPT in surgically treated patients was less than EPT in patients with therapeutic treatment by 3,29 times at the moment of making decision on the method of treatment. |
| format |
Article |
| author |
Buzynovsky, А.B. Kоvalenko, О.S. Bayazitov, N.R. Godlevsky, L.S. |
| author_facet |
Buzynovsky, А.B. Kоvalenko, О.S. Bayazitov, N.R. Godlevsky, L.S. |
| author_sort |
Buzynovsky, А.B. |
| title |
The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment in Women Estimated with the Model of Decision Tree |
| title_short |
The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment in Women Estimated with the Model of Decision Tree |
| title_full |
The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment in Women Estimated with the Model of Decision Tree |
| title_fullStr |
The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment in Women Estimated with the Model of Decision Tree |
| title_full_unstemmed |
The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment in Women Estimated with the Model of Decision Tree |
| title_sort |
effectiveness of surgeon decision on pain syndrome of pelvic origin treatment in women estimated with the model of decision tree |
| publisher |
Міжнародний науково-навчальний центр інформаційних технологій і систем НАН України та МОН України |
| publishDate |
2018 |
| topic_facet |
Медицинская и биологическая кибернетика |
| url |
http://dspace.nbuv.gov.ua/handle/123456789/142092 |
| citation_txt |
The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment in Women Estimated with the Model of Decision Tree / А.B. Buzynovsky, О.S. Kоvalenko, N.R. Bayazitov, L.S. Godlevsky // Кибернетика и .вычислительная техника. — 2018. — № 2 (192). — С. 61-71. — Бібліогр.: 10 назв. — англ. |
| series |
Кибернетика и вычислительная техника |
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| fulltext |
ISSN 2519-2205 (Online), ISSN 0454-9910 (Print). Киб. и выч. техн. 2018. № 2 (192)
Медицинская
и биологическая кибернетика
DOI: https://doi.org/10.15407/kvt192.02.061
UDC 519.71+ 004.652.4+004.827
А.B. BUZYNOVSKY1, PhD Student,
e-mail: arturdoc1983@ukr.net
О.S. KОVALENKO1, D.Sc. (Medicine), Professor,
Head of Medical Information Systems Department
e-mail: askov49@gmail.com
N.R. BAYAZITOV2, D.Sc. (Medicine),
Professor at the Surgery Department
e-mail: ics_video@ukr.net
L.S. GODLEVSKY2, D.Sc. (Medicine), Professor,
Chief of the Department of Biophysics, Informatics and Medical Devices
e-mail: godlevskyleonid@yahoo.com
1 International Research and Training Center for Information Technologies
and Systems of the National Academy of Sciences of Ukraine
and Ministry of Education and Science of Ukraine,
Acad. Glushkova av., 40, Kiev, 03187, Ukraine
2 Odessa National Medical University,
Valekhovsky Lane, 2, Odessa, 65082, Ukraine
THE EFFECTIVENESS OF SURGEON DECISION ON PAIN SYNDROME
OF PELVIC ORIGIN TREATMENT IN WOMEN ESTIMATED
WITH THE MODEL OF DECISION TREE
Introduction. The problem of correct diagnostics with the decision on the consequent ade-
quate treatment of diseases which are causative for pelvic pain syndrome in women is ac-
tual for 15–24% women of fertile age.
The purpose of the work is to investigate the effectiveness of different methods of
treatment women with pain syndrome originated from pelvis and lower part of abdomen on
the basis of retrospective analysis of 1092 histories of diseases during 2013–2017 р.р.,
Methods. Method of decision tree building up was used. The probability of different
outcomes — restoration of health, recurrence of the disease along with the perioperative
complications as well as duration of treatment in each case were taken into consideration
as informative indices for decision tree composing. On the basis of mentioned data the
index of effective period of treatment (EPT) was calculated. Period of observation was six
months from the moment of disease diagnostics.
Results. It was established that the probability of complete health restoration was 0,83
after surgical treatment and 0,62 after drug treatment. In case of initial inefficiency of drug
А.B. BUZYNOVSKY, О.S. KОVALENKO, N.R. BAYAZITOV, L.S. GODLEVSKY, 2018
61
А.B. Buzynovsky, О.S. Kоvalenko, N.R. Bayazitov, L.S. Godlevsky
ISSN 2519-2205 (Online), ISSN 0454-9910 (Print). Киб. и выч. техн. 2018. № 2 (192) 62
treatment the probability of restoration of health as a result of surgical intervention was
0,40. The EPT in surgically treated patients was less than EPT in patients with therapeutic
treatment by 3,29 times at the moment of making decision on the method of treatment.
Conclusions. It was concluded that early decision on surgical intervention as a
method of diagnostics and treatment was more effective when compared with the drug
method of treatment women with pelvic pain syndrome. Dependence of the treatment effects
upon perioperative complications serve as forecasting data for individual medical care
delivered during postoperative period.
Keywords: tree of decision, undertaking of decision in surgery, pain syndrome, the effec-
tiveness of treatment estimation.
INTRODUCTION
Making decisions in surgical practice very often is performed under conditions
of time shrinkage and uncertainty of symptoms. That is why correct chose of
optimal decision on diagnostics and treatment is complicated [1–5]. From other
side, looking for the identification of moments of surgeon’s decision making
and converting that process into autonomic informational support regime
makes delivering surgical service more reliable and effective [1, 2]. Especially
such an approach is of worth for syndromes with uncertain symptoms manifes-
tations such as pain pelvic manifestations in women [6]. Taking into considera-
tion that diagnostic and treatment mistakes are observed almost in one half of
women with pain pelvic syndrome [4, 6], the working out the system aimed for
support of surgeon decision is regarded as a great challenge with substantial
practical consequences.
The building up of decision tree permits to estimate the effectiveness of treat-
ment [7–9]. This method has not been used for the laparoscopic intervention effec-
tiveness estimation in women with pelvic pain syndrome till the last time.
The purpose of the investigation is confined to perform retrospective
comparative estimation of the effectiveness of surgical and conservative treat-
ment of women with the pelvic pain and pain in the lower part of abdomen.
PROBLEM STATEMENT
The problem of heightening of diagnostics and treatment pelvic pain in
women is especially actual taking into consideration that painful syndrome
originated from pelvis and lower parts of abdomen is met in 15–24% of
women of fertile age as well as both from 10 to 35% of diagnostic laparo-
scopies and up to 12% of hysterectomies are performed in women with
chronic pelvic pain in developed countries [6]. Such aspect as differential
diagnostics of appendicitis and inflammation of pelvic organs is also in-
cluded as a separate and most contributive to the general problem on the
effectiveness of diagnostics and treatment of pelvic pain per se [4, 6].
Hence, investigations aimed for comparative analysis of different methods of
surgical and therapeutic treatment of women with pelvic pain is of outstanding prac-
tical significance. The creation of regression trees of decisions are among those
methods which permit to perform such analysis. [10]. It is of worth to note that tree
of regression is valid for the effect of treatment identification which is based on such
argument as duration of patient’s staying at hospital [10].
The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment
ISSN 2519-2205 (Online), ISSN 0454-9910 (Print). Киб. и выч. техн. 2018. № 2 (192) 63
CHARACTERISTICS OF THE VOLUME AND METHODS OF INVESTIGATIONS
The volume of investigations. All results were gained in the course of retrospective
analysis of histories of diseases of women, who were treated at Odessa Regional
Clinical Hospital during 2013–2017 years with the pelvic pain and pain at lower
part of abdomen as an indication for the treatment. Altogether 1092 histories of
diseases of women from 18 up to 47 years old have been analyzed.
Criteria on the inclusion into investigation were the next:
- fertile age of women;
- the presence of painful syndrome of pelvic or / and lower abdomen origin;
- the performance of laparoscopic diagnostics along with the performing
of laparoscopic treatment in the anamnesis;
- clear and reliable chance for the expert estimation of the effectiveness
of diagnostics and treatment as well as possibility to estimate such informative
parameters as complications incidence, duration of staying at hospital after first
and repeated women’s advertising for medical help.
Methods of the analysis. The calculation of the effectiveness of treatment
was performed on the basis of probability of restoration of patient’s health, and
duration of the period of hospital treatment, which was measured in days.
Besides, the probability of the recurrence of the disease (syndrome) as well as
the duration of repeated hospital period of treatment was taken into account.
The recurrence of disease was identified as repeated advertising of the patient
with the same symptoms on the painful syndrome originated from pelvis and
lower part of abdomen. The period between the moment of discharging from
previous treatment and repeated advertising for medical help was estimated in
days and was taken as an informative parameter for the effectiveness of treat-
ment estimation. All histories of diseases were analyzed for the period of half
of a year from the moment of the first women observation at hospital.
Taking into consideration of the possibility of quantitative estimation per-
forming using tree decisions method [3, 8] the quantification of the effective-
ness of treatment was performed with the index “effective period of treatment”
(EPT). Such an index was calculated in accordance to the equation:
( )APx
n
EPT
n
i
i∑
=
=
1
1 , (1)
where xi — an average length of treatment period; P — probability of success-
ful result of treatment (health restoration); n — number of patients.
Similarly, in case of recurrence of disease and repeated treatment, EPT
was calculated as an averaged number of days after the first discharging from
the hospital multiplied by the probability of the recurrence of disease. Taking
into consideration the well-known fact on the reversed dependence between the
length of period before recurrence of the disease and the effectiveness of treat-
ment [5, 6], the EPT for repeated medical care was calculated as reversed value
of average length of period free from pain syndrome after the first treatment
multiplied by 100 and by weight coefficient (Q=10). That was necessary for
correct comparison of EPT calculated for the first period of treatment with the
А.B. Buzynovsky, О.S. Kоvalenko, N.R. Bayazitov, L.S. Godlevsky
ISSN 2519-2205 (Online), ISSN 0454-9910 (Print). Киб. и выч. техн. 2018. № 2 (192) 64
EPT of treatment performed after recurrence of disease:
( )APQ
x
n
EPT n
i
i
×××=
∑
=
100
1
1
1
.
(2)
THE GENERAL CHARACTERISTICS OF TREATMENT RESULTS
Surgical treatment results. In the accordance with retrospective analysis, it was
established that 828 patients (75,8%) have been treated surgically while the rest
234 patients (24,2%) were treated therapeutically.
Intraoperative complications were registered in 84 patients (10,1%), and in
48 out of them complications were also revealed during postoperative period
(Fig. 1). The mean duration of the treatment of intraoperative complications was
11,84 + 1,13 days, while postoperative ones were treated during — 17,52 + 1,22
days. It is worth to note that recurrence of disease was observed in 32 out of 48
patients in the subgroup of patients with both intra- and postoperative complica-
tions, while the rest of them (16 patients, 33,3%) successfully discharged from
hospital. The recurrence of disease was registered in 16 out of 36 patients, who had
only postoperative complications, while the rest 20 patients were successfully dis-
charged from hospital (Fig.1). Those patients who were surgically treated and free
from intraoperative complications (744 patients) demonstrated postoperative com-
plications in 76 cases (10,2%), while the majority of them (668 patients) have been
discharged from the hospital after 4,57 + 0,81 days of treatment. Later on 68 pa-
tients out from those 668 have advertised for medical help again after 97,50 + 6,42
days free from pain syndrome period.
Therapeutic treatment results. 264 patients (24,2%) have started with drug-
based conservative treatment (Fig. 1). The successful results of 23,41 + 2,51 days of
treatment was observed in 108 patients (40,9%). The recurrence of the disease was
registered in the rest 156 (59,0%) patients after 33,92 + 2,85 days of treatment. The
corrected drug-based treatment was restarted in 56 out of those
156 patients with the success ful result in 27,22 + 3,35 days of treatment. The rest
100 patients were decided to treat surgically, and in 44 (44,0%) of them the intraop-
erative complications have been registered, which have been successfully therapeuti-
cally treated in 16,03 + 1,52 days. Besides, in 28 out of 44 patients postoperative
complications have been precipitated as well. The majority of patients with both
intra- and postoperative complications (71,4%) suffered from the recurrent pain syn-
drome, which renovated in average of 50,83 + 6,74 days, while successful treatment,
which was registered in eight patients, finished in 37,32 + 4,59 days of treatment.
Those patients who had intraoperative complications without postoperative ones the
renovated pain symptoms was seen in 74,51 + 7,45 days (eight patients), while suc-
cessful treatment was observed in 16,33 + 2,92 days of treatment (eight patients).
The postoperative complications were observed in 36 out of 56 patients
who had not intraoperative ones. In 24 out of these 36 patients suffered from
the recurrence of disease in average of 70,3 + 5,8 days. Successful treatment
was performed in 12 out of those 24 patients in 27,0 + 3,4 days. The successful
discharging from hospital after 6,33 + 0,62 days of treatment was registered in
The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment
ISSN 2519-2205 (Online), ISSN 0454-9910 (Print). Киб. и выч. техн. 2018. № 2 (192) 65
Fig. 1. Graph on the effectiveness of medical service delivering to patients with chronic
pelvic pain. Notes: at this and next figure — the probability of correspondent patient’s state
(in brackets), and duration of treatment (days) — nearby brackets.
А.B. Buzynovsky, О.S. Kоvalenko, N.R. Bayazitov, L.S. Godlevsky
ISSN 2519-2205 (Online), ISSN 0454-9910 (Print). Киб. и выч. техн. 2018. № 2 (192) 66
12 out of 20 patients, who did not demonstrate both intra- and postoperative
complications (Fig. 1). The rest eight patients have been advertised for medical
help with renovated pain syndrome in 57,3 + 6,7 days.
THE COMPARATIVE EFFECTIVENESS OF SURGICAL AND CONSERVATIVE TREATMENT
The clear rising of EPT was evident when it was compared with such one meas-
ured in patients treated surgically in patients resistant to drug-based treatment with
such one in patients who were treated surgically from the very beginning (Table 1).
The EPT in surgically treated patients, who did not suffer from complica-
tions, was two times less when compared with EPT in patients with periopera-
tive complications (Fig. 2). It should be stressed that EPT in patients with suc-
cessful initial surgical treatment was less by 2,68 times when compared with
such one registered in patients whom surgical intervention was performed after
therapeutic treatment (Fig. 2, B). EPT in patients with recurrent disease, which
was registered after initial therapeutic treatment was higher when compared
with such one in patients with primarily surgical treatment by 3,17 times
(Fig. 2, C). Finally, the EPT in surgically treated patients was less than EPT in
patients with therapeutic treatment by 3,29 times at the moment of making
decision on the method of treatment (Fig. 2, D).
Hence, gained data as a result of retrospective analysis are in favor for
different type of treatment as an initial decision for women with pelvic pain
syndrome. Surgical or drug treatment has been chosen on the basis of both
actual medical protocol and patients desire to be involved in surgical or drug-
based treatment. Also it was established that surgical and therapeutic treatment has
had different consequences with respect to complications precipitance and patient’s
repeated advertisement for medical help. Thus, in case of drugs prescription recovery
was observed with the probability of 0,62 including recovery after repeated medical
help delivering. Similar probability after surgical treatment was 0,83. But surgical
treatment which has been delivered after therapeutic treatment was followed by re-
covery with a probability of 0,40. Such low value is in favor for reduced effective-
ness of surgical treatment under conditions of ineffectiveness of drug treatment of
pelvic pain syndrome. The lowering of surgery effectiveness might be explained by
both resistance of the disease to treatment and increasing of disease severity [4, 6].
It should be emphasized that this fact points on importance of earlier diagnostics and
surgery intervention in women with pelvic pain syndrome.
Table 1. EPT values depending upon the type of complications and the type
of primarily treatment
Type of complications Type of the initial
treatment Intraoperative Postoperative Perioperative (Both)
Surgical 12,99 15,30 13,56
Conservative (thera-
peutical or drug-
based)
14,70 18,48 24,73
The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment
ISSN 2519-2205 (Online), ISSN 0454-9910 (Print). Киб. и выч. техн. 2018. № 2 (192) 67
Fig. 2. Stages on EPT (inside ellipses) calculations in the course of clarifying the effect of
intraoperative complications (A), comparison of the effectiveness of surgical treatment
after the first advertisement for medical help and after recurrence of pain syndrome as a
result of the resistance to therapeutic treatment — marked with arrows (B), as well as
comparison of the effectiveness of surgical and therapeutic treatment (C and D).
А.B. Buzynovsky, О.S. Kоvalenko, N.R. Bayazitov, L.S. Godlevsky
ISSN 2519-2205 (Online), ISSN 0454-9910 (Print). Киб. и выч. техн. 2018. № 2 (192) 68
EPT-index proved to be effective in the course of evaluation of effectiveness of
treatment methods as far as it includes probability of possible results of treatment,
duration of treatment and similar characteristics for cases of disease recurrence. Thus,
gained data revealed that EPT of those patients who have suffered from postopera-
tive complications with the absence of intraoperative ones was 2,98 times fold
greater when compared with the EPT of patients who were successfully treated and
avoided preoperative complications. Similar ratio of ETP (1,71 times) was observed
in patients who were treated therapeutically from the very beginning pertained to
patients whom surgical intervention was performed secondarily to the initial drug-
based treatment. It is also worth to note that ETP was higher in all groups of patients
who were treated initially therapeutically when compared with data gained in groups
of patients who began with surgical treatment.
Gained data are in favor for the recommendation to concentrate resources of the
system of surgeon decision support on the crucial decision — the chose method of
treatment of women who suffered from pelvic pain and pain at lower part of abdo-
men with uncertain origin at the moment of their entrance to hospital. Also it is im-
portant to pay proper attention to chose method of diagnostics and treatment of those
women who were resistant to the initial therapeutical treatment.
CONCLUSIONS
The process of the delivering of medical care to patients with pelvic pain syndrome is
possible to model at satisfactory level with the method of decision tree creation. Us-
ing such an approach the critical points — decisions which are followed by different
level of effectiveness of treatment is possible to identify
In accordance to gained data on the effectiveness of patients treatment who were
successfully discharged from hospital, but advertised again after recurrence of pain
syndrome it was established that in-time performed surgical treatment permitted to
get better results when compared with drug-based treatment.
Surgical treatment performed after primarily delivered drug- based treatment is
followed by greater number of both intra — and postoperative complications as well
as by prolonged hospital period of treatment when compared with patients who were
started in-time with surgery.
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Получено 12.10.2017
А.B. Buzynovsky, О.S. Kоvalenko, N.R. Bayazitov, L.S. Godlevsky
ISSN 2519-2205 (Online), ISSN 0454-9910 (Print). Киб. и выч. техн. 2018. № 2 (192) 70
А.Б. Бузиновський1, аспірант,
e-mail: arturdoc1983@ukr.net
O.С. Коваленко1, д-р мед.наук, проф.,
зав. відд. медичних інформаційних систем
e-mail: askov49@gmail.com
М.Р. Баязітов2, д-р мед.наук,
професор кафедри хірургії
e-mail: ics_video@ukr.net
Л.С. Годлевський2, д-р мед.наук, проф.,
зав. каф. біофізики, інформатики і медичної апаратури
e-mail: godlevskyleonid@yahoo.com
1 Міжнародний науково-навчальний центр інформаційних технологій
та систем НАН України і МОН України,
пр. Академіка Глушкова, 40, м. Київ, 03187, Україна
2 Одеський національний медичний університет,
Валіховський пров., 2, м. Одеса, 65082, Україна
ОЦІНЮВАННЯ ЕФЕКТИВНОСТІ ПРИЙНЯТТЯ РІШЕНЬ ХІРУРГОМ
У РАЗІ БОЛЬОВОГО СИНДРОМУ МИСКОВОГО ПОХОДЖЕННЯ
ЗА ДОПОМОГИ МОДЕЛІ ДЕРЕВА РІШЕНЬ
Вступ. Проблема коректної діагностики і прийняття рішення щодо адекватного ліку-
вання захворювань, які є причиною больового синдрому мискового походження, є важ-
ливою, оскільки синдром трапляється у 15–24% жінок репродуктивного віку.
Мета роботи полягає у порівнянні ефективності різних методів лікування жінок
з больовим синдромом мискового походження на основі ретроспективного аналізу
1092 історій хвороб пацієнтів, яким лікування було надано в період 2013–2017 р.р.
Методи дослідження. Використано метод побудови моделі дерева рішень.
В якості інформаційних критеріїв побудови моделі було використано імовірність
одужання, час відновлення проявів захворювання після лікування, імовірність виник-
нення периопераційних ускладнень, а також тривалість лікування. На основі вказаних
критеріїв розраховано показник ефективного періоду лікування. Період спостережен-
ня пацієнтів складав півроку з моменту виникнення больового синдрому.
Результати дослідження. Встановлено, що імовірність повного відновлення
здоров’я склала 0,83 після хірургічного і 0,62 після консервативного лікування.
У випадку, коли первинне консервативне лікування не приводило до одужання, імо-
вірність одужання після проведення хірургічного втручання дорівнювала 0,40. Ефек-
тивність періоду лікування, розрахована для пацієнтів з первинним хірургічним ліку-
ванням, була менша в 3,29 разу у порівнянні з ефективністю, розрахованої для паціє-
нтів з первинним консервативним лікуванням.
Висновки. Своєчасне прийняття рішення щодо хірургічного лікування захворю-
вань, які є причиною больового синдрому мискового походження, є ефективнішим у
порівнянні із застосуванням медикаментозного лікування. Визначена залежність
ефективності лікування від периопераційних ускладнень може слугувати в якості
прогностичних критеріїв стану пацієнта в післяопераційному періоді.
Ключові слова: дерево рішень, прийняття рішення в хірургії, больовий синдром, оцінка ефе-
ктивності лікування.
The Effectiveness of Surgeon Decision on Pain Syndrome of Pelvic Origin Treatment
ISSN 2519-2205 (Online), ISSN 0454-9910 (Print). Киб. и выч. техн. 2018. № 2 (192) 71
А.Б. Бузиновский1, аспирант,
e-mail: arturdoc1983@ukr.net
А.С. Коваленко1, д-р мед.наук, проф.,
зав. отд. медицинских информационных систем
e-mail: askov49@gmail.com
Н.Р. Баязитов2, д-р мед.наук, професор каф. хирургии,
e-mail: ics_video@ukr.net
Л.С. Годлевский2, д-р мед.наук, проф.,
зав. кафедрой биофизики, информатики и медицинской аппаратуры
e-mail: godlevskyleonid@yahoo.com
1 Международний научно-учебный центр информационных технологий
и систем НАН Украины и МОН Украины,
пр. Академика Глушкова, 40, г. Киев, 03187, Украина
2 Одесский национальный медицинский университет,
Валеховский пер., 2, г. Одесса, 65082, Украина
ОЦЕНКА ЭФФЕКТИВНОСТИ ПРИНЯТИЯ РЕШЕНИЙ ХИРУРГОМ
ПРИ БОЛЕВОМ СИНДРОМЕ ТАЗОВОГО ПРОИСХОЖДЕНИЯ
С ПОМОЩЬЮ МОДЕЛИ ДЕРЕВА РЕШЕНИЙ
Проведены ретроспективные исследования эффективности принятия решений при
диагностике и лечении пациентов хирургического профиля — женщин, страдаючих
хроническим болевым синдромом. Результаты анализа историй болезни 1092 пациен-
ток, которым была оказана врачебная помощь в период 2013–2017 г.г., проведенного
на основе построения дерева решений, показали, что вероятность выздоровления при
проведении хирургического вмешательства составила 0,83, в то время как при прове-
дении медикаментозного лечения — 0,62. В случае неэффективности медикаментоз-
ного лечения вероятность выздоровления уменьшалась до 0,40. Определены ключе-
вые моменты применения системы поддержки решений хирурга, позволяющие повы-
сить эффективность лечения данной категории пациентов.
Ключевые слова: дерево решений, принятие решений хирургом, болевой син-
дром,оценка эффективности лечения.
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