• Title/Summary/Keyword: Delay Risk

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Appraisal of Breast Cancer Symptoms by Iranian Women: Entangled Cognitive, Emotional and Socio-Cultural Responses

  • Khakbazan, Zohreh;Roudsari, Robab Latifnejad;Taghipour, Ali;Mohammadi, Eesa;Pour, Ramesh Omrani
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.19
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    • pp.8135-8142
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    • 2014
  • Background: Breast cancer is the most common cancer in Iranian women and usually features delayed presentation and late diagnosis. Interpretation of symptoms, as the most important step, has a significant impact on patient delay in seeking treatment. There is a dearth of studies on symptom appraisal and the process leading to seeking help in breast cancer patients. This study explored the perceptions and experiences of Iranian women with self-detected possible breast cancer symptoms. Materials and Methods: A qualitative method was conducted involving in-depth semi-structured interviews with 27 Iranian women with self-discovered breast cancer symptoms. Participants were purposefully selected from women who attended Cancer Institute of Tehran University of Medical Sciences during June 2012 to August 2013. The audiotaped interviews were transcribed and analyzed using conventional content analysis with MAXQDA soft ware version 10. The trustworthiness of the study was verified by prolonged engagement, member validation of codes, and thick description. Results: The main concepts emerging from data analysis were categorized in four categories: symptom recognition, labeling of symptoms, interactive understanding, and confronting the fear of cancer. Symptom recognition through breast self-examination, symptom monitoring and employing prior knowledge distinguished normal from abnormal symptoms and accompanied with perception of being at risk of breast cancer led to symptom labeling. Social interaction by selective disclosure and receiving reassurance from a consultant led to confirmation or redefinition of the situation. Perceived seriousness of the situation and social meanings of breast cancer as a stigmatized and incurable illness associated with loss of femininity were reasons for patient worries and fear. Conclusions: This study emphasized that entangled cognitive, emotional and socio-cultural responses affecting understanding of symptom seriousness require further investigation. It is suggested that programs aimed at shortening patient delay in breast cancer should be focused on improving women's knowledge and self-awareness of breast cancer, in addition to correcting their social beliefs.

Criteria for diet pattern and meal management to improve cognitive function: A systematic review (체계적 문헌 고찰을 통한 인지기능 개선에 도움을 주는 식사 관리에 대한 연구)

  • Park, Young-Sook;Lee, Hyun-Jung;Choi, Kui-Jeong;Xu, Lin;Nam, Ye-Rim;Kim, Yoon-Ha;Kim, Min-Ji;Shin, Weon-Sun
    • Korean Journal of Food Science and Technology
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    • v.52 no.5
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    • pp.450-458
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    • 2020
  • The purpose of this study was to conduct a systematic review of the current published research related to improvement in cognitive function. A systematic search was performed in three bibliographic databases (PubMed, Cochrane Library, and EMBASE) using "dementia", "memory", "food", "diet", and "nutrition" as keywords. Meal management intervention, including Dietary Approaches to Stop Hypertension (DASH) diet, Mediterranean (Med) diet, Diet Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, and other studies, was also included in the analysis. Through extensive screening, 21 articles, out of 2101 papers retrieved, were used for the final systematic review. The methodological quality of the randomized controlled clinical trials (RCTs) was assessed using the Cochrane Risk of Bias tool. These articles recommended vegetables, fruits, whole grains, olive oil, fish, berries, nuts, and beans. In conclusion, this study suggests the potential use of meal management to improve cognitive function.

Long-term Management of a Gingival Fibromatosis Patient with the Primary Dentition (유치열기에서 나타난 치은섬유종증 환자의 장기간 관리)

  • Kang, Chungmin;Lee, Jaeho;Choi, Hyungjun;Song, Jeseon;Kim, Seongoh
    • Journal of the korean academy of Pediatric Dentistry
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    • v.41 no.4
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    • pp.328-334
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    • 2014
  • Gingival fibromatosis is a rare oral condition that is characterized by proliferative fibrous overgrowth of the attached gingiva, the marginal gingiva, and the interdental papilla, typically presenting in the growth period. A case of a 27-month-old girl with a generalized severe gingival overgrowth is described herein. The patient had no known systemic disease, but enlarged gingival tissue had gradually covered her teeth. The excess gingival tissue was removed by conventional gingivectomy, which involved extraction of the retentive primary teeth under general anesthesia when she was 5 years old. Post surgical follow-up at 18 months after the surgery demonstrated no recurrence. Resectional surgery of the enlarged gingival tissue is the treatment choice for gingival fibromatosis, although there is a high risk of recurrence. More frequent professional follow-ups and oral hygiene instruction might be required. A delay in the surgical treatment may have significant consequences for the patient, such as primary dentition retention and consequent delay in the eruption of the permanent teeth, difficulties in mastication and phonation, malpositioning of the teeth, and psychological problems. Early surgical treatment should be performed according to the severity of enlargement.

Study on the neurodevelopmental predictors for the results of the Bayley Scales of Infant Development II in high-risk neonates (고위험 신생아에서 Bayley 발달 검사 결과에 영향을 미치는 신경발달 예후인자에 대한 연구)

  • Woo, Mi Kyeong;Kim, Dong Wook;Huh, Kyoung;Shim, Gyu Hong;Chey, Myoung Jae
    • Clinical and Experimental Pediatrics
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    • v.52 no.11
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    • pp.1221-1227
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    • 2009
  • Purpose:To identify the risk factors for poor neurodevelopmental outcomes in high-risk neonates. Methods:We studied 94 infants admitted to the neonatal intensive care unit at the Sanggye Paik Hospital between January 2002 and November 2005 and evaluated the follow-up data. The following events were considered as risk factors: ${\leq}32$ weeks of gestation, very low birth weight, Apgar scores of less than 5, neonatal resuscitation, neonatal seizure, congenital infection, and abnormalities in cranial ultrasound or magnetic resonance imaging (MRI). The infants who had any one of these risk factors were included. They were evaluated at their mean corrected age of 13.84${\pm}$8.03 months. Mental and Psychomotor Developmental Indices (MDI, PDI) were determined by a clinical psychologist using the Bayley Scales of Infant Development II. Results:The mean MDI and PDI of all the patients were 96.28${\pm}$26.70 and 94.00${\pm}$22.80, respectively. Abnormalities on cranial ultrasound or MRI were significant predictors of both low MDI (P<0.05) and low PDI (P<0.001). These abnormalities showed a stronger association with low PDI than with low MDI. The infants with periventricular leukomalacia had the lowest MDI and PDI ($70.10{\pm}28.68$ and $69.70{\pm}24.91$, respectively). Apgar score at 1 minute and very low birth weight were also significant predictors for low PDI (P<0.05, P<0.05, respectively). Conclusion:Image findings with cranial ultrasound or MRI were the strongest predictors of neurodevelopmental outcome. Periventricular leukomalacia was the best predictive factor for mental and psychomotor development.

Guideline of Improvement and Evaluation of Prescribing Errors in Colorectal Chemotherapy (대장암 항암 화학요법의 처방 오류 평가 및 개선안 제시)

  • Lim, Hyun-Soo;Lim, Sung Cil
    • Korean Journal of Clinical Pharmacy
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    • v.23 no.2
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    • pp.158-166
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    • 2013
  • Background: Colorectal cancer shows a significant increase in South Korea due to westernization of diet, lack of dietary fiber, drinking and smoking, irregular defecation. There are surgery, chemotherapy, radiation therapy in treatment of colorectal cancer. There may be a medication errors in the process of chemotherapy because of its high toxicity, narrow therapeutic index and the health status of cancer patients. Consequently medication errors can cause increasing the risk of death, prolonging hospital stay and increasing the cost. Among medication errors on medication use process, prescribing errors are of particular concern due to higher risk of serious consequences. It is important for pharmacist to prevent the prescribing errors before reaching patient. Therefore we analyzed the prescriptions of colorectal cancer, classified prescribing errors, suggested guideline to reduce prescribing errors and verified the importance of pharmacist's role in prevention of medication errors activity. Methods: We collected the numbers of prescriptions of colorectal cancer(n=2,373) through anti cancer management program and EMR and analyzed the errors of prescriptions by categories from Oct 1st 2011 to Sep 30th 2012 at Chungbuk National University Hospital. We reviewed the prescriptions as follows - patients' characteristics, the result of test, previous prescriptions, characteristics of antineoplastic agents and patients' allergy, drug sensitivity, adverse events. Prescriptions are classified into inpatient and outpatient and analyzed the errors of prescriptions by categories (dosage form, dose, input, diluents, regimen, product). Results: Total prescription number of inpatient and outpatient of colorectal cancer was 1,193 and 1,180 and that of errors was 107(9%) and 22(1.9%), respectively. In case of errors of categories, the number of errors of dosage form is 69 and 8, errors of dose is 15 and 5, errors of input is 9 and 9 in inpatient and outpatient prescriptions, respectively. Errors of diluents is 8, errors of regimen is 3, errors of product is 3 in only inpatient prescriptions. In case of errors of categories by inpatient department, the number of errors of dosage form is 34 and 35, errors of dose is 7 and 8, errors of input is 6 and 3, errors of diluents is 4 and 4, errors of regimen is 2 and 1, errors of product is 2 and 1 in SG and HO, respectively. In case of outpatient department, the number of errors of dosage form is 8 in HO, errors of dose is 5 in HO, errors of input is 5 and 4 in SG and HO, respectively. Conclusions: The rate of errors of inpatient is higher than that of outpatient. Junior doctors are engaged in prescriptions of inpatient and pharmacist need to pay attention to review all prescriptions. If prescribing errors are discovered, pharmacist should contact the prescriber and correct the errors without delay. The guideline to reduce prescribing errors might be upgrading software of anti cancer management program, education for physicians as well as pharmacists and calling prescriber's attention to preventing recurrence of errors.

A Case Study of the Deferred Exposure by Real Estate Finance Types: Focusing on the Distortion of Loan and the Overestimation of Value (부동산금융 유형별 익스포저 이연 사례 연구: Loan의 왜곡과 Value의 과대평가 문제를 중심으로)

  • Jeong, Dae-Seok;Hwangbo, Chang
    • The Journal of the Korea Contents Association
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    • v.20 no.6
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    • pp.38-50
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    • 2020
  • The purpose of this study is to identify the risks to financial institutions in terms of expanding potential risks due to the deferral of exposure, by identifying the structures in which real estate finance and financial institutions affect real estate prices at low interest rates. To this end, real estate financing is categorized according to the method of financing and the type of value measurement from a risk management perspective and analyzed for each case. As a result of analysis, in the case of profitable real estate, the rate of real estate is increased by directly decreasing the cap rate and directly affecting the fair value calculation method. In the case of non-profitable real estate, the real estate price is increased by expanding the leverage width of investors or financial institutions. Through the analysis of this case, the continuous increase in real estate prices over the past 10 years has the potential to prevent financial institutions from losing under the circumstances such as the growth of real estate finance due to the advancement of the financial market and the continued low interest rate trend that has continued for 10 years. It is judged that the deferred delay is part of the cause, which leads to an increase in the risk to financial institutions.

Evaluation of Neurologic Abnormalities After Deep Hypothermic Circulatory Arrest for Pediatric Cardiac Surgery (저체온하 순환정지를 이용한 소아 개심술 후의 신경계 이상에 대한 펑가)

  • Park, Kay-Hyun;Jun, Tae Gook;Chee, Hyun Keun;Lee, Jeong Ryul;Kim, Yong Jin;Rho, Joon Ryang;Suh, Kyung Phill
    • Journal of Chest Surgery
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    • v.29 no.1
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    • pp.14-23
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    • 1996
  • Circulatory arrest under deep hypothermia is an important auxiliary means for cardiac surgery, especially useful in pediatric patients. However, its clinical safety, particularly with regard to the neurologic outcome after long duration of circulatory arrest, is still not established. This study is a review of the eight years'clinical experience of hypothermic circulatory arrest at the Seoul national University Children's Hospital. During an eight-year period from January 1986 through December 1993, a total of 589 consecutive cardiac operations were done using circulatory arrest under deep hypothermia. Among them, 434 consecutive patients, in whom the duration of arrest was 20 minutes or more, are the subject of this study. The duration of arrest ranged from 20 minutes to 82 minutes (mean = 38.7 minutes) under rectal temperature in the range from 12.5$^{\circ}C$ to 25.8$^{\circ}C$. Early neurologic abnormalities occurred in 47 patients : seizure attacks in 28 patients, motor paralyses with or w thout seizure in 12, blindness in 2, and no recovery of consciousness in 5 patients. The rate of incidence of early neurologic abnormalities was calculated at 15.7%. 25 patients showed late neuropsychologic sequelae, such as motor paralysis (9 patients), recurrent seizures (6), developmental delay (8), and definitely low intelligence (2). The rate of incidence of late neurologic sequelae was 8.5%, By statistical analysis, the following factors were identified as the risk factors for post-arrest neurologic abnormalities ; 1) long duration of circulatory arrest, 2) lower-than-ideal body weight, 3) preexisting neurological abnormalities, 4) associated non-cardiovascular congenital anouialies, and 5) low blood pressure during the early post-arrest period. It is concluded that circulatory arrest under deep hypothermia is a relatively safe means for pediatric cardiac surgery with acceptable risk. However, to warrant maximal safety, it is desirable to limit the duration of arrest to less th n 40 minutes. In addition, it is our contention that the early post-arrest period is a very critical period during which maintenance of adequate perfusion pressure in important for the neurologic outcome.

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A Study on the Multiple Real Option Model for Evaluating Values based on Real Estate Development Scenario (다중 실물옵션을 활용한 시나리오기반 부동산 개발사업 가치평가 연구)

  • Jang, Mikyoung;Ku, Yohwan;Choi, Hyemi;Kwon, Tae-Hwan;Kim, Juhyung;Kim, Jaejun
    • Korean Journal of Construction Engineering and Management
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    • v.16 no.5
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    • pp.114-122
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    • 2015
  • Real estate development requires significant amount of capital investment. The project duration has been increased according to its enlarged size. For this reason, cost overrun and time delay are important risk factors that should be managed properly. As a method to hedge the risk, varoius real option methods have been presented. However, conventional project value assesment methods such as NPV(Net Present Value) have weakness to support decision making by reflecting dynamic situations in terms of variation of cost and time. Furthermore, the decision making process is serious of actions rather than discrete event. The purpose of this paper is to present a multiple real option valuation method to overcome the deterministic aspect of real option presented in previous research and practice. The method is developed as following: firstly, to select the model that can be applied in the real estate development project through a survey from previous literature on real options analysis; secondly, to apply data from office development case in order to verify the model by applying conventional real option and multiple real option valuation. According to analysis result, multiple real option provides enhanced values comparing to NPV and single real option.

Numerical Simulation based on SPH of Bullet Impact for Fuel Cell Group of Rotorcraft (입자법 기반 항공기용 연료셀 그룹 피탄 수치모사)

  • Kim, Hyun Gi;Kim, Sung Chan
    • Journal of the Computational Structural Engineering Institute of Korea
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    • v.27 no.2
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    • pp.71-78
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    • 2014
  • There is a big risk of bullet impact because military rotorcraft is run in the battle environment. Due to the bullet impact, the rapid increase of the internal pressure can cause the internal explosion or fire of fuel cell. It can be a deadly damage on the survivability of crews. Then, fuel cell of military rotorcraft should be designed taking into account the extreme situation. As the design factor of fuel cell, the internal fluid pressure, structural stress and bullet kinetic energy can be considered. The verification test by real object is the best way to obtain these design data. But, it is a big burden due to huge cost and long-term preparation efforts and the failure of verification test can result in serious delay of a entire development plan. Thus, at the early design stage, the various numerical simulations test is needed to reduce the risk of trial-and-error together with prediction of the design data. In the present study, the bullet impact numerical simulation based on SPH(smoothed particle hydrodynamic) is conducted with the commercial package, LS-DYNA. Then, the resulting equivalent stress, internal pressure and bullet's kinetic energy are evaluated in detail to examine the possibility to obtain the configuration design data of the fuel cell.

Risk Factors for Allergic Diseases in School-Aged Children (알레르기 질환을 가진 초등학교 고학년의 식생활·환경적 요인 및 성장과의 관련성 분석)

  • Min, Seonae;Cho, Mijin;Park, Kyong
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.42 no.9
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    • pp.1387-1394
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    • 2013
  • Allergies are one of the most common chronic diseases during childhood. While the prevalence of allergic disease in children is increasing dramatically, few studies have evaluated the risk and preventive factors related to this health condition, especially in South Korea. The purpose of this case-control study was to evaluate independent determinants of allergic disease, and to examine whether it is associated with growth and other health conditions in childhood. The current study included 209 cases and 311 age and sex-matched controls (fifth and sixth graders) residing in Daegu, South Korea. Environmental data was collected, including child and family histories of allergies, birth information, and reaction to weaning foods during infancy. In addition, current dietary habits (assessed by 2 day-24 hr food records), health conditions, and anthropometric data were obtained through questionnaires and student health check-ups at the school. Based on chi-square tests, cases had a significantly higher prevalence of having a disease at birth, an allergic reaction to weaning foods, frequent hospital visits, and frequent experiences of the common cold and digestive diseases. In addition, significantly more mothers had a higher education in the cases compared to controls. Based on multivariable conditional logistic regression analysis, factors significantly associated with greater odds for having allergies were parental (OR=21.42) and fraternal (OR=14.40) histories of allergies. The anthropometric measures showed that cases tended to be shorter in height and lighter in weight than the controls, but these differences were not statistically significant. These findings may indicate that current nutrient intakes may not be the only critical factor associated with delayed growth delay in the allergic group. A well-planned, large cohort study is warranted to confirm our findings in the future.