• Title/Summary/Keyword: Dependence of a patient

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Impact of Admission Diagnosis on the Smoking Cessation Rate: A Brief Report From a Multi-centre Inpatient Smoking Cessation Programme in Singapore

  • See, Jason Jia Hao;See, Kay Choong
    • Journal of Preventive Medicine and Public Health
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    • v.53 no.5
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    • pp.381-386
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    • 2020
  • Objectives: Few studies have been published regarding the relevance of the admission diagnosis to the smoking cessation rate. We studied smoking cessation rates in relation to admission diagnoses in our inpatient smoking cessation programmes. Methods: This retrospective study included all patients recruited into our inpatient smoking cessation programmes at 2 institutions in Singapore between June 2008 and December 2016. Patients were given individualized intensive counselling and were followed up via phone interviews for up to 6-month to assess their smoking status. Multivariable logistic regression was used to analyse potential associations between admission diagnoses and 6-month abstinence. Results: A total of 7194 patients were included in this study. The mean age was 54.1 years, and 93.2% were male. In total, 1778 patients (24.7%) were abstinent at the 6-month follow-up call. Patients who quit smoking tended to be of Chinese ethnicity, have initiated smoking at a later age, be better educated, and have lower Fagerström Test of Nicotine Dependence scores. After adjusting for these factors, patients with a cardiovascular admission diagnosis had a significantly higher probability of quitting tobacco use than patients with a respiratory or other diagnosis. Conclusions: In patients acutely admitted to the hospital, a diagnosis of cardiovascular disease was associated with the highest quit rate. Smoking cessation interventions need to be incorporated into all cardiovascular disease treatment pathways to leverage the patient's motivation and to improve the quit rate. In addition, patients in groups with lower quit rates may benefit from more intensive programmes to increase the rate of successful cessation.

Linear Energy Transfer Dependence Correction of Spread-Out Bragg Peak Measured by EBT3 Film for Dynamically Scanned Proton Beams

  • Lee, Moonhee;Ahn, Sunghwan;Cheon, Wonjoong;Han, Youngyih
    • Progress in Medical Physics
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    • v.31 no.4
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    • pp.135-144
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    • 2020
  • Purpose: Gafchromic films for proton dosimetry are dependent on linear energy transfers (LETs), resulting in dose underestimation for high LETs. Despite efforts to resolve this problem for single-energy beams, there remains a need to do so for multi-energy beams. Here, a bimolecular reaction model was applied to correct the under-response of spread-out Bragg peaks (SOBPs). Methods: For depth-dose measurements, a Gafchromic EBT3 film was positioned in water perpendicular to the ground. The gantry was rotated at 15° to avoid disturbances in the beam path. A set of films was exposed to a uniformly scanned 112-MeV pristine proton beam with six different dose intensities, ranging from 0.373 to 4.865 Gy, at a 2-cm depth. Another set of films was irradiated with SOBPs with maximum energies of 110, 150, and 190 MeV having modulation widths of 5.39, 4.27, and 5.34 cm, respectively. The correction function was obtained using 150.8-MeV SOBP data. The LET of the SOBP was then analytically calculated. Finally, the model was validated for a uniform cubic dose distribution and compared with multilayered ionization chamber data. Results: The dose error in the plateau region was within 4% when normalized with the maximum dose. The discrepancy of the range was <1 mm for all measured energies. The highest errors occurred at 70 MeV owing to the steep gradient with the narrowest Bragg peak. Conclusions: With bimolecular model-based correction, an EBT3 film can be used to accurately verify the depth dose of scanned proton beams and could potentially be used to evaluate the depth-dose distribution for patient plans.

A Comparison Study of Volumetric Modulated Arc Therapy Quality Assurances Using Portal Dosimetry and MapCHECK 2

  • Jin, Hosang;Jesseph, Fredrick B.;Ahmad, Salahuddin
    • Progress in Medical Physics
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    • v.25 no.2
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    • pp.65-71
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    • 2014
  • A Varian Portal Dosimetry system was compared to an isocentrically mounted MapCHECK 2 diode array for volumetric modulated arc therapy (VMAT) QA. A Varian TrueBeam STx with an aS-1000 digital imaging panel was used to acquire VMAT QA images for 13 plans using four photon energies (6, 8, 10 and 15 MV). The EPID-based QA images were compared to the Portal Dose Image Prediction calculated in the Varian Eclipse treatment planning system (TPS). An isocentrically mounted Sun Nuclear MapCHECK 2 diode array with 5 cm water-equivalent buildup was also used for the VMAT QAs and the measurements were compared to a composite dose plane from the Eclipse TPS. A ${\gamma}$ test was implemented in the Sun Nuclear Patient software with 10% threshold and absolute comparison at 1%/1 mm (dose difference/distance-to-agreement), 2%/2 mm, and 3%/3 mm criteria for both QA methods. The two-tailed paired Student's t-test was employed to analyze the statistical significance at 95% confidence level. The average ${\gamma}$ passing rates were greater than 95% at 3%/3 mm using both methods for all four energies. The differences in the average passing rates between the two methods were within 1.7% and 1.6% of each other when analyzed at 2%/2 mm and 3%/3 mm, respectively. The EPID passing rates were somewhat better than the MapCHECK 2 when analyzed at 1%/1 mm; the difference was lower for 8 MV and 10 MV. However, the differences were not statistically significant for all criteria and energies (p-values >0.05). The EPID-based QA showed large off-axis over-response and dependence of ${\gamma}$ passing rate on energy, while the MapCHECK 2 was susceptible to the MLC tongue-and-groove effect. The two fluence-based QA techniques can be an alternative tool of VMAT QA to each other, if the limitations of each QA method (mechanical sag, detector response, and detector alignment) are carefully considered.

Subjective and Objective Caregiver Burden in Parkinson's Disease

  • Kim, Keum-Soon;Kim, Bog-Ja;Kim, Kyung-Hee;Choe, Myoung-Ae;Yi, Myung-Sun;Hah, Yang-Sook;Chung, Sun-Ju;Kwon, So-Hi
    • Journal of Korean Academy of Nursing
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    • v.37 no.2
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    • pp.242-248
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    • 2007
  • Purpose. Parkinson's disease (PD) is a common neurodegenerative disorder characterized by motor disabilities and increasing dependence on others for daily life activities with consequent impact on patients' and caregivers' quality of life. The aim of this study was to elucidate the burden on primary caregivers of patients with PD, and identify related factors. Methods. A cross-sectional descriptive study. Seventy-six primary caregivers of PD patients in a neurology out-patient clinic, Seoul, Korea completed structured questionnaires, of which 68 were analyzed. The structured self-report questionnaire included (1) demographic information on the caregivers, (2) information regarding the disease characteristics of the patients, and (3) the subjective and objective caregiver burdens as assessed on Montgomery, Gonyea, & Hooyman's scale. Results. The mean age of the caregivers was 54.56 years, and spouses represented the largest proportion (47.0%). Caregivers of PD patients experienced high levels of burden (mean scores on the subjective and objective burdens were 45.22 and 34.90, respectively), which were comparable to the caregiver burdens in stroke, and higher than the caregiver burdens in general chronic disease. Older caregivers and spousal caregivers experienced significantly higher burdens (p=.004 and p=.019, respectively). A greater motor disability and higher modified Hoehn and Yahr grade were related to higher caregiver burden (p=.001 and p=.018, respectively). Conclusion. Caring for PD patients is associated with a high level of caregiver burden. Therefore, healthcare professionals should identify the burden of caregivers who look after PD patients and develop comprehensive management strategies both for patients and their caregivers.

Dynamic Developmental Factors and their Problem Solving of Patients that Abuse Marihuana (마리화나 남용환자의 역동적인 발달요인과 문제해결)

  • 원정숙
    • Journal of Korean Academy of Nursing
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    • v.4 no.3
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    • pp.105-116
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    • 1974
  • This study was made on patients who were Hospitalized due to sickness caused by the abuse of marihuana at the Psychiatric Section of a hospital during the period from Feb. to Oct., 1974. The following conclusion was obtained by reviewing the literature with respect to the nursing, and problem solving of those patients. 1. It appears that marihuana is a comparatively mild intoxicant in ordinary preparation without causing physical dependence or tolerance. 2. According to the status of men who are marihuana smokers, approximately 20% of them were college students, those preparing to retake college entrance examinations, non-employed and pharmacists. The men belong mostly to the middle foreigner′s mistress of higher, income bracket, and in the case of women, most of the smokers were US. servicemen entertainers. 3. Dynamic developmental factors: Case 1. : The patient had a characteristic, hysterical and emotionally unitable character, and was of low intelligence, In addition, to this already existing problem, the added uses of marihuana caused a mental illness to develope. Case 2 : The character, was reserved and introspective, her creative power and sentiment was fading and his ability of self-control was weakened. She used the smoking of marihuana to get rid of her own feeling of inferiority complex and tensions coming from interpersonal relationships. Case 3 : The patient was unconditionally resistive to the authoritativeness of superiors and irresponsible in his relationship with women, in his attitude concerning sex in general. He smoked marihuana because he felt become peace-loving and get enchanted experience through smoking it. 4. The points of issue appearing from the above case; (1) Movement of anti-social feelings against the "established system" by the youngsters. (2) Family problem. (3) Shamelessness, loss of motivation, disorderly attitude toward the sex, (4) Worries concerning the future. (5) Lack of knowledge concerning smoking of cigarette and marihuana. Chronic use of marihuana made, those youngman who had originally been ambitions to achieve something in life, lazy, inefficient, unable to make long-term plans, are such weak mined persons that they did not try to overcome problems when encountered. This will pose a great and important question in the mental health of the society, 5. Treatment and Problem sieving According to the literature, we will have to place importance upon hospitalized treatment The phases of treatment were divided into five parts. (1) Prehospital phase (2) Withdrawal Phase (3) Rehabilitation phase (4) Transitional phase (5) After-care phase The experiments have proved that there was much progress in the recovery of patients through environment therapy, supportive therapy and group psychotherapy. This was the above mentioned 5 phases of treating process in accordance with the weekly schedule of the hospital. It was thought that the patients would require prolonged after care management even after they were released from the hospital and that they will also require periodic visit, to the hospital and doctor′s interview with their family. In conclusion, the question of the young generation and marihuana smoking is becoming a great social problem in which their resistances to the "established system" and society is growing in the from of antiestablishment movements. In our country, the smoking of marihuana is gradually developing, therefore, I think, that it would be a very fortunate thing for us, if this report could be helpful for the motivation of further study on the questions of the young generation and its problems.

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Pilot Study of the Sensitivity and Specificity of the DNA Integrity Assay for Stool-based Detection of Colorectal Cancer in Malaysian Patients

  • Yehya, Ashwaq Hamid;Yusoff, Narazah Mohd;Khalid, Imran A.;Mahsin, Hakimah;Razali, Ruzzieatul Akma;Azlina, Fatimah;Mohammed, Kamil Sheikh;Ali, Syed A.
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.5
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    • pp.1869-1872
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    • 2012
  • Background: To assess the diagnostic potential of tumor-associated high molecular weight DNA in stool samples of 32 colorectal cancer (CRC) patients compared to 32 healthy Malaysian volunteers by means of polymerase chain reaction (PCR). Methods: Stool DNA was isolated and tumor-associated high molecular weight DNA (1.476 kb fragment including exons 6-9 of the p53 gene) was amplified using PCR and visualized on ethidium bromide-stained agarose gels. Results: Out of 32 CRC patients, 18 were positive for the presence of high molecular weight DNA as compared to none of the healthy individuals, resulting in an overall sensitivity of 56.3% with 100% specificity. Out of 32 patients, 23 had tumor on the left side and 9 on the right side, 16 and 2 being respectively positive. This showed that high molecular weight DNA was significantly (p = 0.022) more detectable in patients with left side tumor (69.6% vs 22.2%). Out of 32 patients, 22 had tumors larger than 1.0 cm, 18 of these (81.8%) being positive for long DNA as compared to not a single patient with tumor size smaller than 1.0 cm (p <0.001). Conclusion: We detected CRC-related high molecular weight p53 DNA in stool samples of CRC patients with an overall sensitivity of 56.3% with 100% specificity, with a strong tumor size dependence.

A Comparative Study on Risk Factors Related to Patient with Recurrent Stroke Between Recurrent Group and Non-recurrent Group: Single Hospital Based Cohort Study (뇌졸중 재발자와 비재발자의 뇌졸중 재발 위험 요인의 비교 분석: 일개 병원의 뇌졸중 환자 코호트를 기반으로)

  • Jeon, Mi Yang;Cho, Hyung Je;Park, Mingyeong;Jin, Mi Jeong;Ha, Youngmi
    • Journal of muscle and joint health
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    • v.27 no.3
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    • pp.219-228
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    • 2020
  • Purpose: This study was a comparative analysis of stroke-related factors between recurrent patients and non-recurrent patients. Methods: A retrospective cohort study design was used, and data were collected from March 2020 to April 2020 using electronic medical records. 244 patients (221 first-timers and 23 recurrent) were included in this study. Results: The stroke recurrence rate in 5 years was 9.4%, the readmission rate was 39.3%, and the mortality rate was 2.0%. The number of patients hospitalized for stroke was greater among men than among women. Of the patients, 60.7% had an underlying disease. With regard to daily life abilities, over 70% of participants needed more than moderate dependence and about 40% of participants had more than mild cognitive impairment. More than 50% were moved to wheelchairs or stretcher cars. The difference in the stroke readmission rate between recurrent and non-recurrent patients was statistically significant. Conclusions: Based on our findings, a program to prevent recurrence of stroke should be developed to considering age, ability of daily living, place of discharge, gait ability at discharge, and place of discharge.

Depression, Attachment and Addiction Problems in Runaway Youths (가출청소년에서 우울증상과 애착 및 중독문제)

  • Ko, Miae;Hong, Minha;Kim, Young-Eun;Ha, Juwon;Lee, Sang Min;Kim, Hyun-Soo
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.27 no.3
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    • pp.181-187
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    • 2016
  • Objectives: This study investigated the relationship between depression, attachment and addiction problems in runaway youths. Methods: We sent a questionnaire package to 187 runaway youths in 18 adolescent shelters. The questionnaire package collected their sociodemographic data and included the Patient Health Questionnaire-9, Inventory of Parent Attachment (IPA), Korean Internet Addiction Self-Scale (K-Scale), Korean version of Alcohol Use Disorders Identification Test, and Korean version of the $Fagerstr{\ddot{o}}m$ Test for Nicotine Dependence. Results: The percentage of youth with depression was 28.8% (N=54). In the depression group, there were significantly more problematic alcohol users (53.06%, p=.0199) and significantly lower IPA scores (p=.0064). There was a significant negative correlation between depression and a IPA, and significant positive correlation between depression and the K-Scale. Conclusion: These results suggest that runaway youths with depression have more problematic alcohol drinking and attachment problems.

Salvage Transoral Robotic Surgery for Recurrent or Residual Head and Neck Squamous Cell Carcinoma: A Single Institution Experience

  • Dabas, Surender;Dewan, Abhinav;Ranjan, Reetesh;Dewan, Ajay Kumar;Shukla, Himanshu;Sinha, Rupal
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.17
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    • pp.7627-7632
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    • 2015
  • Background: The present study was conducted to evaluate the technical feasibility, safety and adequacy of surgical margins with salvage transoral robotic surgery (TORS) for recurrent or residual head and neck squamous cell carcinoma patients. Materials and Methods: Thirty patients who underwent salvage TORS using the 'DaVinci' robot were enrolled in the study and data related to their surgical time, complications and functional outcome were recorded. Results: The feasibility of salvage TORS in our study was observed to be 100%. Positive margins were encountered in only 6.7% of patients. Mean blood loss was 23.3 ml with no patient requiring blood transfusion. Postoperative complications in the form of primary haemorrhage requiring active surgical intervention occurred in 13.3%. Oral feeding could be started as early as the 3rd postoperative day in a few patients, with nasogastric tubes being removed on the 12th postoperative day. Long term gastrostomy tube dependency was seen in 10% cases. Median survival of patients was 19 months. Conclusions: Salvage TORS is a safe, effective and feasible option in the management of treatment failure cases. It offers an alternative surgical approach with unexpected benefits in terms of tracheostomy tube use, Ryle's tube and gastrostomy dependence.

Consumer Satisfaction with Paid Caregiving in General Hospitals According to Type of Paid Caregiver (종합병원 유료간병인 이용행태에 따른 의료소비자의 만족도)

  • Chung, Kyung-Ok
    • Journal of Korean Academy of Nursing Administration
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    • v.10 no.3
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    • pp.375-386
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    • 2004
  • The purpose of this study was to identify the present use of caregiver services, to evaluate the degree of satisfaction with the services according to type of caregiver service, private or public, and to provide data for the development of a plan which will provide good quality service with less economic and psychological burden to the patients and their families. Survey data were collected from 130 patients in 4 general hospitals in Seoul, and their families. Data were collected during April, 2004, using a questionnaire which included the patient satisfaction scale developed by Jun (2001). Data were analyzed using frequencies, percentages, means and standard deviations, $X^2$ analysis, t-test. The SPSS computer program was used to facilitate analysis. The results of this study are summarized as follows; The total score for satisfaction was high for both groups. For the private caregiver group it was $52.38{\pm}11.08$, and for the public caregiver group, $58.14{\pm}9.64$. This difference was significant(t=-3.391, p=.001). In all of areas, the scores for satisfaction of the public caregiver service group were higher than private caregiver service group, ie. caregivers' attitude, role, confidence, performance, and service charge, and all the differences were significant. In conclusion, it was found that long-term hospitalization of older patients with high dependence resulted in more caregiver service. There were more severe patients in the public caregiver group, but the service charges, additional costs and paid holidays were less. Based on these results, patients and their families were significantly more satisfied with public caregiver service because it was not only less expensive but also had a high quality of service. Thus, caregiver services should be systemized so that patients and their families will get the best quality caregiver service

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