• Title/Summary/Keyword: Low risk

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Modification of HEART Pathway for Patients With Chest Pain: A Korean Perspective

  • Bora Chae;Shin Ahn;Youn-Jung Kim;Seung Mok Ryoo;Chang Hwan Sohn;Dong-Woo Seo;Won Young Kim
    • Korean Circulation Journal
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    • v.53 no.9
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    • pp.635-644
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    • 2023
  • Background and Objectives: The History, Electrocardiography, Age, Risk factors, and Troponin (HEART) pathway was developed to identify patients at low risk of a major adverse cardiac event (MACE) among patients presenting with chest pain to the emergency department. Methods: We modified the HEART pathway by replacing the Korean cut-off of 25 kg/m2 with the conventional threshold of 30 kg/m2 in the definition of obesity among risk factors. The primary outcome was a MACE within 30 days, which included acute myocardial infarction, primary coronary intervention, coronary artery bypass grafting, and all-cause death. Results: Of the 1,304 patients prospectively enrolled, MACE occurred in 320 (24.5%). The modified HEART pathway identified 37.3% of patients as low-risk compared with 38.3% using the HEART pathway. Of the 500 patients classified as low-risk with HEART pathway, 8 (1.6%) experienced MACE, and of the 486 low-risk patients with modified HEART pathway, 4 (0.8%) experienced MACE. The modified HEART pathway had a sensitivity of 98.8%, a negative predictive value (NPV) of 99.2%, a specificity of 49.0%, and a positive predictive value (PPV) of 38.6%, compared with the original HEART pathway, with a sensitivity of 97.5%, a NPV of 98.4%, a specificity of 50.0%, and a PPV of 38.8%. Conclusions: When applied to Korean population, modified HEART pathway could identify patients safe for early discharge more accurately by using body mass index cut-off levels suggested for Koreans.

Clinical Study on Risk Factors of Acute Brain Infarction And NIH stroke scale (급성기 뇌경색의 위험인자와 NIH stroke scale에 관한 임상적 연구)

  • Kim, Do-Gyoung;Jeong, Hyun-Yun;Son, Ho-Young;Lee, Jae-Wook;Lee, Young-Jun;Choi, Sang-Ok;Kim, Kyung-Min;Kim, Young-Kyun;Kwon, Jung-Nam
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.25 no.3
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    • pp.573-581
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    • 2011
  • This study was done to examine the risk factors between controls group and acute brain infarction patients group, and to compare high risk group with low risk group through NIHSS(National Institutes of Health stroke scale). We compared the risk factors between acute brain infarction patients group(N=180) and controls group(N=93). And according to risk factors, we analyzed 1st NIHss, after 3 weeks improved extent within acute brain infarction patients group. The results were as follows. 1. Among the risk factors, HTN, DM, the blood levels of HCY were significantly higher and the blood levels of HDL-C was significantly lower in patients group than controls group. 2. In scale analysis according to risk factors, 1st NIHss were significantly higher in Hypo-HDL-cholesterolemia, Obesity, High-Homocysteine, HTN, DM, previous CVA history group than low risk group within acute brain infarction patients group. 3. In after 3 weeks improved extent analysis according to risk factors, improved extent were lower in Hyperlipidemia, HTN, DM, previous cardiac history, older age group than low risk group within acute brain infarction patients group. The above results suggest that significant risk factors of acute brain infarction, and shows the High risk group that had risk factor of brain infarction recognized from the former research tends to have higher 1st NIHss. Also the High risk group tends to have lower improved extent, but the results are not statistically significant. Furthur research on subject is needed.

Hypofractionated stereotactic body radiotherapy in low- and intermediate-risk prostate carcinoma

  • Kim, Hun Jung;Phak, Jeong Hoon;Kim, Woo Chul
    • Radiation Oncology Journal
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    • v.34 no.4
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    • pp.260-264
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    • 2016
  • Purpose: Stereotactic body radiotherapy (SBRT) takes advantage of low ${\alpha}/{\beta}$ ratio of prostate cancer to deliver a large dose in few fractions. We examined clinical outcomes of SBRT using CyberKnife for the treatment of low- and intermediate-risk prostate cancer. Materials and Methods: This study was based on a retrospective analysis of the 33 patients treated with SBRT using CyberKnife for localized prostate cancer (27.3% in low-risk and 72.7% in intermediate-risk). Total dose of 36.25 Gy in 5 fractions of 7.25 Gy were administered. The acute and late toxicities were recorded using the Radiation Therapy Oncology Group scale. Prostate-specific antigen (PSA) response was monitored. Results: Thirty-three patients with a median 51 months (range, 6 to 71 months) follow-up were analyzed. There was no biochemical failure. Median PSA nadir was 0.27 ng/mL at median 33 months and PSA bounce occurred in 30.3% (n = 10) of patients at median at median 10.5 months after SBRT. No grade 3 acute toxicity was noted. The 18.2% of the patients had acute grade 2 genitourinary (GU) toxicities and 21.2% had acute grade 2 gastrointestinal (GI) toxicities. After follow-up of 2 months, most complications had returned to baseline. There was no grade 3 late GU and GI toxicity. Conclusion: Our experience with SBRT using CyberKnife in low- and intermediate-risk prostate cancer demonstrates favorable efficacy and toxicity. Further studies with more patients and longer follow-up duration are required.

Risk Perceived by Consumers in Apparel Buying Situation ( I ) - Risk Types and Their Relationships with Consumers' Demographic Variables- (의복구매시 소비자가 지각하는 위험에 관한 연구( I ) -위험의 유형분류, 소비자 인구변인과의 관련을 중심으로-)

  • Kim Chanjn
    • Journal of the Korean Society of Clothing and Textiles
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    • v.15 no.4 s.40
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    • pp.405-416
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    • 1991
  • This paper examined the risks perceived by consumers in apparel buying situation by 1) measuring the contents and perception level of risk, 2) categorizing each risk into meaningful factors (risk types), 3) analyzing the relationships between risk types and consumers' demo-graphic variables. 224 respondents deliberately selected to include each level of S demographic variables were contacted with 37-item question3.ire. Factor analysis showed that 32-item perceived risk could be categorized into 6 risk types: psychological. social, economic, time/convenience loss, fashionability loss, performance risk. Psychological risk were perceived highest in terms of perception level while social and performance risk showed relatively low perception level. 4 of 5 demographic variables including sex, education level, income, occupa-tion showed partial relationship with each risk type after ANOVA and Duncan test. Sex had the greatest influence on risk perception level and each age level (20's, 30's, 40's) showed different risk structure.

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Different Influence of Risk Factors on Self-rated Health between The Economically Poor and Non-poor Elderly Populations Living Alone: Based on One Sub-area in Seoul (일반 독거노인과 저소득 독거노인간의 주관적 건강에 미치는 영향요인 차이: 서울시 일개 지역을 중심으로)

  • Ko, Young-Mi;Cho, Youngtae
    • Korean Journal of Health Education and Promotion
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    • v.30 no.2
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    • pp.41-53
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    • 2013
  • Objectives: As the size of elderly population living alone grows, socioeconomic diversity has also increased. This study examined if social risk factors of poor self-rated health were distinguishable between the low income elderly and their non-low income counterparts both living alone. Methods: The '2006 Elderly Health Interview Survey' conducted by D-gu in Seoul was utilized. We divided the elderly living alone into two groups depending on their economic status: low income and non-low income. Employing logistic regression, we analyzed the associations of poor self-rated health with socio-demographic factors, health-related factors, social support, the relations with children, social activities, welfare service use, and the perception of neighborhood safety. Results: Proportion of rating one's own health being poor was different between two populations. Social support was important for the self-rated health of the non-low income elderly, while welfare service use, the perception of neighborhood safety, and the relations with children were noticeable for the low income elderly. Conclusions: To better understand the health need of elderly population living alone, their heterogeneity in socioeconomic characteristics should be taken into account.

Increased Wall Enhancement Extent Representing Higher Rupture Risk of Unruptured Intracranial Aneurysms

  • Jiang, Yeqing;Xu, Feng;Huang, Lei;Lu, Gang;Ge, Liang;Wan, Hailin;Geng, Daoying;Zhang, Xiaolong
    • Journal of Korean Neurosurgical Society
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    • v.64 no.2
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    • pp.189-197
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    • 2021
  • Objective : This study aims to investigate the relationship between aneurysm wall enhancement and clinical rupture risks based on the magnetic resonance vessel wall imaging (MR-VWI) quantitative methods. Methods : One hundred and eight patients with 127 unruptured aneurysms were prospectively enrolled from Feburary 2016 to October 2017. Aneurysms were divided into high risk (≥10) and intermediate-low risk group (<10) according to the PHASES (Population, Hypertension, Age, Size of aneurysm, Earlier SAH history from another aneurysm, Site of aneurysm) scores. Clinical risk factors, aneurysm morphology, and wall enhancement index (WEI) calculated using 3D MR-VWI were analyzed and compared. Results : In comparison of high-risk and intermediated-low risk groups, univariate analysis showed that neck width (4.5±3.3 mm vs. 3.4±1.7 mm, p=0.002), the presence of wall enhancement (100.0% vs. 62.9%, p<0.001), and WEI (1.6±0.6 vs. 0.8±0.8, p<0.001) were significantly associated with high rupture risk. Multivariate regression analysis revealed that WEI was the most important factor in predicting high rupture risk (odds ratio, 2.6; 95% confidence interval, 1.4-4.9; p=0.002). The receiver operating characteristic (ROC) curve analysis can efficiently differentiate higher risk aneurysms (area under the curve, 0.780; p<0.001) which have a reliable WEI cutoff value (1.04; sensitivity, 0.833; specificity, 0.67) predictive of high rupture risk. Conclusion : Aneurysms with higher rupture risk based on PHASES score demonstrate increased neck width, wall enhancement, and the enhancement intensity. Higher WEI in unruptured aneurysms has a predictive value for increased rupture risk.

A Study on Hepatitis Infection Risk of Funeral director related to wearing PPE(Personal Protect Equipment) (한국 장례종사자의 개인보호물품 착용에 따른 A형 간염, B형 간염 위험도 및 로지스틱 분석)

  • Hwang, Kyu-Sung;Kim, Jeong-Lae
    • The Journal of the Convergence on Culture Technology
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    • v.3 no.2
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    • pp.15-20
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    • 2017
  • We are investigated about the Hepatitis infection risk of the funeral director related to wearing PPE(Personal Protect Equipment) within Metropolitan, Chungcheong and Gyeongsang regions in Korea. We are classified that the vaccinated group was classified as low risk group and the non-vaccinated group was classified as high risk group. And we are analyzed the risk rate of infection based on whether or not to wear PPE(personal protective equipment) among high-risk groups. The result is as follows. The mask wearing rate of high-risk group about HAV(hepatitis A virus) is three times lower than that of low-risk group. The surgical glove wearing rate of high-risk group about HBV(hepatitis B virus) is twice lower than that of low-risk group. The surgical glove and mask not wearing rate among the high-risk group observe that potential infection risk was high 4.23 times and 3.5 times, respectively. We are concluded that increasing the risk of potential infection risks from the funeral director could result in increased risk of infection to national public health, including the bereaved family. We are suggested that the funeral director must be bound to vaccinate against hepatitis and make PPE mandatory. It is deemed necessary for the government to develop policies to promote personal health and national health care.

Health Literacy, Health Risk Perception and Health Behavior of Elders (노인의 건강정보이해능력, 건강 관련 위험인식과 건강행위)

  • Jeong, Jeong Hee;Kim, Jung Soon
    • Research in Community and Public Health Nursing
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    • v.25 no.1
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    • pp.65-73
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    • 2014
  • Purpose: The aim of this study is to clarify the level of health literacy, health risk perception and health behavior of Korean elders and to determine the impact of their health literacy and health risk perception on their health behavior. Methods: A descriptive correlation study was conducted with 188 elders aged 65 or older in senior welfare centers in Busan. Questionnaires were used to measure levels of health literacy, health risk perception, and health behavior. Descriptive statistics, t-test, ANOVA, Kruskal Wallis test, Pearson's correlation, and hierarchical regression were performed. Results: 43.6% of the subjects had low levels of health literacy. There was a negative relation between health literacy and health risk perception, and between health risk perception and health behavior. There was a positive relation between health literacy and health behavior. Health concern, health literacy affected health behavior. Health literacy independently accounted for 24% of health behavior. Health risk perception didn't affect health behavior. Conclusion: Many of the Korean elders had low levels of health literacy and health literacy was independently associated with health behavior. These findings show that interventions for improving health literacy are necessary to enhance health behavior of the elderly.

Factors Associated with Suicide Risk in Advanced Cancer Patients: A Cross-Sectional Study

  • Park, Sun A;Chung, Seung Hyun;Lee, Youngjin
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.11
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    • pp.4831-4836
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    • 2016
  • The study aimed to find out to what degree suicidal thoughts and associated factors affect the suicide risk of advanced cancer patients. The frequency of suicidal thoughts among patients with cancer, especially in the advanced stages, is about 3 times greater than the adult average in South Korea. We recruited 457 participants with four types of cancers (colon, breast, cervical, and lung) using stratified sampling. Data collection was carried out through one-on-one interviews by trained nurses using a structured questionnaire. Advanced cancer patients with high, vs. low, levels of anxiety and pain had a higher suicide risk. In contrast, having one's spouse as the primary care provider was associated with a low suicide risk. Overall, the three factors of anxiety, pain, and the primary caregiver being one's spouse explained 17.2% of the variance in suicide risk. In conclusion, we derived influencing factors of suicide risk using a sample of patients with various types of advanced cancer. The results provide systematic baseline data for preparing nurse-led interventions to prevent suicidal thoughts and suicide attempts among advanced cancer patients.

Compliance with Screening Recommendations According to Breast Cancer Risk Levels in Izmir, Turkey

  • Acikgoz, Ayla;Ergor, Gul
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.3
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    • pp.1737-1742
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    • 2013
  • Early diagnosis has a major role in improving prognosis of breast cancer. The purpose of this study was to assess the risk status of women 35-69 years of age using risk assessment models and the prevalence of mammography in a community setting. The sample of this cross sectional study consisted of 227 women, 35-69 years of age residing in Izmir, a city located in western region of Turkey. A questionnaire was used to collect data and the Gail and Cuzick-Tyrer models were applied to assess the risk of breast cancer. In this study, 52.7% of women had mammography at least once, and 41.3% of the women over the age of 40 had mammography screening in the last two years. The five years risk for breast cancer was high in 15.8% of women according to the Gail model and ten years risk was high in 21.7% with the Cuzick-Tyrer model. In the present study, the breast cancer risk levels were assessed in a population setting for the first time in Turkey using breast cancer risk level assessment models. Being in 60-69 age group, having low education and not being in menopause were significant risk factors for not having mammography according to logistic regression analysis. Mammography utilization rate was low. Women must be educated about breast cancer screening methods and early diagnosis. The women in the high risk group should be informed on their risk status which may increase their attendance at breast cancer screening.