• Title/Summary/Keyword: Post-Management

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Late-term effects of hypofractionated chest wall and regional nodal radiotherapy with two-dimensional technique in patients with breast cancer

  • Yadav, Budhi Singh;Bansal, Anshuma;Kuttikat, Philip George;Das, Deepak;Gupta, Ankita;Dahiya, Divya
    • Radiation Oncology Journal
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    • v.38 no.2
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    • pp.109-118
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    • 2020
  • Purpose: Hypofractionated radiotherapy (RT) is becoming a new standard in postoperative treatment of patients with early stage breast cancer after breast conservation surgery. However, data on hypofractionation in patients with advanced stage disease who undergo mastectomy followed by local and regional nodal irradiation (RNI) is lacking. In this retrospective study, we report late-term effects of 3 weeks post-mastectomy hypofractionated local and RNI with two-dimensional (2D) technique in patients with stage II and III breast cancer. Methods: Between January 1990 and December 2007, 1,770 women with breast cancer who were given radical treatment with mastectomy, systemic therapy and RT at least 10 years ago were included. RT dose was 35 Gy/15 fractions/3 weeks to chest wall by two tangential fields and 40 Gy in same fractions to supraclavicular fossa (SCF) and internal mammary nodes (IMNs). SCF and IMNs dose was prescribed at dmax and 3 cm depth, respectively. Chemotherapy and hormonal therapy was given in 64% and 74% patients, respectively. Late-term toxicities were assessed with the Radiation Therapy Oncology Group (RTOG) scores and LENT-SOMA scales (the Late Effects Normal Tissue Task Force-Subjective, Objective, Management, Analytic scales). Results: Mean age was 48 years (range, 19 to 75 years). Median follow-up was 12 years (range, 10 to 27 years). Moderate/marked arm/shoulder pain was reported by 254 (14.3%) patients. Moderate/marked shoulder stiffness was reported by 219 (12.3%) patients. Moderate/marked arm edema was seen in 131 (7.4%) patients. Brachial plexopathy was not seen in any patient. Rib fractures were noted in 6 (0.3%) patients. Late cardiac and lung toxicity was seen in 29 (1.6%) and 23 (1.3%) patients, respectively. Second malignancy developed in 105 (5.9%) patients. Conclusion: RNI with 40 Gy/15 fractions/3 weeks hypofractionation with 2D technique seems safe and comparable to historical data of conventional fractionation (ClinicalTrial.gov Registration No. NCT04175821).

IS Continuance of Hedonic Information Systems (헤도닉 정보시스템의 지속적인 사용에 관한 연구: UCC를 중심으로)

  • Seo, Ho-Cheol;Ahn, Joong-Ho;Yang, Ji-Youn
    • Asia pacific journal of information systems
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    • v.17 no.3
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    • pp.25-53
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    • 2007
  • The Expectation Confirmation Model (ECM) of information systems investigates the continued information systems usage behavior. This paper expands the original post-adoption beliefs and searches the applications in the emerging hedonic information systems. Previous IS researches focused on the organizational environments. However as the information technology (especially internet) evolves, information systems have not only emerged for the organizations but also for the individual users, such as internet portals, internet communities, on-line games etc. These information systems so called Hedonic Information Systems aims to provide self-fulfilling value rather than instrumental value to the users. Researches in other disciplines, including marketing and consumer behavior research, illustrate that the hedonic and utilitarian perspective of goods and services have different influence on the consumer behavior. Goods and services used to be classified into either hedonic or utilitarian aspect but now they may belong to both aspects simultaneously. Moreover consumer's goals or tasks have both hedonic utilitarian aspects. When a consumer makes a decision to purchase or repurchase goods or services, he/she compares the hedonic and utilitarian perspectives of goods to find most suitable ones to satisfy their goals/tasks. Finally, consumer's behavior is determined by the trade-off between what the goods can provide to the consumers and in what extent the goods fulfill consumer's purchase behavior. Consumer also shows that the salience of hedonic perspective is relatively greater when consumer decides which of several items to give up (forfeiture choices) than the time when they decide which item to acquire (acquisition choices). Some researches in MIS discipline have found out that the information systems also have both hedonic and utilitarian perspectives. The decision process of whether to use information systems or not is similar to that of a consumer's decision of purchasing or repurchasing goods or services. However most of researches in MIS tend to focus on the extrinsic motivation variables which only cover the utilitarian perspective of information systems. It is only recent that researches start to investigate the intrinsic motivation variable - Perceived Enjoyment - for the hedonic perspective. Considering the consumer's purchasing decision process, users of information systems evaluate the systems through balancing between intrinsic (hedonic) and extrinsic (utilitarian) variables according to their main tasks or tendencies. This paper proposes a model that is based on the ECM of IS Continuance model modified from Expectation Confirmation Model to fit into the continued usage of information system. It first started from the decision process regarding hedonic and utilitarian perspectives in the consumer behavior literatures. The model deals with continued usage of information systems beyond the mere technology adoption as in most of the previous MIS researches. This research is particularly important to the hedonic information systems, because their business model depends on the frequent usages rather simple adoption at the beginning. Because the basic model only considered the extrinsic motivations (perceived usefulness) to explain the users' behavior and as the information systems can have both hedonic and utilitarian dimensions, it should consider both perspectives. Therefore, this newly proposed model considers intrinsic variable (perceived enjoyment) as well. Since the individual user can have a preference on either aspects that is between the hedonic and utilitarian perspective depending on his/her main tasks or goals, some variables (Hedonic Orientation and Utilitarian Orientation) meaning the extents of users' pursuing from the information system were additionally studied.

Retrograde Analysis of Complications of Jejunal Free Flap after Total Pharyngo-Laryngo-Cervical Esophagectomy in Advanced Hypopharyngeal Cancer Treatment (하인두암에서 후두인두 및 경부 식도 전 적출술 후 유리 공장 이식술의 합병증에 대한 후향적 분석)

  • Min, Hyun-Jin;Hyun, Dong-Woo;Kim, Young-Ho;Choi, Eun-Chang;Kim, Kwang-Moon;Kim, Se-Heon
    • Korean Journal of Head & Neck Oncology
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    • v.24 no.1
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    • pp.43-46
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    • 2008
  • Hypophayngeal cancers are usually diagnosed in advanced stages and in many cases, they need total pharyngocervical esophagectomy and surgical reconstruction. Among many surgical reconstructive methods, jejunal free flap has anatomical and functional advantages such as tubed nature, peristaltic activity, excellent blood supply. In this study we analysed the surgical procedure and complications of jejunal free flap after total pharyngo-cervical esophagectomy. 20 cases performed jejunal free flap from 1995 to 2007 at Severance Hospital were reviewed. According to time of onset, early and late complications were reviewed. Surgical procedure was reviewed with operation record. Oral diet tolerance was reviewed on the basis of pharyngogram and subjective symptoms. The most common complication was stricture, and it occurred in 40% of cases and 63% of them were managed with conservative care. As early complication, fistula formation was all managed with conservative care. Oral feeding tolerance after jejunal free flap was 65% and 7 patients were tolerable to general diet. In our study, stricture was the most common complication and its management is important in post op oral diet tolerance.

Effectiveness of $Myprodol^{(R)}$ in ram Management (통증 조절에 있어서 $Myprodol^{(R)}$의 효과)

  • Shin, Sang-Wook;Lee, Hyun-Sub;Kim, Inn-Se;Baik, Seong-Wan
    • Journal of Hospice and Palliative Care
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    • v.4 no.1
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    • pp.41-46
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    • 2001
  • Background : Many analgesics are used to relieve the pain of various causes. Among these, $Myprodol^{(R)}$, a combination analgesic with codeine, ibuprofen and paracetamol, was recently used as a new analgesics. This study was performed to survey the kinds of diseases, side effects and pain relief effect of $Myprodol^{(R)}$ in clincal practice. Methods : This retrograde study surveyed the medical records of 183 patients treated with $Myprodol^{(R)}$ at Pain Clinic, Pusan National University Hospital. From medical records, the disease entities, the pain characteristics, duration of $Myprodol^{(R)}$ medication, the analgesic effect and side effects were evaluated. Results : $Myprodol^{(R)}$ is used in the treatment of cancer pain (64.3%) and non-cancer pain (35.7%). Among side effects of $Myprodol^{(R)}$ medication, nausea with vomiting, constipation and generalized edema were common in cancer pain, but epigatric pain was common in non cancer pain. $Myprodol^{(R)}$ was more effective in non cancer pain than cancer pain. Conclusions: $Myprodol^{(R)}$ was used in cancer and non-cancer pain patients. In cancer pain patients, $Myprodol^{(R)}$ was effective in early cancer pain but, not effective in advanced cancer. $Myprodol^{(R)}$ was also used and effective in non-malignant benign chest pain, lumbago, post-operative pain.

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The Prognosis of Spontaneous Intracerebral Hemorrhage in over the Seventies with Poor Initial Conditions (초기상태가 불량한 자발성 뇌출혈 환자의 예후 - 70세 이상의 고령환자를 대상으로 -)

  • Kim, Joo Han;Lee, Ja Kyu;Lim, Dong Jun;Kwon, Tack Hyun;Park, Jung Yul;Chung, Hung Seob;Lee, Hoon-Kap;Suh, Jung Keun
    • Journal of Korean Neurosurgical Society
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    • v.30 no.2
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    • pp.207-210
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    • 2001
  • Objective : The prognosis of spontaneous intracerebral hemorrhage often depends on initial neurologic condition, size and location of hemorrhage and associated intraventricular hemorrhage. However, age of patient, coagulation state and other associated vascular diseases may also play a role when present. In recent years, the geriatric population has been increasing. The age distribution of the patients with intracerebral hemorrhages also has been increased, accordingly. However, such patients, especially when associated with poor initial conditions often tend to be managed rather conservatively. The authors analyzed retrospectively on forty-five patients with spontaneous intracerebral hemorrhage over the seventies with poor initial condition to find out whether there exists a difference of outcome between surgery and non-surgery group. Material and Method : A total of 45 patients over seventies with spontaneous intracerebral hemorrhage with Glasgow Coma Scale(GCS) 4-8 treated over last six years were included. The validity of surgical management for these patients as well as clinical variables which might have been operated on the outcome of these patients were evaluated. The Glasgow Outcome Scale(GOS) after three months was used for comparison of outcome. Results : In surgical group(19 cases), mean age was 74.5 years old, mean hematoma volume 67.2ml and mean GCS score 5.7 points. In nonsurgical group(26 cases), mean age was 79.3 years old, mean hematoma volume 32.1ml, and mean GCS score 6.8 points. Mortality rate in surgical group was 47.4%(9 patients), including 2 cases of post-operative rebleeding, while that in nonsurgical group was 46.2%. However, when patients with initial GCS 4-6 points and over 30ml in hematoma volume were regrouped, mortality rate in surgical group was 46.2%, whereas mortality rate in nonsurgical group was 66.7%. Conclusion : It is concluded that the mortality rate is much low in surgery group with initial GCS less than 6 points and hematoma volume over 30cc. There was no significant difference of outcome in patients with basal ganglia and thalamic hemorrhage. However, surgical treatment lowered the mortality and morbidity rate in patients with subcortical and cerebellar hemorrhage.

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Study on the Production and Management of Aquatic Animal : Application of ELISPOT-Assay for the Detection of Antibody Secreting Cells in Flounder, Paralichthys olivaceus (수산생물의 생산과 관리에 관한 기초연구 : ELISPOT 기법을 이용한 넙치의 항체생성 세포분석)

  • HA Jai Yi;PARK Jun-Hyo;KIM Myoung Sug;CHUNG Joon-Ki;JEONG Hyun Do
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.32 no.4
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    • pp.420-426
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    • 1999
  • We examined the immune response in flounder, Paralichthys olivaceus, with immunization of formalin killed Edwardsiella tarda as an antigen. The ELISPOT-assay (enzyme-linked immunospot assay) was optimized technically and applied to count the number of total and specific antibody secreting cells (TASC and SASC) in lymphocytes of different lymphatic organs. Incubation of lymphocytes on 96 well plate for more than 2.5hrs came out enough time in ELISPOT-assay for counting the antibody secreting cells in the anterior kidney and spleen. However, too much of plate-coated antigen or rabbit anti-flounder immunoglobulin for SASC or TASC counting, respectively, was appeared to decrease the sensitivity of the assay system. Specificity of the system was also confirmed by the absence of TASC in lymphocytes treated with cycloheximide to prevent protein synthesis. The peak numbers of SASC appeared at wk 3 post immunization after that there was a sharp decrease and reached to almost zero at wk 7. In the spleen and kidney, the timing and numbers of SASC on peak response were concurrent without preferential organ distribution. The specific antibody level in the sera increased rapidly between wk 2 and 3 after immunization, i.e. like the specific cellular response found with ELISPOT-assay on that period, However, the remained high level of specific serum antibody from wk 5 after immunization until the end of experiment was clearly distinguishable from the kinetics of SASC response decreased sharply.

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Qualitative Changes in Precooling and Storage Temperatures on the Post-harvest Management of the Fruits in Strawberry for Export (수출딸기의 수확 후 예냉 및 저장온도에 따른 품질변화)

  • Park, Ji-Eun;Kim, Hye-Min;Hwang, Seung-Jae
    • Journal of agriculture & life science
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    • v.46 no.6
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    • pp.67-74
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    • 2012
  • A study was conducted to examine the effect of precooling and storage temperatures on the storage life of 'Maehyang' strawberry for export. Fruits at a 80% ripe stage were harvested from a commercial greenhouse in Gyeongsangnamdo Jinju on January 11, 2011. Fruits were precooled at 0, 2, $4^{\circ}C$ for 2-5 hours, and then transported for about 30 minutes. And stored in set chamber at 4, 8, $10^{\circ}C$, immediately. Fruits were examined for their changes in weight, hardness, Hunter color values, soluble solid content (SSC), acidity, and incidence of gray mold (Botrytis cinerea) during storage. The fresh weight decreased during storage at all temperatures. Especially, strawberry treated the lowest precooling and storage temperatures was the greatest in quality. The hardness was drastically decreased in precooled at $4^{\circ}C$ and stored at $10^{\circ}C$ after storage 10 days. SSC was the greatest when strawberry stored at the lowest temperature. Acidity increased during storage at all temperatures. But in the last day after storage, the strawberry of precooled at $4^{\circ}C$ and stored at $10^{\circ}C$ was the highest as 0.7%. Gray mold was the greatest at $10^{\circ}C$ storage temperature. The results indicate that effectiveness for keeping the freshness was best achieved by precooling at $0^{\circ}C$ and storage at $4^{\circ}C$.

Bottom-up Approach: the Effects of Performing Arts Fostering Program, Chang-jak-san-shil (상향식접근(bottom-up approach)이론을 이용한 창작산실육성지원사업의 효과연구)

  • Kim, InSul;Shin, Hyesun;Lee, Heungjae
    • Review of Culture and Economy
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    • v.19 no.2
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    • pp.97-120
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    • 2016
  • This study aims to identify how performing artists in Korea, who are the target beneficiaries of the Arts Council Korea's Performing Arts Fostering Program, Chang-jak-san-shil(CJSS), would perceive and assess the current state of CJSS and its effects. To do so, this paper has adopted a bottom-up approach as a theoretical lens for policy evaluative analysis. This research engages with qualitative research design by conducting a series of in-depth interviews and FGIs with 28 participants in total. The interview participants consist of CJSS grantees(n=21) and peer-review panels(n=7) based on the intension to enhance objectivity and reliability of the study. Results of the data analysis suggest that the grant program still carries pressing needs to achieve a success as follows: providing post-program support, enhancing transparency of the panel appointment process and the peer review process, reflecting different nature of each arts discipline, and having more open communications with arts professionals. Based on these findings, this paper will provide and discuss about policy implications which can contribute to the performing arts domain at large.

A Review and Its Implications on School-based Crisis Response Team in the U.S. (미국의 학교기반 위기대응팀에 대한 고찰과 시사점)

  • Lee, Dong Hun;Jeong, Bo Young;Kang, Eun Jin;Myung, So Yeon
    • Korean Journal of Comparative Education
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    • v.27 no.1
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    • pp.1-28
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    • 2017
  • In this study, the school crisis response system and intervention are examined in the U.S. by reviewing Crisis Response Team(CRT) to give a direction for establishing and improving the school crisis response system in Korea. To do this, a literature review has been conducted focusing on domestic and foreign literature on the school - based crisis response system about the U.S. and Korea. The characteristics of the school-based CRT in the U.S. are as follows. First, in the U.S., the organizational structure and financial support for school - based crisis response has been stated by law so that the roles and responsibilities of region, district, school have been clearly defined. Second, in the event of a school crisis, the school have been shared the role of professional crisis response according to the Incident Command System and coordinates communication smoothly between each area of society through cooperation with CRT. Third, CRT prevents burnout by showing flexibility in team composition so that CRT members are not tired or overwhelmed by a crisis event, and focuses on strengthening the crisis capability of the school itself through cooperation between the school and CRT. Fourth, the school-based CRT in the U.S. conducts a step by step crisis intervention from prevention to prolonged post management. Based on these results, implications for the establishment and improvement of school-based crisis response system in Korea are discussed.

Profile of sexual violence experiences among the survivors using victim support services in Korea (성폭력 피해특성에 따른 피해경험자 유형화와 지원 서비스 이용양태 연구)

  • Kim, Kihyun;Kim, Jae-Won;Park, Haeyoung;Ryou, Bee
    • Korean Journal of Social Welfare Studies
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    • v.47 no.4
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    • pp.255-280
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    • 2016
  • This study examined sexual violence characteristics among the individuals who utilized victim support services provided by National Rape Crisis Intervention Centers in Korea. The study is the part of a Korean longitudinal study on sexual assault characteristics and its implications for post-abuse adjustments, which is supported by Korean Mental Health Technology R&D Project. Eleven national rape crisis centers nationwide and 29 NGO's participated in the study. The participating centers provided the data on sexual abuse characteristics from their standardized case management system. The cases were randomly selected from the system. Total of 1077 cases were gleaned from the system and utilized for this analysis. Results indicated that the abuse characteristics differed by victims' age (children, adolescent vs. adults) as well as relationship with perpetrator. We could identify six different profile groups based on the detailed violence characteristics. The results assured us of the importance to understand the detailed characteristics of sexual violence and the old notion that 'one size may not fit all'. The results from the profile analyses may have important implication for developing victim support programs and appropriately allocating agency resources according to the different profiles of the service users.