Purpose: To identify baseline prognostic factors for survival in patients with disease progression, during or after chemotherapy for the treatment of advanced gastric or gastroesophageal junction (GEJ) cancer. Materials and Methods: We pooled data from patients randomized between 2009 and 2012 in 2 phase III, global double-blind studies of ramucirumab for the treatment of advanced gastric or GEJ adenocarcinoma following disease progression on first-line platinum- and/or fluoropyrimidine-containing therapy (REGARD and RAINBOW). Forty-one key baseline clinical and laboratory factors common in both studies were examined. Model building started with covariate screening using univariate Cox models (significance level=0.05). A stepwise multivariable Cox model identified the final prognostic factors (entry+exit significance level=0.01). Cox models were stratified by treatment and geographic region. The process was repeated to identify baseline prognostic quality of life (QoL) parameters. Results: Of 1,020 randomized patients, 953 (93%) patients without any missing covariates were included in the analysis. We identified 12 independent prognostic factors of poor survival: 1) peritoneal metastases; 2) Eastern Cooperative Oncology Group (ECOG) performance score 1; 3) the presence of a primary tumor; 4) time to progression since prior therapy <6 months; 5) poor/unknown tumor differentiation; abnormally low blood levels of 6) albumin, 7) sodium, and/or 8) lymphocytes; and abnormally high blood levels of 9) neutrophils, 10) aspartate aminotransferase (AST), 11) alkaline phosphatase (ALP), and/or 12) lactate dehydrogenase (LDH). Factors were used to devise a 4-tier prognostic index (median overall survival [OS] by risk [months]: high=3.4, moderate=6.4, medium=9.9, and low=14.5; Harrell's C-index=0.66; 95% confidence interval [CI], 0.64-0.68). Addition of QoL to the model identified patient-reported appetite loss as an independent prognostic factor. Conclusions: The identified prognostic factors and the reported prognostic index may help clinical decision-making, patient stratification, and planning of future clinical studies.
Objectives: Several pattern diagnosis questionnaires have been developed to objectify the process of pattern diagnosis in Korean medicine. In this context, this study aimed to develop a food retention questionnaire for functional dyspepsia (FRQ-FD) by modifying the previously developed food retention questionnaire (FRQ) and to verify its reliability and validity. Furthermore, this study aimed to identify the optimal cut-off value of the FRQ-FD for standardization and use in clinical situations. Methods: To develop the FRQ-FD, we extracted the major symptoms of food retention pattern for functional dyspepsia from Chinese/Korean medicine textbooks and requested an importance survey from experts using the Delphi method. The first draft of the FRQ-FD was composed of 25 questions comprising 8 questions from the textbooks and the Delphi method and 17 questions from the FRQ already developed in 2013. To analyze its reliability, validity, and optimal cut-off value, 60 subjects were enrolled in this study from June 25 to August 13, 2018. Thirty patients were diagnosed as both functional dyspepsia and food retention pattern, and 30 healthy participants were not. All participants were requested to fill up the FRQ-FD, Stomach Qi Deficiency Questionnaire (SQDQ), Scale for Stomach Qi Deficiency pattern (SSQD), visual analog scale (VAS) for dyspepsia, Nepean Dyspepsia Index-Korean version (NDI-K), and functional dyspepsia-related quality of life (FD-QoL). Results: No statistically significant differences were found in sex distribution, age, and body mass index between the patient group and the control group. As five questions affected the reliability negatively and three questions affected the clinical validity negatively, we decided to exclude the eight questions upon further investigation. The Cronbach's ${\alpha}$ coefficient of the revised FRQ-FD (17 items) was 0.899, and its clinical validity was verified. Construct validity was analyzed by factor analysis and produced five factors. Statistically significant positive correlations were found between the revised FRQ-FD and the other dyspepsia scales, namely, SQDQ, SSQD, VAS, NDI-K, and FD-QoL. VAS and NDI-K especially had strong positive correlations with FRQ-FD. Conclusions: The FRQ-FD developed in this study can provide fundamental reliability and validity for a pattern diagnosis questionnaire. FRQ-FD can help to diagnose food retention pattern in functional dyspepsia patients. Further studies are required to inspect several statistical factors.
Objectives: The objective of this study is to compare a nutritionally balanced soft blend diet (SBD) with a soft fluid diet (SFD) on the health of inpatients who have undergone oral and maxillofacial (OMF) surgery, ultimately aiming to enhance care outcomes, improve health-related quality of life (QOL), and increase satisfaction with the hospital. Methods: Thirty-two patients were randomized into two groups: sixteen received SFD and sixteen received SBD. Anthropometric, laboratory evaluations were conducted upon admission and discharge. Patients filled out questionnaires on demographics, diet satisfaction, food intake amount, and health-related QOL on the day of discharge, assessed using the EuroQoL 5 Dimensions 3 Level and EuroQoL Visual Analogue Scale (EQ-VAS) instruments. Data were analyzed with descriptive statistics, χ2 tests for group differences, and paired nonparametric t-tests for within-group comparisons. The Mann-Whitney U test evaluated inter-group differences in preoperative weight and body mass index (BMI), postoperative changes, meal satisfaction, intake, health-related QOL, and self-assessed health status. P-values were set at a significance level of 0.05. Results: The SBD group had higher dietary intake (63.2% vs. 51.0%) and greater diet satisfaction (80.6 vs. 48.1, P < 0.0001) compared to SFD group. Health-related QOL, measured by EQ-VAS, was better in SBD group (70.3 vs. 58.8, P < 0.05). Postoperative weight and BMI decreased in SFD group but increased in SBD group (P < 0.01). Changes in laboratory results showed more stability in the SBD group. No postoperative infections were reported in SBD group, whereas SFD group had a 31.25% complication rate. Conclusions: While SFD is often recommended after OMF surgery to protect oral wound healing process, our study reveals that SBD not only enhances physical and psychological outcomes but also, somewhat unexpectedly, supports wound healing and reduces complications. Essentially, SBD promotes physical recovery and enhances health-related QOL than SFD by supporting both somatic and mental healing aspects.
Chronic pain is one of the leading causes of hospital visits. It not only affects the patients themselves but also has a major negative impact on their families and society. In this study, we investigated epidemiology of musculoskeletal disorders induced chronic pain among general population based on Korea National Health and Nutrition Examination Survey database and also analysed how it influenced on the use of medical services. This study was done by using the data of 5th Korea National Health and Nutrition Examination Survey (KNHANES V), taking aged 20 years and over adults as research subjects. The EuroQoL-5 Dimension Index(EQ-5D) was used as a survey instrument. T-test, chi-square test and multivariate logistic regression were used for statistical analysis. Subjects with chronic pain had a higher likelihood than control group to use medical services(odds ratio : 5.858, confidence interval 3.636-9.438). Controlling for existence of chronic pain, more women were likely to use medical services than men(1.156, 0.707-1.889). Age, gender and household income level did not affect the use of medical services. Proper control of chronic pain is very helpful in improving patient's quality of life and it also accounts for a large proportion in suppressing excessive consumption of medical services. Anesthesia and pain medicine specialists have superior knowledge about analgesics and anticonvulsants than other physicians do and also have specialized skills to perform procedures like nerve blocks in treating chronic pain. Therefore Anesthesia and pain medicine specialists need to play a leading role in managing chronic pain.
This study recognizes it as a social problem that can be prevented by basic research on safety security design for the elderly, and aims to clearly analyze risk factors for injury. For this study, raw data from the 6th Korean National Health and Nutrition Survey were employed and analyzed. Their social characteristics were classified with standards including gender, education, EuroQoL(human locomotion, normal activity and pain uncomfortableness), the quality of life(PHQ-(1)(2)(4)), recognition on stress, activity restriction status and associated causes(bone fracture and joint injury). Their epidemiological traits were chronic diseases, 'diabetes and hip-joint pain', and health-behavioral traits were 'smoking, breakfast frequency and high-level physical activity status.' In conclusion, it can be found that damage risk of elderly rose in case of female, lower education, inconvenience or limitation, pain or discomfort in locomotion and daily activities, higher recognition of stress, lower interest in work, feeling of depression, despair, and weariness, restriction in activity caused by bone fracture and joint injury, having diabetes and hip-joint pain, smoking, low frequency in having breakfast and high-level physical activities. Based on this study, we envision that an effective solution for injury risk factors caused by the organic relation can be reached in the near future.
Objectives : Quality of life(QoL) in patients with lung cancer usually goes down after pneumoectomy, and the pain is the most common cause. Uncontrolled postoperative pain can restrict the movements of shoulders resulting in frozen shoulder. This case report is to report the effect of herb medicine, Ohjuksan on a 49-year-old female lung cancer patient with shoulder pain after lobectomy. Methods : The patient was treated with Ohjuksan for 10 days. The patient's symptoms were assessed by range of motion(ROM) of shoulder, Visual analogue scale(VAS) of shoulder pain and abdominal diagnosis. Results & Conclusions : The patient showed improvement of ROM, VAS and abdominal diagnosis. As the shoulder pain is relieved from VAS6 to VAS3, ROM of abduction, adduction and internal rotation were increased. Also discomfort of abdomen was disapeared to a certain degree. This suggests that herb medicine, Ohjuksan is effective for treating postoperative pain of shoulder for a Lung cancer patient.
Objectives : This study analyzed the contents of research papers of complementary and alternative medicine (CAM) concerning chronic obstructive pulmonary disease (COPD) published in PubMed during the last 5 years. This study was conducted to help clinical studies for treating COPD with Oriental medicine. Materials and Methods : We inspected 31 theses and scrutinized their objectives, periods, participants, materials and methods, methods of assessment, results and Jadad score. Results : The treatments in the studies were supplements, physical training, acupuncture, acu-TENS, Bojungikgi-tang (Buzhongyiqi-tang), counseling, breathing training, osteopathic manipulative treatment, reflexology, and distractive auditory stimuli. The aims of treatment were improvement of exercise capacity, lung function, quality of life, oxidative status, nutrient status, systemic inflammation, and cessation of smoking. The median for treatment period of study was 8 weeks, the median number of participants was 35 and the differences between mean $FEV_1$ from groups were less than 10% in 22 studies. The methods of assessment were lung function test, exercise capacity test, muscle strength test, questionnaire of QoL, laboratory studies, and measurement of nutrient state. The mean of Jadad score was $2.4\;{\pm}\;1.03$, and 24 treatment were assessed as effective. Conclusion : Recent CAM studies of COPD have focused on various topics in alternative and complementary medicine, and it is necessary to provide objective studies for treatment of this disease with Oriental medicines.
Objectives : To obtain necessary fundamental data for the development of oral health improvement programs for senior citizens in the manner of investigating the Status of their oral health. Methods : Data were collected from 346 senior citizens aged 65 years or older who had lived in Seoul and Gyeonggido province, Republic of Korea. This study was conducted for 3 months from April 2011 to June 2011. Excluding those obtained from 34 respondents who gave inadequate responses to given questions, the data from 312 respondents were analyzed. Results : 1. The number of senior citizens who chose 'Sometimes' to as an answer to the question about the self-perception of their own oral conditions such as mastication, swallowing, gingiva hemorrhage, dry mouth, and/or oral malodor was the largest. As an answer to the question about the presence of interpersonal avoidance, 'No' accounted for the largest proportion. The number of respondents choosing gingiva treatment regarding the perception of the necessity for medical interventions was the largest. 2. In regard to the knowledge of oral health care, the percentage of correct answers was the highest for 'I brush my tooth before each meal' ($0.69{\pm}0.156$), while the lowest percentage of correct answers was seen for 'Gingival diseases can be improved by medications' ($0.33{\pm}0.472$). Conclusions : Based upon the above mentioned results, the author conclude that developing relevant national programs and support policies at a national level as well as implementing proactive and systematic home-visiting oral health programs at the levels of local autonomous entities or communities will lead to significant improvements in senior citizens' oral health and QoL (quality of life).
Kim, Hyun-Woo;Byun, Sung-Ho;Park, Hui-Jung;Lee, Seung-Hwan;Jung, Yoo-Suk;Cho, We-Duke
Journal of the Institute of Electronics Engineers of Korea CI
/
v.46
no.2
/
pp.27-35
/
2009
A paradigm of medical industry is changing quickly to u-healthcare according to entry toward an aging society and improvement of quality of life(QoL). The change toward u-healthcare is meaningful since meaning of healthcare is redefined by prevention and management instead of medical service such as diagnosis of disease and treatment. However, the interest about u-healthcare is only concentrated to derivation of new healthcare service, development of medical measurement appliances(Sensors), and integration and standardization of medical information. Therefore, in this paper, the main ai of this study is trying to realize and implement u-healthcare technology through primary philosophies of ubiquitous composition such as Disappear Computing, Invisible Computing, and Calm Computing and development of user-centered technology.
Purpose: The purpose of this study was to investigate of the effects of the mode of delivery on pelvic floor muscle function by examining bladder base movement and urinary incontinence. Methods: This study was conducted on 100 females who had delivered in the previous 3-8 months. There were 2 groups: 56 vaginal deliveries and 44 cesarean section deliveries. Prior to the study, a survey was conducted on the subjects' general status, delivery mode, urinary incontinence, and physical activity. The groups could not be blinded due to scar tissue from the operations. The function of the pelvic floor muscle was observed with the bladder base movement using transabdominal ultrasound during pelvic floor contraction. To objectify and measure the subjective symptoms of subjects suffering from urinary incontinence, an incontinence quality of life (I-QoL) test was administered. Statistical analysis of the data was performed using SPSS version 20.0. An independent t-test was used to assess the statistical significance of pelvic floor muscle function between the 2 groups after delivery. Results: The movement of the bladder base in the pelvic floor muscle function was decreased in the vaginal delivery group, but the difference was not significant. Urinary incontinence was significantly increased in the vaginal delivery group. Conclusion: The function of the pelvic floor muscles was better in the cesarean section group and the incidence of urinary incontinence was relatively low in this group. Therefore, vaginal delivery requires more efforts to restore the function of the pelvic floor muscles than cesarean delivery.
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