• Radiation Oncology Journal
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• 제37권1호
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• pp.60-65
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• 2019

Purpose: The quality assurance (QA) chart rounds are multidisciplinary meetings to review radiation therapy (RT) treatment plans. This study focus on describing the changes in RT management based on QA round reviews in a single institution. Materials and Methods: After 9 full years of implementation, a retrospective review of all patients whose charts passed through departmental QA chart rounds from 2007 to 2015. The reviewed cases were presented for RT plan review; subcategorized based on decision in QA rounds into: approved, minor modifications or major modifications. Major modification defined as any substantial change which required patient re-simulation or re-planning prior to commencement of RT. Minor modification included treatment plan changes which didn't necessarily require RT re-planning. Results: Overall 7,149 RT treatment plans for different anatomical sites were reviewed at QA rounds. From these treatment plans, 6,654 (93%) were approved, 144 (2%) required minor modifications, while 351 (5%) required major modifications. Major modification included changes in: selected RT dose (96/351, 27%), target volume definition (127/351, 36%), organs-at-risk contouring (10/351, 3%), dose volume objectives/constraints criteria (90/351, 26%), and intent of treatment (28/351, 8%). The RT plans which required major modification according to the tumor subtype were as follows: head and neck (104/904, 12%), thoracic (12/199, 6%), gastrointestinal (33/687,5%), skin (5/106, 5%), genitourinary (16/359, 4%), breast (104/2387, 4%), central nervous system (36/846, 4%), sarcoma (11/277, 4%), pediatric (7/251, 3%), lymphoma (10/423, 2%), gynecological tumors (2/359, 1%), and others (11/351, 3%). Conclusion: Multi-disciplinary standardized QA chart rounds provide a comprehensive and an influential method on RT plans and/or treatment decisions.

• Journal of Preventive Medicine and Public Health
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• 제56권3호
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• pp.238-247
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• 2023

Objectives: Low adherence to antiretroviral (ARV) therapy in pregnant women with human immunodeficiency virus (HIV) increases the risk of virus transmission from mother to newborn. Increasing mothers' knowledge and motivation to access treatment has been identified as a critical factor in prevention. Therefore, this research aimed to explore barriers and enablers in accessing HIV care and treatment services. Methods: This research was the first phase of a mixed-method analysis conducted in Kupang, a remote city in East Nusa Tenggara Province, Indonesia. Samples were taken by purposive sampling of 17 people interviewed, consisting of 6 mothers with HIV, 5 peer facilitators, and 6 health workers. Data were collected through semi-structured interviews, focus group discussions, observations, and document review. Inductive thematic analysis was also performed. The existing data were grouped into several themes, then relationships and linkages were drawn from each group of informants. Results: Barriers to accessing care and treatment were lack of knowledge about the benefits of ARV; stigma from within and the surrounding environment; difficulty in accessing services due to distance, time, and cost; completeness of administration; drugs' side effects; and the quality of health workers and HIV services. Conclusions: There was a need for a structured and integrated model of peer support to improve ARV uptake and treatment in pregnant women with HIV. This research identified needs including mini-counseling sessions designed to address psychosocial barriers as an integrated approach to support antenatal care that can effectively assist HIV-positive pregnant women in improving treatment adherence.

• Environmental Engineering Research
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• 제14권3호
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• pp.186-194
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• 2009

Understanding the environmental fate of human and animal pharmaceuticals and their risk assessment are of great importance due to their growing environmental concerns. Although there are many potential pathways for them to reach the environment, effluents from sewage treatment plants (STPs) are recognized as major point sources. In this study, the removal efficiencies of the 43 selected priority pharmaceuticals in a conventional STP were evaluated using two simple models: an equilibrium partitioning model (EPM) and STPWIN$^{TM}$ program developed by US EPA. It was expected that many pharmaceuticals are not likely to be removed by conventional activated sludge processes because of their relatively low sorption potential to suspended sludge and low biodegradability. Only a few pharmaceuticals were predicted to be easily removed by sorption or biodegradation, and hence a conventional STP may not protect the environment from the release of unwanted pharmaceuticals. However, the prediction made in this study strongly relies on sorption coefficient to suspended sludge and biodegradation half-lives, which may vary significantly depending on models. Removal efficiencies predicted using the EPM were typically higher than those predicted by STPWIN for many hydrophilic pharmaceuticals due to the difference in prediction method for sorption coefficients. Comparison with experimental organic carbon-water partition coefficients ($K_{ocs}) revealed that log KOW-based estimation used in STPWIN is likely to underestimate sorption coefficients, thus resulting low removal efficiency by sorption. Predicted values by the EPM were consistent with limited experimental data although this model does not include biodegradation processes, implying that this simple model can be very useful with reliable Koc values. Because there are not many experimental data available for priority pharmaceuticals to evaluate the model performance, it should be important to obtain reliable experimental data including sorption coefficients and biodegradation rate constants for the prediction of the fate of the selected pharmaceuticals.

• Journal of Chest Surgery
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• 제34권7호
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• pp.539-546
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• 2001

배경: 면역저하 환자에게 발생하는 폐 합병증은 흔히 치명적이다. 폐생검술과 같은 침습적인 진단 술기의 위험도 때문에 일반적으로 임상 양상과 방사선 영상 소견에 근거하여 경험적인 치료가 적용된다. 그러나 최근 수술 술기와 수술 전후의 환자 관리의 발전으로 인해 술기와 연관된 위험도는 줄어든 실정이다. 이에 폐합병증을 동반한 심한 면역저하 환자에서 시행된 폐생검술의 위험성 및 유효성에 대하여 전향적으로 분석하였다. 대상 및 방법: 1996년 6월부터 1999년 12월까지 폐합병증을 동반한 면역저하 환자 42명에서 43례의 폐생검술을 실시하였다. 면역저하는 다음과 같이 정의하였고(1, 혈액학적인 질환으로 인해 화학요법이나 다른 치료를 동반하여 받은 경우, 2. 이식 수술 후 면역 억제제를 복용하는 경우, 3. 1 개월 이상의 스테로이드 복용, 4. 원발성 면역결핍 질환), 이상의 면역저하 환자에서 새로운 폐합병증을 동반하고 1 주간의 경험적 치료에 호전이 없거나 급속하게 진행되는 경우를 대상으로 하였다 기저 질환은 혈액학적 질환(31명), 이식 수술 환자(3명), 고형암으로 인한 화학요법(2명)등이었으며 수술은 개흉술이나 video-aided thoracoscopic surgery (VATS)를 통하여 이루어 졌다.

• Journal of Chest Surgery
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• 제52권3호
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• pp.148-154
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• 2019

Background: This study investigated the clinical outcomes of surgical treatment of primary chest wall soft tissue sarcoma (CW-STS). Methods: Thirty-one patients who underwent surgery for CW-STS between 2000 and 2015 were retrospectively reviewed. The disease-free and overall survival rates were estimated using the Kaplan-Meier method, and prognostic factors were analyzed using a Cox proportional hazards model. Results: The median follow-up duration was 65.6 months. The most common histologic type of tumor was malignant fibrous histiocytoma (29%). The resection extended to the soft tissue in 14 patients, while it reached full thickness in 17 patients. Complete resection was achieved in 27 patients (87.1%). There were 5 cases of local recurrence, 3 cases of distant metastasis, and 5 cases of combined recurrence. The 5-year disease-free rate was 49%. Univariate analysis indicated that incomplete resection (p<0.001) and stage (p=0.062) were possible risk factors for recurrence. Multivariate analysis determined that incomplete resection (p=0.013) and stage (p=0.05) were significantly associated with recurrence. The overall 5- and 10-year survival rates were 86.8% and 64.3%, respectively. No prognostic factor for survival was identified. Conclusion: Long-term primary CW-STS surgery outcomes were found to be favorable. Incomplete microscopic resection and stage were risk factors for recurrence.

• Advances in nano research
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• 제15권5호
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• pp.451-466
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• 2023

Gastrointestinal cancer (GC) is a prevalent malignant tumor of the digestive system that poses a severe health risk to humans. Due to the specific organ structure of the gastrointestinal system, both endoscopic and MRI diagnoses of GIC have limited sensitivity. The primary factors influencing curative efficacy in GIC patients are drug inefficacy and high recurrence rates in surgical and pharmacological therapy. Due to its unique optical features, good biocompatibility, surface effects, and small size effects, nanotechnology is a developing and advanced area of study for the detection and treatment of cancer. Because of its deep location and complex surgery, diagnosing and treating gastrointestinal cancer is very difficult. The early diagnosis and urgent treatment of gastrointestinal illness are enabled by nanotechnology. As diagnostic and therapeutic tools, nanoparticles directly target tumor cells, allowing their detection and removal. XGBoost was used as a classification method known for achieving numerous winning solutions in data analysis competitions, to capture nonlinear relations among many input variables and outcomes using the boosting approach to machine learning. The research sample included 300 GC patients, comprising 190 males (72.2% of the sample) and 110 women (27.8%). Using convolutional neural networks (CNN) and artificial neural networks (ANN)-EXtreme Gradient Boosting (XGBoost), the patients mean± SD age was 50.42 ± 13.06. High-risk behaviors (P = 0.070), age at diagnosis (P = 0.037), distant metastasis (P = 0.004), and tumor stage (P = 0.015) were shown to have a statistically significant link with GC patient survival. AUC was 0.92, sensitivity was 81.5%, specificity was 90.5%, and accuracy was 84.7 when analyzing stomach picture.

• 한국전문물리치료학회지
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• 제30권4호
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• pp.288-305
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• 2023

Background: The compression therapy, which is the standard treatment for lymphedema patients, may be difficult to implement and contraindicated to some patients depending on their health condition. Objects: The purpose of this study is to investigate whether kinesiology taping (KT) can be used effectively and safely in the management of lymphedema as an alternative treatment through systematic review and meta-analysis. Methods: In February 2023, the literature was systematically collected through eight search engines with a combination of terms, 'lymphedema' and 'kinesiology taping.' We qualitatively analyzed the differences and safety of KT methods, and quantitatively meta-analyzed the effects of volume reduction in edema, range of motion (ROM), and pain improvement using Review Manager ver. 5. 4. To assess the risk of bias in the randomized controlled trial (RCT) studies, Risk of Bias was used. Results: A total of 616 articles searched and 20 studies were selected, including 12 RCTs and eight case studies. KT intervention could not replace multilayer compression bandage (MLB), but it demonstrated similar or better results compared to compression garment (CG), with reduced pain and improved intervention comfort. Studies reported skin adverse events ranging from 2.5% to 20.68%, with a total adverse event incidence of 7.7%. There was no significant difference in the application method of KT. As a result of the meta-analysis from the 8 RCTs, the KT intervention showed a mean difference (MD) of -7.18 with a 95% confidence interval (CI) [-12.64 to -1.72] in the volume change of lymphedema, while the pain difference was MD 0.82 with CI 95% [0.50 to 1.15], in comparison to the MLB and CG intervention. Conclusion: KT therapy led to a reduction in edema size, volume, pain, and improved ROM and quality of life. KT may be a viable option for lymphedema patients who have trouble applying traditional compression therapies.

• 대한영상의학회지
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• 제84권1호
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• pp.92-109
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• 2023

갑상선 결절 환자에서 초음파 검사는 일차적 영상 진단법으로 정립되어 있으며 치료 결정을 위한 핵심적인 진단 역할을 갖는다. Korean Thyroid Imaging Reporting and Data System(이하 K-TIRADS)는 초음파 유형에 기초한 암 위험도 분류체계로서 실시간 초음파 검사를 시행하면서 쉽게 결절 진단이 가능하다는 장점을 갖고 있다. 개정된 2021 K-TIRADS는 결절의 초음파 분류 기준을 보다 명확히 하였고, 고위험 갑상선암의 의심 소견이 없는 환자에서 병리진단검사를 결정하는 결절 크기 기준을 개정하여 불필요한 병리진단검사를 최소화하고 적절한 갑상선암 진단 예민도가 유지되도록 개정하였다. 갑상선영상의학진료는 갑상선 결절 환자의 진단 및 비수술적 치료를 수행하는 중요한 임상적 역할을 가지고 있으며, 적절한 환자 진료를 위해서는 표준적 진료 지침에 근거하여 진료가 수행되어야 한다.

• Journal of Chest Surgery
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• 제41권3호
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• pp.347-353
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• 2008

배경: 식도천공은 빠른 진단과 효과적인 치료를 요하는 응급상황이다. 잘못된 진단과 치료의 지연은 이환율과 사망률을 증가시킨다. 대상 및 방법: 1990년 1월부터 2006년 12월까지 본 의료원 병원들에서 수술한 식도천공 환자는 37명을 대상으로 환자의 생존에 영향을 미치는 인자를 알아보기 위해 식도천공의 수술적 치료결과를 후향적으로 조사하였다. 결과: 환자의 연령분포는 21세에서 87세까지 이었고 평균 연령은 $52.7{\pm}16.98$세이었다. 남자가 31명, 여자가 6명이었다. 자연성 천공인 경우가 23 예(62%)이었고 외상성 경우가 10예(27%), 의인성인 경우가 4예(11%)이었다. 식도천공의 위치는 경부가 5예, 흉부가 31예, 복부가 1예 이었다. 식도 일차봉합술은 29예의 환자에게 시행하였고 5예의 환자에서는 T-tube 배액술을 시행하였다. 배제술과 전환술은 2예, 식도제거술은 1예에서 시행하였다. 6명의 환자가 사망하였고(16.22%) 15명의 환자에서(40.5%) 25예의 술 후 합병증이 있었다. 천공 후 치료까지의 시간이 24시간 이상인 군이 사망률과 이환율이 유의하게 높았다(p<0.05). 결론: 식도천공의 가장 중요한 위험인자는 천공에서 치료시작까지의 소요시간이었다. 사망률과 이환율을 낮추기 위해 신속한 진단과 효과적인 치료가 필요하다.

• Radiation Oncology Journal
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• 제12권3호
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• pp.349-359
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• 1994

목적 : 일차성 위장관 악성 림프종은 기장 흔한 림프절외 림프종으로서 치료 방법으로 주로 수술과 수술후 방사선치료 또는 약물치료가 시행되어 왔다. 그러나 빈도수가 낮을뿐만 아니라 체계적인 무작위 비교 연구가 없어 수술후의 치료방침에 대해서는 아직 확립되어 있지 않다. 이에 본 저자들은 위장관에 국한된 악성 림프종의 치료성적 및 예후인자를 분석 고찰하고 그에 따른 생존 분석을 통하여 외과적 절제술후의 적절한 치료방침을 세우는데 도움이 되고자 본 연구를 시행하였다. 방법 : 1976년 1월부터 1991년 4월까지 본원에서 국소적 위장관 악성 림프종으로 진단받고 외과적인 절제술을 시행받은 73명의 환자를 대상으로 치료방법을 포함하여 다변량 예후인자 분석을 시행하고, 치료방법과 예후인자에 따른 치료성적을 비교 분석하였다. 결과 : 전체 환자의 5년 생존율은 62.3%였으며 Ann Arbor 병기 I에서는 86.0%, 병기 II에서는 45.7%였다. 외과적 절제술후에 약물치료의 시행 여부, 병기, 잔류암의 유무가 통계적으로 유의한 독립 예후인자였다. 또한 수술후 방사선치료 또는 약물치료가 시행된 경운에 통계적으로 유의한 생존율의 향상을 나타냈으며 병기 II이거나 수술후 잔류암이 남은 위험군에서는 수술후 방사선치료와 약물치료가 병행 시행되는 경우 가장 좋은 생존율을 보여 주었다. 결론 : 약물치료 여부, 병기, 수술후 잔류암 유무가 중요한 예후인자 였으며 병기 II 또는 수술후 잔류암이 남은 경우를 위험인자로 보았을 때 위험인자가 없는 경우에는 수술후에 방사선치료 또는 약물치료중 어느 한가지만이 시행되어도 충분하며 위험인자를 가지고 있는 경우에는 방사선치료와 약물치료를 병합 시행하는것이 필요하다고 생각된다.