• Title/Summary/Keyword: Therapeutic ratio

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Evaluation of Peri-procedural Warfarin Therapy Undergoing Cardioversion in Patients with Atrial fibrillation (심방세동 환자의 심율동전환 시행 전·후 warfarin 치료의 적절성 평가)

  • Moon, Jung-Yeon;Kim, Bo-Ram;Jo, Eun-Jung;Cho, Yoon-Sook;Han, Hyun-Joo;Choi, Eue-Keun
    • Korean Journal of Clinical Pharmacy
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    • v.26 no.3
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    • pp.201-206
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    • 2016
  • Objective: Direct current cardioversion for atrial fibrillation could be associated with the risk of thromboembolic events. Anticoagulation therapy with warfarin (INR 2.0-3.0) is recommended 3 weeks before and 4 weeks after cardioversion to reduce the risk of thromboembolism. This study evaluated warfarin therapy in pharmacist-managed anticoagulant services (ACS). Methods: This retrospective study was performed in 106 patients with atrial fibrillation from 2012 to 2013. The primary efficacy endpoint was the composite of stroke, transient ischemic attack, myocardial infarction, and cardiovascular death. The primary safety measure was major bleeding. To evaluate the peri-procedural effects of warfarin treatment, we studied whether target INR was maintained, as well as the maintenance period of the therapeutic range. Quality of treatment was measured by time in therapeutic range (TTR) by using the Rosendaal method. Results: There were no thromboembolic events, but TEE examination at time of cardioversion showed a left atrial thrombus in three patients (2.8%). Bleeding complications after cardioversion occurred in 2 patients (1.9%). The average INR value at the time of cardioversion was $2.59{\pm}0.8$, and was within the therapeutic range in 83 patients (78%). Analysis of the patients in whom the value was within the therapeutic range twice consecutively showed that the ratio of TTR was 80% and the therapeutic range was maintained in 67 patients (63%) for an average of 4.90 weeks prior to cardioversion. Similarly, 76 patients (72%) had a stable INR within the therapeutic range for an average of 5.70 weeks and a mean TTR of 83%. Conclusion: Pharmacists significantly contributed to appropriate warfarin treatment with close monitoring during cardioversion. Likewise, active pharmacist monitoring and systemic management should be considered to reduce thromboembolism and bleeding complications in the peri-cardioversion period.

A Study on the Relationship between Individual Patient Behavior, Medical Care Level and Therapeutic Compliance: Community Health Survey (개인 건강행태 및 지역보건의료 수준과 치료순응의 관계: 지역사회 건강조사 바탕으로)

  • Kim, Young-Ran;Lee, Tae-Yong;Park, Chang-Soo
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.17 no.5
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    • pp.104-115
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    • 2016
  • Objective: This study was conducted in order to investigate the effects of individual patient behavior regarding the health and medical care level on their therapeutic compliance for people diagnosed with high blood pressure by a physician, in order to evaluate the impact of treatment compliance. In this study, the therapeutic compliance was defined as the hypertension drug cure rate. The current blood pressure controls were persons about 30 years of age diagnosed with high blood pressure by their doctor one month fraction of the people who take more than 20 days (30 days). Methods: The data was analyzed by using the X2-test for different comparisons of the therapeutic compliance in the individual characteristics and using a two-stage multilevel logistic regression to identify the community variance of the related index of high blood pressure therapeutic compliance using the data from 229 adults over the age of 19 in a community health survey conducted in 2010. The Spss 18.0 statistical program was used with HLM 7 (hierarchical linear model) Results: It was found that the rate of therapeutic compliance was affected by the individual health behavior and health and medical care levels. Conclusion: In this study, although the odds ratio of the variable region of the high level of health care, I was able Unlike previous studies and focuses on the personal level of variation found variations in the local health care level was a significant. More studies on multilevel analysis are needed in the future considering regional level data.

Correlation of Glasgow Prognostic Score or Procalcitonin to Clinical Variables in Patients with Pretreatment Lung Cancer

  • Kim, Young;Seok, Ji-Yoon;Hyun, Kyung-Yae;Lee, Gil-Hyun;Choi, Seok-Cheol
    • Biomedical Science Letters
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    • v.22 no.1
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    • pp.9-17
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    • 2016
  • Unfortunately, the five-year survival rate of lung cancer is relatively low compared with other cancers. Therefore, better predictors are need for prognosis, therapeutic strategy, risk stratification and predicting long-term mortality of lung cancer. Recently, increasing data suggest that Glasgow Prognostic Score (GPS) and procalcitonin levels are useful predictor cancer prognosis. In this study, we retrospectively investigated the correlation of GPS or procalcitonin to clinical variables in patients with pretreatment lung cancer. In 135 patients with pretreatment lung cancer, GPS, procalcitonin, demographic characteristics, hematological, coagulation, biochemical, inflammatory and cardiac markers were measured. Monocyte, eosinophil, basophil, neutrophil to lymphocyte ratio, red cell distribution width (RDW), platelet to lymphocyte ratio, mean platelet volume to platecrit ratio, D-dimer and prothrombin time (PT) levels were higher, whereas mean platelet volume was lower than their normal ranges. Glucose and sodium levels were low, whereas gamma glutamyl transferase (GGT), total bilirubin, creatinine and inorganic phosphorus concentrations were increase compared their normal ranges. Procalcitonin, high sensitivity C-reactive protein and troponin-I concentrations were elevated compared with their normal ranges. GPS had significantly positive or negative relations to cancer stage, hematological, coagulation, biochemical, inflammatory and troponin-I. Based on the data, we suggest that GPS may be a potent and useful predictor for prognosis, therapeutic strategy, risk stratification and predicting long-term mortality of lung cancer.

Some Measurements of Scattered Radiation from Various Radiation Shielding Materials (방사선(放射線) 차폐물질(遮蔽物質)에서 발생(發生)하는 산란선(散亂線)의 측정(測定))

  • Kim, Chang-Kyun
    • Journal of radiological science and technology
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    • v.4 no.1
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    • pp.15-22
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    • 1981
  • Half value layer(radiation energy) of $90^{\circ}$ scattered radiation from various radiation shielding materials was measured at 1 m distance from the central ray of the primary beam. Scattered radiation was measured from 100 to 200 kVp for 0-2.0mm Cu+1.0mm Al added filter in the primary beam for a deep therapeutic unit, the obtained results were as follows: 1. The ratio of scattered radiation to primary radiation was increased by using lighter filter. 2. The ratio of scattered radiation to primary radiation was decreased by using heavier filter. 3. The ratio of scattered radiation to primary radiation was independent of tube voltage. 4. The scattered radiation of high energy was produced, when the effective atomic number and density of shielding material were high.

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Results of Conventional Radiotherapy in Hypopharyngeal Cancer (하인두암의 방사선 치료 성적)

  • Nam, Taek-Keun;Park, Seung-Jin;Ahn, Sung-Ja;Chung, Woong-Ki;Nah, Byung-Sik
    • Radiation Oncology Journal
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    • v.13 no.2
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    • pp.143-148
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    • 1995
  • Purpose: We tried to evaluate the role of conventional radiotherapy alone or with neoadjuvant chemotherapy in the hypopharyngeal cancer by retrospective analysis. Materials and Methods: Between Jul.1985 and Sep.1992, 42 patients of hypopharyngeal cancer were treated by conventional radiotherapy alone or combined with neoadjuvant chemotherapy. The male to female ratio was 20:1 with a median age of 58 years, Twelve Patients were treated by conventional radiotherapy alone and 30 patients were treated by neoadjuvant chemotherapy and radiotherapy. Results: Seven Patients were Stage I,II and the patients with stage III and IV were 10 and 25, respectively at the time of presentation. The overall survival and disease-specific survival rates at 24 months were $12.9\%$ and $15.5\%,$respectively Two-year survival rates of stage I+II and III+IV patients were $50\%$ and $6.3\%,$ respectively(p(0.05). Sixteen Patients$(38\%)$ revealed CR and 26 patients$(62\%)$ revealed less than CR at the end of radiotherapy and their 2-year survival rates were $31.3\%\;and\;0\%,$ respectively(p(0.05). On univariate analysis, stage, T-stage, N-stage and treatment response were the significant prognostic factors, but only stage and treatment response were significant on multivariate analysis Conclusion : This conventional radiotherapy alone or with neoadjuvant chemotherapy does not seem to be sufficient in the treatment of most advanced hypopharyngeal cancer Therefore other treatment modalities such as hyperfractionation or concurrent chemoradiotherapy should be considered.

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Comparison of IVF-ET Outcome after Various Therapeutic Approaches for Ovarian Endometriomas (난소의 자궁내막종에 대한 다양한 치료적 적용에 따른 체외수정 및 배아이식술 결과의 비교 연구)

  • Lee, Bang-Hyun;Kwon, Hyuck-Chan;Lee, Jae-Hyun;Kim, Bo-Hyun;Lee, Sang-Hee;Park, Min-Hye;Lee, Byung-Kwan;Lim, Jung-Ae
    • Clinical and Experimental Reproductive Medicine
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    • v.31 no.2
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    • pp.95-103
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    • 2004
  • Objective: To compare COH characteristics and IVF outcomes among IVF-ET patients who were treated with various therapeutic modalities for ovarian endometriomas and to propose effective pre-cyclic therapeutic modalities to improve IVF-ET outcomes in the patients with ovarian endometriomas. Methods: All cases that had undergone IVF-ET after laparoscopy between January 1997 to August 2003 were reviewed. Forty-eight patients with tubal factor were assigned to Group I. Twenty seven, 22 and 38 patients diagnosed as severe pelvic adhesion with ovarian endometriomas by laparoscopy received only medical therapy (Group II), cyst aspiration (Group III), and sclerotherapy (Group IV), respectively. Laparoscopic cystectomy was performed in 20 patients (Group V). Resistance index was measured on day administering hCG. Results: As compared with Group I, in Group II resistance index increased (p<0.05) but number of oocytes, good-quality oocyte ratio (mature and intermediate oocytes/total retrieval oocytes), fertilization rate, and embryo development rate decreased (p<0.05). In Group III fertilization rate and embryo development rate decreased (p<0.05). There was no difference between Group IV and Group I in all parameters except basal FSH which increased (p<0.05). In Group V basal FSH, and resistance increased (p<0.05) and number of oocytes and good-quality oocytes ratio decreased (p<0.05). Conclusion: Sclerotherapy is an effective therapeutic option which can be done prior to IVF-ET cycles in the patients with ovarian endometriomas. Further studies on a large scale are necessary to confirm these data.

Reduction of Patient Dose in Radiation Therapy for the Brain Tumors by Using 2-Dimensional Vertex or Oblique Vertex Beam Technique

  • Kim, Il-Han;Chie, Eui-Kyu;Park, Charn-Il
    • Journal of Radiation Protection and Research
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    • v.28 no.3
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    • pp.225-231
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    • 2003
  • Up-front irradiation technique as 3-dimensional conformation, or intensity modulation has kept large proportion of brain tumors from being complicated with acute radiation reactions in the normal tissue during or shortly after radiotherapy. For years, we've cannot help but counting on 2-D vertex beam technique to reduce acute reactions in the brain tumor patients because we're not equipped with 3-dimensional planning system. We analyzed its advantages and limitations in the clinical application. From 1998 to 2001, vertex or oblique vertex beams were applied to 35 patients with primary brain tumor and 25 among them were eligible for this analysis. Vertex(V) plans were optimized on the reconstructed coronal planes. As the control, we took the bilateral opposed techniques(BL) otherwise being applied. We compared the volumes included in 105% to 50% isodose lines of each plan. We also measured the radiation dose at various extracranial sites with TLD. With vertex techniques, we reduced the irradiated volumes of contralateral hemisphere and prevented middle ear effusion at contralateral side. But the low dose volume increased outside 100%; the ratio of V to BL in irradiated volume included in 100%, 80%, 50% was 0.55+/-0.10, 0.61+/-0.10, and 1.22+/-0.21, respectively. The hot area within 100% isodose line almost disappeared with vertex plan; the ratio of V to BL in irradiated volume included in 103%, 105%, 108% was 0.14+/-0.14, 0.05./-0.17, 0.00, respectively. The dose distribution within 100% isodose line became more homogeneous; the ratio of volume included in 103% and 105% to 100% was 0.62+/-0.14 and 0.26+/-0.16 in BL whereas was 0.16+/-0.16 and 0.02+/-0.04 in V. With the vertex techniques, extracranial dose increased up to $1{\sim}3%$ of maximum dose in the head and neck region except submandibular area where dose ranged 1 to 21%. From this data, vertex beam technique was quite effective in reduction of unnecessary irradiation to the contralateral hemispheres, integral dose, obtaining dose homogeneity in the clinical target. But it was associated with volume increment of low dose area in the brain and irradiation toward the head and neck region otherwise being not irradiated at all. Thus, this 2-D vertex technique can be a useful quasi-conformal method before getting 3-D apparatus.

The association of rectal equivalent dose in 2 Gy fractions (EQD2) to late rectal toxicity in locally advanced cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University

  • Tharavichtikul, Ekkasit;Meungwong, Pooriwat;Chitapanarux, Taned;Chakrabandhu, Somvilai;Klunklin, Pitchayaponne;Onchan, Wimrak;Wanwilairat, Somsak;Traisathit, Patrinee;Galalae, Razvan;Chitapanarux, Imjai
    • Radiation Oncology Journal
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    • v.32 no.2
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    • pp.57-62
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    • 2014
  • Purpose: To evaluate association between equivalent dose in 2 Gy (EQD2) to rectal point dose and gastrointestinal toxicity from whole pelvic radiotherapy (WPRT) and intracavitary brachytherapy (ICBT) in cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University. Materials and Methods: Retrospective study was designed for the patients with locally advanced cervical cancer, treated by radical radiotherapy from 2004 to 2009 and were evaluated by rectosigmoidoscopy. The cumulative doses of WPRT and ICBT to the maximally rectal point were calculated to the EQD2 and evaluated the association of toxicities. Results: Thirty-nine patients were evaluated for late rectal toxicity. The mean cumulative dose in term of EQD2 to rectum was 64.2 Gy. Grade 1 toxicities were the most common findings. According to endoscopic exam, the most common toxicities were congested mucosa (36 patients) and telangiectasia (32 patients). In evaluation between rectal dose in EQD2 and toxicities, no association of cumulative rectal dose to rectal toxicity, except the association of cumulative rectal dose in EQD2 >65 Gy to late effects of normal tissue (LENT-SOMA) scale ${\geq}$ grade 2 (p = 0.022; odds ratio, 5.312; 95% confidence interval, 1.269-22.244). Conclusion: The cumulative rectal dose in EQD2 >65 Gy have association with ${\geq}$ grade 2 LENT-SOMA scale.

Radioprotective Effects of Cordyceps Sinensis Extracts on r-Irradiated Mice

  • Yoo BG;Lee JS;Lee DK;Park HD;Park IK
    • Journal of The Korean Radiological Technologist Association
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    • v.25 no.1
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    • pp.21-21
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    • 1999
  • Since little or no informations are available regarding the effect of Cordyceps sinensis extract on mice exposed to $\gamma$ - irradiation we attempted to look at the effect of Cordyceps sinenis extract on the survival ratio, body weight and or

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임상적 이용에 필요한 중성자 측정

  • Chung, Hyun-Woo
    • The Journal of Korean Society for Radiation Therapy
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    • v.3 no.1
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    • pp.19-25
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    • 1989
  • The purpose of this presentation is to outline the measurement made at Korea Cancer Center Hospital, KAERI, and to present the result obtained. These measurements were designed to demonstrate the complicance of the isocentric fast neutron facility. 1. Neutron production and delivary. 2. Physical parameters of the neutron beam. 3. Neutron beam calibration including 'n' ratio and detector design. 4. Treatment planning. 5. Health physics consideration etc. will be covered the above topics.

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