Background: In recent decades, the prognosis for childhood leukemia has improved, especially for acute lymphoblastic leukemia (ALL). In Thailand, though, the survival rate for ALL is unimpressive. In 2006, standard national protocols for childhood leukemia treatment were implemented. We herein report the outcome of the ALL national protocols and explanations behind discrepancies in outcomes between institutions. Materials and Methods: Between March 2006 and February 2008, 486 children with ALL from 12 institutions were enrolled in the Thai national protocols. There were 3 different protocols based on specific criteria: one each for standard risk, high risk and Burkitt's ALL. We classified participating centers into 4 groups of institutions, namely: medical schools in Bangkok, provincial medical schools, hospitals in Bangkok and provincial hospitals. We also evaluated supportive care, laboratory facilities in participating centers, socioeconomics, and patient compliance. Overall and event-free survival were determined for each group using the Kaplan Meier method. Statistical differences were determined using the log-rank test. Previous outcomes of Thai childhood ALL treatment between 2003 and 2005 served as the historic control. Results: Five-year overall survival of ALL treated using the Thai national protocol was 67.2%; an improvement from the 63.7% of the 12-institute historical control (p-value=0.06). There were discrepancies in event-free survival of ALL between centers in Bangkok and up-country provinces (69.9% vs 51.2%, p-value <0.01). Socioeconomics and patient compliance were key elements in determining the outcome (65.5% vs 47.5%, 59.4% vs 42.9%) (p-value < 0.02). Conclusions: Implementation of standard national protocols for childhood leukemia in Thailand did not significantly improve the outcome of ALL. Factors leading to better outcomes included (a) improvement of treatment compliance (b) prevention of treatment abandonment and (c) financial support to the family.
Background: A retrospective analysis of all cancer patients attending the radiotherapy outpatient department (OPD) of a single unit during the period of January 2005 till December 2006 was conducted to know the geographical distribution and incidence of the most common cancers, their stage of presentation, treatment compliance among the patients and follow-up. Materials and Methods: A total of 4,484 patients were registered in the Institute of Medical Sciences, Banaras Hindu University during the period of January 2005-December 2006; of which 1,975 registered in an individual unit were included for the retrospective analysis. Results: Most of the patients hailed from the various districts of UP and Bihar. Females outnumbered males with a ratio of 1.33:1. Females mostly belonged to the age group of 40-59 years; whilst males were a decade older. Major cancer sites in females were cervix and breast followed by head and neck. Leading cancer sites in males were head and neck, brain, bone, soft tissue and lung. Most of the cases presented in advanced stage of disease (74%). Squamous cell carcinoma was the most common histopathology (56%). A significant proportion of patients defaulted after undergoing preliminary investigations (16%). Only 53.9% of females and 58.5% of males took treatment out of which 68% and 63% completed the prescribed treatment. Compliance with follow-up was poor. Conclusions: The outcome of this study will significantly help us to define region specific strategies needed for cancer management in eastern Uttar Pradesh.
Purpose: To evaluate compliance by analyzing and comparing treatment duration, degree of improvement after treatment and treatment response of oral lichen planus (OLP) patients according to characteristics of them and the severity of the lesion. Methods: According to treatment process, 132 subjects with OLP who first visited the Department of Oral Medicine at the Pusan National University Dental Hospital from January 2017 to December 2020were classified into three groups: Treatment completed (CT) group, Under treatment (UT) group, and Dropped out during follow-up (DT) group. The reticulation/keratosis, erythema, and ulceration (REU) scoring system was used to assess the severity of OLP. The degree of improvement after treatment was evaluated in CT group. Results: There were 53 (40.15%) CT, 27 (20.45%) UT and 52 (39.39%) DT. In CT group, according to initial REU score there was a statistical difference in the degree of improvement, but not in the length of time to complete treatment. There was no statistical difference between the days it took for patients to feel symptom relief, and the days of entire treatment among three groups. However, there was a positive correlation between the REU score of gingiva and duration of treatment in DT group. In the CT and DT groups, there was a correlation between the length of time taken to relieve symptoms and the duration of treatment. Conclusions: The severity of the gingival lesion and the initial response to treatment have a large effect on the entire treatment period and prognosis, so it should be considered when explaining the disease prognosis and treatment period to patients, and the clinician needs to focus on initial symptom relief.
Background: This study documented the performance of providers of visual inspection with acetic acid (VIA) at primary health centers, assessing their compliance with the VIA skills checklist and determinants of non-compliance, and exploring their perceptions of VIA training sessions. Materials and Methods: A cross-sectional study was conducted among VIA providers in the $Mekn\grave{e}s$-Tafilalet region of Morocco. Structured observation of their performance was conducted through supervisory visits and multiple focus group discussions (FGDs). Results: Performance of all the recommended steps for effective communication was observed in a low proportion of procedures (36.4%). Midwives/nurses had higher compliance than general practitioners (GPs) (p<0.001). All recommended steps for VIA examination were performed for a high proportion of procedures (82.5%). Compliance was higher among midwives/nurses than among GPs (p<0.001) and among providers in rural areas than those in urban areas (p<0.001). For pre-VIA counselling, all recommended steps were performed for only 36.8% of procedures. For post-VIA counseling, all recommended steps were performed in a high proportion (85.5% for VIA-negative and 85.1% for VIA-positive women). Midwives/nurses had higher compliance than GPs when advising VIA-positive women (p=0.009). All infection prevention practices were followed for only 14.2% of procedures, and compliance was higher among providers in rural areas than those in urban areas (p<0.001). Most FGD participants were satisfied with the content of VIA training sessions. However, they suggested periodic refresher training and supportive supervision. Conclusions: Quality assurance of a cervical cancer screening program is a key element to ensure that the providers perform VIA correctly and confidently.
The fracture toughness, $J_{IC}$ of high frequency electric resistance welded steel pipe for smooth and side-grooved CT specimen was evaluated by unloading compliance method. The crack growth, .${\delta}a$ was obtained from the equation of Donald and Saxena & Hudak, and $J_{IC}$ was determined from the curve of J-${\delta}a$ relations. The crack growth on the experiment using unloading compliance method is underestimated as compared with ${\delta}a$ measured directly by the SEM, so the reliability of $J_{IC}$ from saxena & Hudak equation is large than that from Donald. The $J_{IC}$ value of side-grooved CT Specimen is estimated less than that of smooth, and this is the effect of the side-groove, the shear-lip of crack tip and the reduction of crack tunnelling phenomena.
Purpose: This study was to examine the effects of the hypertension self-help program on knowledge, self-efficacy, self-management compliance, and physiological parameters for workers with hypertension. Methods: The subjects of study were 54 patients with hypertension, divided into 28 of experimental group and 26 of control group, working in a general work place located in K city from June to September, 2009. Experiment treatment was a 12-week self-care program given for two hours, once a week. Results: After conducting a self-help program, the experimental group showed significant increase in knowledge level, self-efficacy, self-management compliance, and physiological parameters including blood pressure, BMI, total cholesterol level, neutral fat, and LDL-cholesterol of blood lipids compared to the control group. Conclusion: This program is greatly recommended for workshops.
Journal of the Korean Society of Manufacturing Process Engineers
/
v.12
no.4
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pp.22-28
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2013
It is important to begin left ventricular assist device (LVAD) treatment at appropriate time for heart failure patients who expect cardiac recovery after the therapy. In order to predict the optimal timing of LVAD implantation, we predicted pumping efficacy of LVAD according to the severity of heart failure theoretically. We used LVAD-implanted cardiovascular system model which consist of 8 Windkessel compartments for the simulation study. The time-varying compliance theory was used to simulate ventricular pumping function in the model. The ventricular systolic dysfunction was implemented by increasing the end-systolic ventricular compliance. Using the mathematical model, we predicted cardiac responses such as left ventricular peak pressure, cardiac output, ejection fraction, and stroke work according to the severity of ventricular systolic dysfunction under the treatments of continuous and pulsatile LVAD. Left ventricular peak pressure, which indicates the ventricular loading condition, decreased maximally at the 1st level heart-failure under pulsatile LVAD therapy and 2nd level heart-failure under continuous LVAD therapy. We conclude that optimal timing for pulsatile LVAD treatment is 1st level heart-failure and for continuous LVAD treatment is 2nd level heart-failure when considering LVAD treatment as "bridge to recovery".
To investigate the factors related with the compliance and the treatment of the patients with pulmonary tuberculosis in urban and suburb area, we followed up all the 755 registered patients(at urban Public Health Office 544, at suburb 210) as follow from January 1,1992 to December 31, 1993. We describe the general characteristics and the characteristics related with the disease of the patients according to the area as follow. 150 patients(27.5%) were at their age of 20 to 29 years in the urban area, whereas 45 patients (21.4%) were 60 to 69 years and another 45 patients(21.4%) were 70 to 79 years in the suburb area. According to the first chest X -ray examination, 54.5% of all cases were proved to be mild in the urban area. But in the suburb area, moderate cases (44.3%) were more than mild cases(p<0.01). Follow-up X-ray's were performed more properly(p<0.05) in the urban area(94.3%) than in the suburb area(90.0%). Most cases were found in the chest X -ray examination performed by Public Health Office (p<0.01) : payable chest X-ray in the urban area (56.7%) and free chest X-ray in the suburb area(35.2%). More patients were cured in the urban area(90.8%) than in the suburb area(87.1%). The presence of supporting family member were significantly higher(p<0.05) in the urban area(79.1%) than in the suburb area(88.1%). In the analysis of the treatment efficacy, more cure ate were found in the patients cytologically confirmed to be culture (+). In the urban area, 201 culture (+) patients (93.5%) 294 culture (-) patients (89.1%) were cured. In the suburb area, 99 culture (+) patients(91.7%) and 84 culture (-) patients(82.4%) were cured. Age, the presence of supporting family member, and the socioeconomic status of the patient had significant association with the prescription compliance related with the general characteristics of the patients. Whereas, X-ray finding and AFB culture finding were the significant factors associated with the prescription compliance related with pulmonary tuberculosis (p<0.05). The cumulative compliance in the survival analysis was 92.5% in the urban area and 88.1% in suburb area, at sixth month of follow-up. Failure rate for regular drug receipt was highest at second month in the urban area(3.75%) and at fourth month in the suburb area(4.15%). In logistic regression of the factors related with the tratment result, first X-ray examination and prescription compliance were significantly associated in the urban area(p<0.05). However, there is no factor significantly associated with the treatment result in the suburb area. It could be explained by too small size of the sample. In logistic regression of the factors related with the prescription compliance, first chest X-ray, sputum culture outcome and the presence of supporting family member were significant variables in the urban area(p<0.05). Most patients with family member were proved to be compliant with the prescription. This shows that it is important for the patients with long-lasting ilnesses to have supporting family member. Therefore, to improve prescription compliance we should strengthen the health education before the initiation of treatment and take special interest in the patients without supporting family member.
The objective of this study was to evaluate the efficacy and the pattern of regimens prescribed for the treatment of peptic ulcer disease in a regional community hospital. 226 patients were treated as an outpatient and followed for one year. 88 patients $(38.9\%)$ had gastric ulcer (GU) alone, 6 patients $(2.7\%)$ had duodenal ulcer (DV) alone, 5 patients $(2.2\%)$ had gastroesophageal reflux disease (GERD) alone, 25 patients $(11.1\%)$ had both GU and DU, 88 patients $(38.9\%)$ had both GU and GERD, and 14 patients $(6.2\%)$ had both DU and GERD. During this study period no one was treated for Zollinger-Ellison Syndrome. The disease showed higher occurrence in male population (139 patients, $61.5\%$) and among the ages of 30 and 40 $(62.4\%)$. The average age of these patients was 41.3 years and there was no difference between the genders. $81.4\%$ of these patients underwent CLO test to check for the existence of Helicobacter and $66.3\%$ of these Patients showed the positive response. $65.6\%$ of patients with GU and $80\%$ of patients with DU showed the positive response and there was no difference between the genders $(65.4\%\;vs.\;67.6\%)$. 184 patients $(81.4\%)$ were deemed to be cured based on the disappearance of their symptoms after completing the regimens. Compliance rate did not differ for gender or different diseases, while showing a difference in age. Patients between the ages of 20 to 30 years old showed the worst compliance rate. In addition, the compliance was lower among the patients who had previous occurrence of the disease, and this was more evident among female patients. Although 184 patients out of the total 226 patients were deemed to be cured, 36 patients $(20.65\%)$ of these returned to the hospital for relapsed diseases within one year. The factors that affected for patients to relapse were the diseases accompanied by ulcer and social environments, such as smoking, alcohol consumption, and previous history of the diseases (smoking P<0.001, alcohol consumption P<0.02, previous history of disease P<0.05). The regimen using $H_2$ receptor antagonists+tripotassium dicitrato bismuthate+clarithromycin showed the lower rate of relapse, and the regimens of omeprazole (OMP)+amoxicillin+tripotassium dicitrato bismuthate and OMP+amoxicillin+metronidazole showed better compliance rate. Patient education by pharmacists on the importance of compliance to regimens and the risk factors fer relapse can provide a better patient care. This would ultimately result in more cost-effective treatments by preventing additional cost for treating relapsed symptoms in approximately $20\%$ of patients.
Journal of agricultural medicine and community health
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v.26
no.2
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pp.111-132
/
2001
This study was conducted to examine the therapeutic compliance and its related factors in rural women with osteoporosis. A questionnaire survey was performed from April to May in 2000 for 140 osteoporotic patients who were diagnosed from April to June in 1999 through community health program. The study employed the health belief model for predicting and explaining sick role behavior. The analysis techniques employed included contingency table analysis and path analysis using LISREL. The major results of this study were as follows: Of the subjects, 12.1% were continuously complaint, 53.6% were intermittently compliant, and 34.3% were non- compliant to calcium supplement therapy. As the result of path analysis, the therapeutic compliance was significantly higher(${\mid}T{\mid}$ >2.0) as patients had higher perceived severity of disease, lower perceived barriers of treatment, and when patients thought their disease status as severe. As the patients had higher educational level, more experience of mass media contact or health education about osteoporosis, and when family had more concern for patient treatment, they had higher perceived susceptibility of complication(bone fracture)${\mid}T{\mid}$ >2.0). The patients had higher perceived severity(${\mid}T{\mid}$ >2.0) as they had more educational level, more advice for treatment from their doctors, and when family had more concern for their treatment. As the patients had more advice for treatment from their doctors and when family had more concern for their treatment, they had higher perceived benefit of treatment and lower perceived barriers to treatment(${\mid}T{\mid}$ >2.0). In order to improve the therapeutic compliance in rural osteoporotic women, it would be necessary that the patient should recognize their disease severity properly. And the perceived barriers should be removed through supportive environments for osteoporosis treatment such as doctor 's more advice and family 's more concern for treatment. In addition, effective and continuous management system for osteoporotic patients should be established.
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