• Title/Summary/Keyword: adherence to therapy

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The Kuala Lumpur Qigong Trial for Women in the Cancer Survivorship Phase-Efficacy of a Three-Arm RCT to Improve QOL

  • Loh, Siew Yim;Lee, Shing Yee;Murray, Liam
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.19
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    • pp.8127-8134
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    • 2014
  • Background: Qigong is highly favoured among Asian breast cancer survivors for enhancing health. This study examined the hypothesis that quality of life (QoL) in the Qigong group is better than the placebo (aerobic) or usual care group. Materials and Methods: A total of 197 participants were randomly assigned to either the 8-week Kuala Lumpur Qigong Trial or control groups in 2010-2011. Measurement taken at baseline and post-intervention included QoL, distress and fatigue. Analysis of covariance (ANCOVA) and Kruskal Wallis were used to examine for differences between groups in the measurements. Results: There were 95 consenting participants in this 8week trial. The adherence rates were 63% for Qigong and 65% for the placebo group. The Qigong group showed significant marginal improvement in Quality of life scores compared to placebo (mean difference=7.3 unit; p=0.036), compared to usual care (mean difference=6.7 unit; p=0.048) on Functional Assessment Cancer Therapy-Breast measure. There were no significant changes between the placebo and usual care groups in fatigue or distress at post intervention (8-week). Conclusions: Cancer survivors who participated in the Qigong intervention showed slightly better QOL. Follow up studies are greatly needed to evaluate which subgroups may best benefit from Qigong. With a steep rise of cancer survivors, there is an urgent need to explore and engage more cultural means of physical activity to fight side effects of treatment and for cancer control in developing countries.

Psychiatric Treatment of Chronic Pain Disorder (만성 통증장애의 정신과적 치료)

  • Rho, Seung-Ho
    • Korean Journal of Psychosomatic Medicine
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    • v.7 no.2
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    • pp.256-262
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    • 1999
  • Because chronic pain disorder may has multiple causes or contributing factors, including physical, psychological, and socio-environmental variables, the treatment of patients with the disorder requires biopsychosocial approaches in a multidisciplinary setting. In treating chronic pain, it is important to address functioning as well as pain, and treatment should be to increase functional capacity and manage the pain as opposed to curing it. Therefore treatment goal should be adaptation to pain or minimizing pain with corresponding greater functioning. Treatment begins with the initial assessment, which includes evaluation of psychophysiologic mechanisms, operant mechanisms, and overt psychiatric comorbidity. Psychiatric treatment of the patients requires adherence to sound pharmacologic and behavioral principles. There are four categories of drugs useful to psychiatrist in the management of chronic pain patients : 1) narcotic analgesics, 2) nonsteroidal antiinflammatory drugs, 3) psychotropic medications, and 4) anticonvulsants, but antidepressants are the most valuable drugs in pharmnacotherpy for them. Psychological treatments tend to emphasize behavioral and cognitive-behavioral modalities, which are divided into self-management techniques and operant techniques. Psychodynamic and insight-oriented therapies are indicated to some patients with long-standing interpersonal dysfunction or a history of childhood abuse.

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Adherence to Recommended Treatments for Early Invasive Breast Cancer: Decisions of Women Attending Surgeons in the Breast Cancer Audit of Australia and New Zealand

  • Roder, David M.;Silva, Primali De;Zorbas, Helen N.;Webster, Fleur;Kollias, James;Pyke, Chris M.;Campbell, Ian D.
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.4
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    • pp.1675-1682
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    • 2012
  • Aim: The study aim was to determine the frequency with which women decline clinicians' treatment recommendations and variations in this frequency by age, cancer and service descriptors. Design: The study included 36,775 women diagnosed with early invasive breast cancer in 1998-2005 and attending Australian and New Zealand breast surgeons. Rate ratios for declining treatment were examined by descriptor, using bilateral and multiple logistic regression analyses. Proportional hazards regression was used in exploratory analyses of associations with breast cancer death. Results: 3.4% of women declined a recommended treatment of some type, ranging from 2.6% for women under 40 years to 5.8% for those aged 80 years or more, and with parallel increases by age presenting for declining radiotherapy (p<0.001) and axillary surgery (p=0.006). Multiple regression confirmed that common predictors of declining various treatments included low surgeon case load, treatment outside major city centres, and older age. Histological features suggesting a favourable prognosis were often predictive of declining various treatments, although reverse findings also applied with women with positive nodal status being more likely to decline a mastectomy and those with larger tumours more likely to decline chemotherapy. While survival analyses lacked statistical power due to small numbers, higher risks of breast cancer death were suggested, after adjusting for age and conventional clinical risk factors, (1) for women not receiving breast surgery for unstated reasons (RR=2.29; p<0.001); and (2) although not approaching statistical significance $p{\geq}0.200$), for women declining radiotherapy (RR=1.22), a systemic therapy (RR1.11), and more specifically, chemotherapy (RR=1.41). Conclusions: Women have the right to choose their treatments but reasons for declining recommendations require further study to ensure that choices are well informed and clinical outcomes are optimized.

Induction of osteoclastogenesis-inducing cytokines and invasion by alive Aggregatibacter actinomycetemcomitans in osteoblasts (조골세포에서 Aggregatibacter actinomycetemcomitans 생균의 파골세포분화유도 cytokine 발현 유도능 및 침투능)

  • Choi, Ho-Kil;Lee, Yang-Sin;Kim, Min-Young;Kim, Kyoung-Dae;Cha, Jeong-Heon;Yoo, Yun-Jung
    • Journal of Periodontal and Implant Science
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    • v.37 no.3
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    • pp.553-562
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    • 2007
  • Osteoblasts regulate osteoclastogenesis by production of various cytokines. Aggregatibacter(A) ac-tinomycetemcomitans is one of periodontopathogens which invades gingival tissue. Therefore, clarifying the effect of alive A. actinomycetemcomitans on osteoblasts is important to understand the mechanism of alveolar bone resorption in periodontitis. We investigated induction of osteoclastogenesis-inducing cytokines, adherence, and invasion by A. actinomycetemcomitans in osteoblasts. Osteoblasts were isolated from mouse calvaria and expression of cytokines was determined by RT-PCR. When the ratio of the number of A. actinomycetemcomtians to the number of osteoblasts was 10:1, 50:1 and 100:1, RANKL mRNA expression was increased. A. actinomycetemcomitans also increased expression of macrophage inflammatory protein (MIP) -1${\alpha}$, interleukin (IL)-1${\beta}$, and tumor necrosis factor (TNF)-${\alpha}$. A. actinomycetemcomitans attached to and invaded osteoblasts at ratio of 1000:1. These results suggest that A. actinomycetemcomitans increases osteoclastogenesis-inducing ability of osteoblasts by stimulating the expression of RANKL, MIP-1${\alpha}$,IL-1${\beta}$, and TNF-${\alpha}$ and that invasion of A. actinomycetemcomitans provides a means by which the bacteria escape from immune system and antibiotic therapy.

Epidemiologic Survey of Infantile Cancer in Iran based on the Data of the Largest Pediatric Cancer Referral Center (Ali-Asghar Children Hospital), 1996-2005

  • Bahoush-Mehdiabadi, Gholamreza;Habibi, Roshanak;Shariftabrizi, Ahmad;Vossough, Parvaneh
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.3
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    • pp.1211-1217
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    • 2014
  • Background: Cancer in infants younger than one year of age represents a unique problem with distinct epidemiological, clinical and genetic characteristics compared with older age groups. No report is yet available from Iran regarding epidemiological and survival rate of cancers diagnosed in this age group. Materials and Methods: The population under study comprised of patients which were diagnosed and admitted to Ali-Asghar hospital between years 1996-2005. In total, 287 infants were included in the retrospective descriptive survey. Patient files were evaluated for age of patient at the time of diagnosis, sex, geographical residence, consanguinity of parents, histological diagnosis, site of cancer involvement, type of therapy, date of last follow-up and cause of death (if applicable). Results: The average age at the time of diagnosis was 7.2 months old. The most frequent malignancy was retinoblastoma (44%), followed by leukemia (19%) and neuroblastoma (10%), with five-year overall survival rates of 77.7%, 41% and 90%, respectively Parents of 40 infants (13.9%) had consanguinity relationships. Conclusions: Although we cannot make any conclusions regarding the incidence of infant cancer subtypes based on this study, survival rates for major types were similar to the developed countries, which signifies strict adherence to standards of care in Ali-Asghar hospital, the main infant cancer care centre in Iran. A Childhood Cancer Registry with high-resolution data collection and also advanced genetic testing is advocated for in-depth analysis of variation in incidence and survival.

Study on Clinical Patient-oriented Education System for Medical Organizations (의료기관에서의 환자 중심 교육 시스템 연구)

  • Park, Hwagyoo
    • Journal of The Korean Association of Information Education
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    • v.17 no.4
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    • pp.475-486
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    • 2013
  • Recent healthcare studies evaluate the effective impacts of a patient educational information intervention in hospitals on adherence to communicating knowledge, life quality, and therapeutic response in patients treated with highly active therapy in medical organizations. Therefore, the aim of this study is to design and implement the effective and systematic frameworks by providing clinical patient-oriented education system(CPES), which enhances health promotion and medical cures. CPES initiatives accelerate positive financial returns with network-driven educational system. To validate the CPES, the author analyzes the efficiency and effectiveness using statistical survey works. With this outcome, it is compared with previous system. One of the findings is that the system can improve compliance with treatment right dietetics and give patients self-manage their conditions in S hospital. Patients' acknowledge of their condition and its treatment process can be improved through the educational systems.

Correlations among Blood Pressures, Dietary Intakes and Other Environmental Factors in Korean Adult Males (성인 남성의 혈압과 식이섭취 실태 및 기타 환경 요인과의 관계에 대한 사례연구)

  • 이일하
    • Journal of the Korean Home Economics Association
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    • v.24 no.4
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    • pp.57-68
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    • 1986
  • The present survey was designed to investigate correlations among blood pressure, nutritional intakes, and various environmental factors in Korean adult males, and to observe the difference in dietary intakes between hypertensive patients and normotensive subjects. Two hundred forty-three adult men from Seoul and rural areas were interviewed about their food intakes, dietary patterns, food habits, and general environmental factors from December 20, 1982 to February 15, 1983. Their dietary intakes were surveyed by means of 24-hour recall diet method. Dietary score card was used in order to evaluate the quality of routine diet of the subject. Variables of environmental factors and factors related to hypertension were expressed as percentage, and the differences in nutrient intake and food score of each sub-group were examined by means of t-test. Correlation of all the variables were analyzed by Pearsons Correlation Coefficient. The results obtained are summarized as follows: 1. 38% of the subjects were between the ages of 40~49, and about one-half of the subjects were middle or high school graduates. 28% of the subjects earned 210, 000~350, 000 Won per month, and income distribution was almost identical to that of the urban population of Korea. 2. There was more overweight or obese found in the hypertensive patients than in the normotensive subjects. About 40% of the hypertensive patients reported a family history of hypertension, and their knowledge about hypertension was rather poor, but slightly better than the normotensive subjects. The patient group had less adherence to smoking and alcohol compared with the normotensive subjects, but no difference was observed in coffee drinking. The mean value of the blood pressure for the normotensive subjects was 127/86mmHg and 175/109mmHg for the hypertensive group. 3. Nutrient intake for the hypertensive group was lower for most of nutrients than in the healthy group. Hypertensive patients on diet therapy consumed less calories and carbohydrates compared with those who do not follow diet therapy. 4. There was no difference intake of these food groups between patients and the healthy group. Food score was strongly related to consumption of animal protein, saturated fats, Calcium, Iron, Vitamin A, Riboflavin, and Vitamin C, which are prone to be deficient in the typical Korean diet. 5. Blood pressure had a strong positive correlation with age, body weight, and socioeconomic level. In addition, monthly income was positively related with age and education level. 6. Three was a positive relationship between blood pressure and consumption of vegetable protein, and a negative relationship with consumption of Calories, Carbohydrates, Calcium, Iron, Vitamin A, Vitamin B1, Niacin, and Vitamin C. Animal protein intake increased as income and education levels increased, but this tendency was opposite for carbohydrates. In summary, nutritional intakes are strongly correlated with various environmental factors and the level of blood pressure. There was no difference between normotensive and hypertensive subjects with respect to the quality of food consumed except restricting energy and carbohydrate in the patient group.

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The Occlusal Evaluation and Treatment Planning for Prosthodontic Full Mouth Rehabilitation (보철학적 교합 재구성을 위한 교합진단과 치료계획)

  • Lee, Seung-Kyu;Lee, Sung-Bok;Choi, Dae-Gyun
    • Journal of Dental Rehabilitation and Applied Science
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    • v.16 no.2
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    • pp.149-159
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    • 2000
  • Occlusal disease is comparable to periodontitis in that it is generally not reversible. Occlusal disease, however, like periodontitis, often maintainable. It does itself to treatment and when restorative dentistry is utilized it becomes, in that sense, reversible. Moreover, a systematized and integrated approach will lead to a prognosis that is favorable and predictable. This approach facilitates development of optimum oral function, comfort, and esthetics, resulting in a satisfied patient. Such a systematized approach consists of four logical phase : (1) patient evaluation, (2) comprehensive analysis and treatment planning, (3) integrated and systematic reconstruction, and (4) postoperative maintenance. An integrated treatment plan is first developed on one set of diagnostic casts, properly mounted on a semiadjustable articulator using jaw relationship records. This is accomplished by using wax to make reconstructive modifications to the casts. These modified casts become the blueprint for planned occlusal changes and the fabrication of provisional restorations. The treatment goals are : (1) comfortably functioning temporomandibular joints and stomatognathic musculature, (2) adherence to the basic principle of occlusion advocated by Schuyler, (3) anterior guidance that is in harmony with the envelope of function, (4) restorations that will not violate the patient's neutral zone. This report shows the treatment procedures for a patient whose mandibular position has been altered due to posterior bite collapse. Migration of the maxillary anterior teeth had occurred, and the posterior occlusal contacts showed pathologic interference. Precise diagnosis using mounted casts was executed and prosthodontic reconstruction by the aid of an unconventional orthodontic correction on maxillary flaring was planned. An unconventional orthodontic correction can be accomplished by using preexisting natural teeth, which can be modified for use in active tooth movement or splinted together for orthodontic anchorage. This technique has an advantage over conventional fixed appliance orthodontic therapy because it can accomplish tooth movement concurrently with restorative and periodontal therapy. On occasion, minor tooth movement can be necessary to achieve the optimum occlusal scheme, crown form, and tooth position for the forces of occlusion to be displaced down the long axis of the periodontally compromised teeth. Once the occlusion, periodontal health, and crown contours for the provisional splinted restoration are acceptable, the final splinted restoration can be similarly fabricated, and it becomes an excellent orthodontic retainer.

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A Case of Intramuscular Abscess in the Sternocleidomastoid Muscle after Intramuscular Stimulation (IMS) (근육내 자극요법 후 목빗근내 농양의 치험례)

  • Kim, Jae-In;Choi, Hwan-Jun;Choi, Chang-Yong;Yang, Hyung-Eun
    • Archives of Plastic Surgery
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    • v.37 no.2
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    • pp.182-186
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    • 2010
  • Purpose: Intramuscular stimulation (IMS) shows good results in the treatment of chronic pain patients who did not respond to other treatments such as oral analgesics, trigger point injection, nerve block and epidural steroid injection. But, IMS procedure especially, patients with diabetes mellitus (DM) has sometimes serious problem. So, we present a very rare case of intramuscular abscess in the sternocleiomastoid muscle after IMS with literature review. Methods: A 66 year old male visited our department 7 days after IMS in the neck. His premorbid conditions and risk factors of deep neck infection was DM and old age. Computed tomographic scans of the head and neck region were performed in this patient: signs of deep neck infection, were seen enhanced abscess in the sternocleidomastoid muscle, cellulitis overlying tissue of the neck, and air bubbles involved muscle. Necrotic wound was excised serially and we treated this with the Vacuum-assisted closure (VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge in the pockets, continuous negative pressure of 125 mmHg was applied. The VAC therapy was utilized for a period of 12 days. Results: We obtained satisfactory results from wide excision, drainage of the abscess with the VAC system, and then primary closure. The postoperative course was uneventful. Results: We suggest that many of the infectious complications may be preventable by strict adherence to aseptic techniques and that some of the other complications may be minimized by refining the techniques with a clear understanding of the medical disorders of patients. And, the refined technique using the VAC system can provide a means of simple and effective management for the cervical intramuscular abscess, with better cosmetic and functional results.

The Endotoxin Assay of Contaminated Titanium Implants following Various Techniques of Detoxification (오염된 임프란트 표면의 해독 방법에 따른 내독소 제거 효과에 관한 연구)

  • Park, Joong-Hee;Lim, Sung-Bin
    • Journal of Periodontal and Implant Science
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    • v.34 no.1
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    • pp.71-81
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    • 2004
  • Peri-implantitis could be the result of biomechanical and occlusal overload as well as microbiologic invasion. The dental implant may be more susceptible to dental plaque than the natural tooth, as the predictability of a stable soft tissue attachment complex has not yet been confirmed. With the development of peri-implantitis, the implant surface would be exposed to the oral environment and becomes coated with bacteria. The objective of therapy for this condition is to regain integration of the implant with bone. Since fibroblast adherence to surfaces is impeded by endotoxin, it would seem that decontamination would be desirable to obtain maximum osseointegration. The purpose of this study was to determine whether various chemotherapeutic and mechanical treatments(distilled water, air-powder abrasive, hypersaturated citric acid, tetracycline) can detoxify contaminated titanium implant surface by means of kinetic LAL test. Experimental rough surface titanium disks were fabricated. All of them were divided into two groups(A.a group and P.g group) and each contaminated by A. actinomycetemcomitans and P. gingivalis suspension. Contaminated disks were treated with distilled water, air-powder abrasive, citric acid and tetracycline, and then all disks were placed into LPS-free water for elution. The results were as follows : 1. In A.a group, LPS elute level of all test groups were significantly lower than control group(p<0.05). 2. In A.a group, LPS elute level of test 2, test 3 and test4 groups were significantly lower than that of control group(p<0.05). But, among the test 2, test 3, test4 groups, the significant differences were not detected. 3. In P.g group, LPS elute level of test 2, test 3 and test 4 groups were lower than that of control group(p<0.05). But, among the test groups, the significant differences were not detected. From the result of this study, it would be concluded that air-powder abrasive, hypersaturated citric acid and tetracycline treatments may be effective at reducing endotoxin level on rough titanium implant surfaces, and can be clinically used. But the treatments in peri-implantitis differentially impact osseointegration making one method clinically superior. To gain this knowledges, further molecular biologic and histopathologic studies should be developed.