• Journal of Korean Neurosurgical Society
• /
• 제54권4호
• /
• pp.296-301
• /
• 2013

Objective : We conducted a retrospective study examining the outcomes of intracerebral hemorrhage (ICH) in patients with chronic kidney disease (CKD) to identify parameters associated with prognosis. Methods : From January 2001 to June 2008, we treated 32 ICH patients (21 men, 11 women; mean age, 62 years) with CKD. We surveyed patients age, sex, underlying disease, neurological status using Glasgow Coma Scale (GCS), ICH volume, hematoma location, accompanying intraventricular hemorrhage, anti-platelet agents, initial and 3rd day systolic blood pressure (SBP), clinical outcome using the modified Rankin Scale (mRS) and complications. The severity of renal functions was categorized using a modified glomerular filtration rate (mGFR). Multifactorial effects were identified by regression analysis. Results : The mean GCS score on admission was $9.4{\pm}4.4$ and the mean mRS was $4.3{\pm}1.8$. The overall clinical outcomes showed a significant relationship on initial neurological status, hematoma volume, and mGFR. Also, the outcomes of patients with a severe renal dysfunction were significantly different from those with mild/moderate renal dysfunction (p<0.05). Particularly, initial hematoma volume and sBP on the 3rd day after ICH onset were related with mortality (p<0.05). However, the other factors showed no correlation with clinical outcome. Conclusion : Neurological outcome was based on initial neurological status, renal function and the volume of the hematoma. In addition, hematoma volume and uncontrolled blood pressure were significantly related to mortality. Hence, the severity of renal function, initial neurological status, hematoma volume, and uncontrolled blood pressure emerged as significant prognostic factors in ICH patients with CKD.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제20권1호
• /
• pp.41-46
• /
• 2017

Purpose: Vitamin D deficiency is common in Crohn disease (CD). The aim of the study was to examine the prevalence of vitamin D deficiency and evaluate the association between vitamin D status and growth outcome in Korean pediatric CD patients. Methods: In this retrospective study, 17 children younger than 18 years old diagnosed with CD were enrolled and their serum 25-hydroxy vitamin D (25[OH]D) was checked between 2011 and 2015. We categorized the patients into two groups, Group 1 and Group 2. Group 1 included patients with serum 25(OH)D levels below 10 ng/mL, and Group 2 was for patients with a 25(OH)D serum levels between 10 ng/mL and 30 ng/mL. The z-scores for height (Htz), weight (Wtz), and body mass index (BMIz) were measured at baseline, 6 months, and 12 months. Results: The mean serum 25(OH)D levels of the total 65 CD patients and 17 enrolled patients were $15.64{\pm}6.9ng/mL$ and $13.1{\pm}5.1ng/mL$, respectively. There was no correlation at the beginning of the study between vitamin D level and growth parameters (Htz, Wtz, BMIz) or other variables including laboratory data and Pediatric Crohn Disease Activity Index. The Htz, Wtz, and BMIz in Group 1 showed no significant improvement at 6 months and 12 months follow-up. In Group 2, Wtz and BMIz showed significant improvements sustained until 12 months of follow-up. Htz showed no significant improvement at 6 months but there was significant improvement at 12 months. Conclusion: It seems that baseline vitamin D status affects growth outcome in pediatric CD.

• Tuberculosis and Respiratory Diseases
• /
• 제81권2호
• /
• pp.116-122
• /
• 2018

Background: Chronic obstructive pulmonary disease (COPD) is a serious chronic condition with a global impact. Symptoms of COPD include progressive dyspnea, breathlessness, cough, and sputum production, which have a considerable impact on the lives of patients. In addition to the human cost of living with COPD and the resulting death, COPD entails a huge economic burden on the Chinese population, with patients spending up to one-third of the average family income on COPD management in some regions is clinically beneficial to adopt preventable measures via prudent COPD care utilization, monetary costs, and hospitalizations. Methods: Toward this end, this study compared the relative effectiveness of six indices in predicting patient healthcare utilization, cost of care, and patient health outcome. The six assessment systems evaluated included the three multidimensional Body mass index, Obstruction, Dyspnea, Exercise capacity index, Dyspnea, Obstruction, Smoking, Exacerbation (DOSE) index, and COPD Assessment Test index, or the unidimensional measures that best predict the future of patient healthcare utilization, cost of care, and patient health outcome among Chinese COPD patients. Results: Multiple linear regression models were created for each healthcare utilization, cost, and outcome including a single COPD index and the same group of demographic variables for each of the outcomes. Conclusion: We conclude that the DOSE index facilitates the prediction of patient healthcare utilization, disease expenditure, and negative clinical outcomes. Our study indicates that the DOSE index has a potential role beyond clinical predictions.

• 기본간호학회지
• /
• 제19권4호
• /
• pp.463-473
• /
• 2012

Purpose: The main purpose of this study was to identify factors affecting medication adherence and to develop an explanatory model for medication adherence in elders with chronic disease. Method: Empirical data were collected from 312 older adults with chronic disease and the data collect period was from August 8 to 31, 2011, and were analyzed using SPSS for Windows 19.0 program and confirmatory factor analysis with the structural equation model (SEM) procedure performed with AMOS 19.0 program. Results: Results of this study showed that perceived self-efficacy was the strongest factor influencing medication adherence, and it affected also outcome expectations positively but impediments were negatively influenced by self-efficacy. Outcome expectations and impediments subsequently acted on medication adherence with the same relationship as self-efficacy. In additional results, self-efficacy and medication adherence were further significantly affected by the factors; social support, medication knowledge, and depression. Conclusion: These results show that nursing interventions to promote medication adherence in this population should focus on self-efficacy promotion including social support, education for delivery of medication knowledge, and reduction in depression.

• 한국의료질향상학회지
• /
• 제7권2호
• /
• pp.204-216
• /
• 2000

Background : There has been a concern that the quality of care provided to end-stage renal disease (ESRD) patients in the United States may not be as good as recommended. This paper illustrates a composite measure to assess, the quality of care received by ESRD patients undergoing in-center hemodialysis by incorporating outcomes for 4 major treatment areas. The 4 treatment areas are: dialysis treatments, anemia control, nutritional management, and blood pressure control. Methods : The major data source for the study was the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study Wave 1 (DMMS-1) d Sixteen categories of a composite quality indicator were constructed by combining 4 dichotomous variables (16=2*2*2*2). representing the optimal vs. less than optimal level of outcome for each of the 4 treatment outcome measure respectively. Optimal outcome level for each treatment area was defined based on the recommendation from the National Kidney Foundation: (a) delivered dialysis doses (Kt/V) ${\geq}$ 1.2; (b) hematocrit level ${\geq}$ 30%; (c) serum albumin concentration ${\geq}$ 3.8g/dl ; and (d) blood pressure of <140 / <90mmHg. The 16 quality indicator were ranked according to their relative quality weights, which were estimated from its association with the relative risk of survival, adjusting for patient's baseline severity and dialysis facility characteristics. Results : Out of the entire sample of 2,179 patients, only 229 (10%) meet th recommended outcome levels for all 4 treatment areas. Overall, the study patients were distributed evenly over the 16 quality indicators, indicating a great variation in the quality of ESRD care. It appears that the rank of the 16 quality-indicators is driven by serum albumin concentration, suggesting that serum albumin concentration may be the most powerful predictor of ESRD patient survival among the 4 outcome measures. Conclusion : The developed quality indicator has the advantage of describin a range of care for dialysis patients and thus providing a more complete picture of care as compared to previous studies that have focused on only single or few components of the ESRD care.

• Healthcare Informatics Research
• /
• 제24권4호
• /
• pp.346-358
• /
• 2018

Objectives: The association between obstructive sleep apnea (OSA) and mortality or serious cardiovascular events over a long period of time is not clearly understood. The aim of this observational study was to estimate the clinical effectiveness of continuous positive airway pressure (CPAP) treatment on an outcome variable combining mortality, acute myocardial infarction (AMI), and cerebrovascular insult (CVI) during a follow-up period of 15.5 years ($186{\pm}58$ months). Methods: The data set consisted of 978 patients with an apnea-hypopnea index (AHI) ${\geq}5.0$. One-third had used CPAP treatment. For the first time, a data-driven causal Bayesian network (DDBN) and a hypothesis-driven causal Bayesian network (HDBN) were used to investigate the effectiveness of CPAP. Results: In the DDBN, coronary heart disease (CHD), congestive heart failure (CHF), and diuretic use were directly associated with the outcome variable. Sleep apnea parameters and CPAP treatment had no direct association with the outcome variable. In the HDBN, CPAP treatment showed an average improvement of 5.3 percentage points in the outcome. The greatest improvement was seen in patients aged ${\leq}55$ years. The effect of CPAP treatment was weaker in older patients (>55 years) and in patients with CHD. In CHF patients, CPAP treatment was associated with an increased risk of mortality, AMI, or CVI. Conclusions: The effectiveness of CPAP is modest in younger patients. Long-term effectiveness is limited in older patients and in patients with heart disease (CHD or CHF).

• 한국환경보건학회지
• /
• 제47권6호
• /
• pp.505-512
• /
• 2021

Background: The occurrence of environmental disease is known to be associated with chronic exposure to toxic chemicals, including waterborne contaminants, air/indoor pollutants, asbestos, ingredients in humidifier disinfectants, etc. Objectives: In this study, we reviewed toxicological studies related to environmental disease as defined by the Environmental Health Act in Korea and toxic chemicals. We also suggested a direction for future toxicological research necessary for the prevention and management of environmental disease. Methods: Trends in previous studies related to environmental disease were investigated through PubMed and Web of Science. A detailed review was provided on toxicological studies related to the humidifier disinfectants. We identified adverse outcome pathways (AOPs) that can be linked to the induction of environmental diseases, and proposed a chemical screening system that uses AOP, chemical toxicity big data, and deep learning models to select chemicals that induce environmental disease. Results: Research on chemical toxicity is increasing every year, but there is a limitation to revealing a clear causal relationship between exposure to chemicals and the occurrence of environmental disease. It is necessary to develop various exposure- and effect-biomarkers related to disease occurrence and to conduct toxicokinetic studies. A novel chemical screening system that uses AOP and chemical toxicity big data could be useful for selecting chemicals that cause environmental diseases. Conclusions: From a toxicological point of view, developing AOP related to environmental diseases and a deep learning-based chemical screening system will contribute to the prevention of environmental diseases in advance.

• 대한한의학회지
• /
• 제43권1호
• /
• pp.112-135
• /
• 2022

Objectives: The objective of this study was to summarize clinical studies conducted over the last five years that investigated the effect of acupuncture on Parkinson's disease and to propose a better process of study. Methods: Research Information Sharing Service (RISS), Korea Studies Information Service (KISS), Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and China National Knowledge Infrastructure (CNKI) were systemically searched for clinical trials that had investigated the effect of acupuncture on the course of Parkinson's disease from May 2016 to April 2021. Results: A total of 23 studies met all the inclusion criteria. In most reports, acupuncture had significant positive effects on the course of Parkinson's disease. Furthermore, there were no serious adverse events associated with acupuncture in any of the studies. In addition to the acupuncture methods that showed effectiveness in previous studies, various types of acupuncture have been used to treat sub-symptoms of Parkinson's disease. The outcome measures were subdivided through individual symptom evaluation and mechanical analysis. Follow-up assessments were also performed to analyze the continuous effect. Conclusion: In the clinical studies conducted over the last five years, many studies investigated the various types of acupuncture used to treat Parkinson's disease and the segmentation and diversification of outcome measures focusing on individual symptoms, and a new approach for excluding placebo effects through follow-up studies has been made. Further attempts like these are needed to overcome methodological flaws in studies on the effects of acupuncture on Parkinson's disease.

• Tuberculosis and Respiratory Diseases
• /
• 제78권3호
• /
• pp.156-160
• /
• 2015

Severe sepsis and septic shock is a life-threatening disease. It is combined with multi-organ failure. In the past decade, early goal directed therapy has been proposed as an effective treatment strategy for better outcome. Recent epidemiologic studies showed that the outcome of sepsis has been improved with the introduction of early goal directed therapy. However, it is unclear which elements of early goal directed therapy contributed to the better outcome. Recent prospective and randomized trials suggested that some elements of early goal directed therapy did not have any effect on the outcome benefit. In this paper, recent articles about early goal directed therapy will be reviewed and the effectiveness of individual elements of early goal directed therapy will be discussed.

• Asian Pacific Journal of Cancer Prevention
• /
• 제14권6호
• /
• pp.3565-3568
• /
• 2013

Background: Cholangiocarcinoma is the most common cancer in males in Thailand. The outcome is poor although systemic chemotherapy has been used in attempts to improve disease control, quality of life and prolong survival in patient with unresectable and advanced disease. Materials and Methods: In this retrospective study the medical records of all patients diagnosed as having unresectable and metastatic cholangiocarcinoma and receiving systemic chemotherapy at Udonthani Cancer Hospital during January 2007 to December 2010 were reviewed. Results: Among the total of 105 patients, 21 received gemcitabine-based chemotherapy and 84 5FU-based chemotherapy. Most received platinum doublet regimens. 5FU-based regimens yielded an overall response rate (tumor control) of 23.8% and a median survival of 7.2 months while gemcitabine-based regimens yielded an overall response rate (tumor control) 19.1% and a median survival of 10.0 months. Conclusions: Tumor control and survival of patient with advanced cholangiocarcinoma treated with gemcitabine-based and 5FU-based chemotherapy do not markedly differ.