Introduction: Febrile neutropenia is a relatively frequent event in cancer patients treated with chemotherapy and improvement in absolute neutrophil count (ANC) has been linked directly to improved outcome. Evaluation of granulocyte colony stimulating factors (GCSFs) for treatment has shown reduced incidences of episodes of prolonged neutropenia and protracted hospitalization. To determine absolute neutrophil counts with GCSF in febrile neutropenic cancer patients admitted to a tertiary care centre and to co-relate the improvement in ANC with mortality and hospital discharge. Methods: A prospective cross sectional study was carried at an oncology ward at Aga Khan University hospital from January 2010 to June 2011. All adult patients who were admitted and treated with GCSF for chemotherapy induced febrile neutropenia were included. Multivariable regression was conducted to identify the factors related with poor outcomes. Results: A total of 131 patients with febrile neutropenia were identified with mean age of 43.2 (18-85) years, 79 (60%) being ${\leq}50$. Seventy-five (57%) had solid tumors and 56 (43%) hematological malignancies, including lymphoma. Fifty seven (43.5%) had an ANC less 100 cells/$mm^3$, 34 (26%) one between 100-300 cells/$mm^3$ and 40 (31%) an ANC greater than 300 cells/$mm^3$. Thirty (23%) patients showed ANC recovery in 1-3 days, and 74(56%) within 4-7 days. Thirteen (10%) patients showed no recovery. The overall mortality was 18 (13.7%) patients. The mean time for ANC recovery seen in hematological malignancies was 6.34 days whereas for solid tumors it was 4.88 days. Patients with ANC <100 cells/$mm^3$ were more likely to die than patients with ANC >300 cells/$mm^3$ by a factor of 4.3. Similarly patients >50 years of age were 2.7 times more likely to die than younger patients. Conclusion: Our study demonstrated that use of GCSF, in addition to intravenous antibiotics, in treatment of patients with chemotherapy induced febrile neutropenia accelerates neutrophil recovery, and shortens antibiotic therapy and hospitalization. We propose to risk classify the patients at the time of admission to evaluate the cost effectiveness of this approach in a resource constrained setup.
Jeong, Hyung Joo;Ahn, Yo Han;Park, Eujin;Choi, Youngrok;Yi, Nam-Joon;Ko, Jae Sung;Min, Sang Il;Ha, Jong Won;Ha, Il-Soo;Cheong, Hae Il;Kang, Hee Gyung
Clinical and Experimental Pediatrics
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v.60
no.3
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pp.86-93
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2017
Purpose: To evaluate the clinical spectrum of posttransplantation lymphoproliferative disorder (PTLD) after solid organ transplantation (SOT) in children. Methods: We retrospectively reviewed the medical records of 18 patients with PTLD who underwent liver (LT) or kidney transplantation (KT) between January 1995 and December 2014 in Seoul National University Children's Hospital. Results: Eighteen patients (3.9% of pediatric SOTs; LT:KT, 11:7; male to female, 9:9) were diagnosed as having PTLD over the last 2 decades (4.8% for LT and 2.9% for KT). PTLD usually presented with fever or gastrointestinal symptoms in a median period of 7 months after SOT. Eight cases had malignant lesions, and all the patients except one had evidence of Epstein-Barr virus (EBV) involvement, assessed by using in situ hybridization of tumor tissue or EBV viral load quantitation of blood. Remission was achieved in all patients with reduction of immunosuppression and/or rituximab therapy or chemotherapy, although 1 patient had allograft kidney loss and another died from complications of chemotherapy. The first case of PTLD was encountered after the introduction of tacrolimus for pediatric SOT in 2003. The recent increase in PTLD incidence in KT coincided with modification of clinical practice since 2012 to increase the tacrolimus trough level. Conclusion: While the outcome was favorable in that all patients achieved complete remission, some patients still had allograft loss or mortality. To prevent PTLD and improve its outcome, monitoring for EBV infection is essential, which would lead to appropriate modification of immunosuppression and enhanced surveillance for PTLD.
This study addresses information technology using level has an effect on the collaboration and organization's performance depending on the partnership that is important because of rapid development of information technology and internet diffusion. In the long view, information technology persistently increases the performance and expects the useful factor for the examing the organization's performance. Information technology using level leaves the lowness or highly, information technical application effort for the future value of each enterprise is necessary, the staff education which continuous for this the fact that the introduction is more important what continuously is information technology which is suitable at the enterprise of execution. The main purpose of this study is to figure out the difference between collaboration and organization's outcome using information technology using level that is moderating variable and difference the effect.
Journal of the Korea Academia-Industrial cooperation Society
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v.21
no.4
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pp.173-180
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2020
This is the report of a case study to describe the results of applying an evaluation tool for communication ability when performing core basic nursing skills in fundamental nursing practice education. The communication ability evaluation tool was constructed based on a literature review and expert advice. The tool was applied to test 94 students who were taking fundamental nursing practice courses from October to November 2019. As a result, five factors (self-introduction, eye contact, emotional support, information provision, and therapeutic touch) were derived as evaluable items of communication ability to be evaluated when performing core basic nursing skill, and were evaluated when performing core basic nursing skills to measure vital signs. The average communication ability was 3.96 out of 5 points. According to the rubric, 95.8% of all students attained 'medium' and reached their goal achievement level. The findings of this study are meaningful in providing an important basis for improving the performance outcome evaluation process and for constructing a systematic evaluation system in fundamental nursing practicum. Further studies to secure the validity and reliability of this communication ability evaluation tool and comparative studies with various evaluation tools are suggested.
Purpose: This research with one group pre-post design was carried out to test the practical feasibility to administrate the Music Movement program developed for the stroke patients. Subjects: 12 stroke survivors at "J" Public Health Center in Seoul. were participated in. The average age was 68 years old, the ratio of sex was almost 5.8:4.2, the duration of was almost over 1 year. Method: Music Movement program was conducted for 2 hours ${\times}$ 1day ${\times}$ 6 weeks. The contents of Music Movement program were consisted of the preparatory activities, main activities and the wrap up activities. The preparatory activities are ice braking, greeting, explanation of the aims of music movement program, and introduction of stroke disease and ROM exercise. The main activities are the body motions with singing and playing musical instruments. The wrap up activities are stretching and joints and discussion of home activities. Data Collection: The outcome variables are muscle strength, finger pinch power, ROMs, flexibility, depression, and life satisfaction. Depression was measured by CES-D(Kim, I. J., 1999), life satisfaction by ladder scale(McDowell & Newell, 1996), and ADL state(Holbrook & Skilbeck, 1983). Data Analysis: SPSS/PC 10.0 for Window was used. Wilcoxon Signed Ranks Test was used to analyze outcome measures. The level of statistical significance was set at p<.05. Results: This program was effective to decrease the depression level of subjects(p<.05). The muscle strength, hand grip power, ROMs, life satisfaction, and rehabilitation state of the subjects were slightly increased but no significant differences were found between the pre and post test. Additionally every patient replied that they were very satisfied and expressed their appreciation for this program very much. Of course they strongly want to continue to participate in and meet the peer group again. Conclusion: Considering these results, the practical feasibility of Music Movement program can be supported. Therefore, this Music Movement program can be examined with the quasi-experimental design with control group and ongoing reviews. After that, this program would be applied in public health centers, medical institutes, and welfare centers for the rehabilitation of stroke patients.
We report and analyze the Korean physicians' recent general strike over the implementation of the Separation of Prescribing and Dispensing Practice (SPDP) in which more than 18,000 private clinics and 280 hospitals participated. Utilizing game-theoretic models of bargaining we explain why the Korean physicians were so successful in organizing intense collective action against the government and securing very favorable policy outcomes. In particular, we highlight the role of distributional conflict among social actors in shaping the details of institutional reform. The introduction of the SPDP was a necessary first step in the overall reform of health care system in Korea. However, the SPDP was perceived to be a serious threat to the economic viability of their profession by the vast majority of Korean physicians who had long been relied on the profits from selling medicines to compensate for the loss of income due to the low service fee under the previous health care system. The strong political coalition among heterogeneous physicians enabled them to organize an intense form of collective action, the general strike. Thus, physicians were successful not only in dragging the government to a bargaining table, but also winning in the bargaining and securing an outcome vastly favorable to them. On the other hand, the lack of an overall reform plan in the health care policy area, especially the finance of the National Health Insurance and the need for maintaining an image as a successful reform initiator, motivated the government to reach a quick resolution with the striking physicians.
Journal of Korean Society of Industrial and Systems Engineering
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v.40
no.2
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pp.31-40
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2017
In this paper, we compared the efficiencies of national R&D investments between NT (Nanotechnology) areas in terms of papers, patents, and commercializations, and found ways to improve the efficiencies of national R&D investments for each NT area. This is in response to huge R&D investments government has made recently in NT areas. Here, we collected data on investments, papers, patents, and commercializations for the R&D projects in NT areas through National Science & Technology Information Service. Based on the data, we analyzed the investment and performances (papers, patents, and commercializations) for each NT area, calculated the efficiency for each NT area, and compared the efficiencies between NT areas. Next, using cluster analysis, we identified several NT areas with similar characteristics in terms of paper efficiency, patent efficiency and commercialization efficiency. Finally, we derived implications for the efficiency enhancement for each grouping. The cluster analysis showed that there could be two groups, one being low in terms of technological outcome (papers and patents) efficiencies and high in terms of commercialization efficiencies, while the other being high in terms of technological outcome (papers and patents) efficiencies and low in terms of commercialization efficiencies. Therefore, the strategy for one group calls for support for technology transfer or technology introduction from other R&D performers and grant of guidance for improving R&D performers' commercialization ability to other R&D performers while the strategy for the other group calls for R&D support for transfer of technology to other R&D performers, activation of technology transfer and support for commercialization of R&D performers.
Introduction: Soft-tissue impingement syndrome is now increasingly recognized as a significant cause of the chronic ankle pain. As a method to detect soft-tissue ankle impingement, a characteristic history and physical examination, routine MR imaging, and direct MR arthrography were used. The efficacy of routine MR imaging has been controversial for usefulness because of low sensitivity and specificity. Direct MR artrhography was recommaned for diagnosis because of the highest sensitivity, specificity and accuracy, but it requires an invasive procedure. The purpose of this study is to investigate the diagnostic accuracy of Fat suppressed, contrast enhanced, three-dimensional fast gradient recalled acquisition in the steady state with rediofrequency spoiling magnetic resonance imaging(CE 3D-FSPGR MRI) and to evaluate the clinical outcome of the arthroscopic treatment in assessing soft-tissue impingement associated with trauma of the ankle. Materials and Methods: We reviewed 38 patients who had arthroscopic evaluations and preoperative magnetic resonance imaging studies(3D-FSPGR MRI) for post-traumatic chronic ankle pain between January 2000 and August 2002. Among them, 24 patients had osteochondral lesion, lateral instability, loose body, malunion of lateral malleoli, and peroneal tendon dislocation. The patient group consisted of 23 men and 15 women with the average age of 34 years(16-81 years). The mean time interval from the initial trauma to the operation was 15.5 months(3 to 40 months), The mean follow-up duration of the assessment was 15.6months(12-48 months). MRI was simultaneously reviewed by two radiologists blinded to the clinical diagnosis. The sensitivity, specificity and accuracy of MRI was obtained from radiologic and arthroscopic finding. Arthroscopic debridement and additional operation for associated disease were performed. We used a standard protocol to evaluate patients before the operation and at follow-up which includes American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. Results: For the assessment of the synovitis and soft tissue impingement, fat suppressed CE 3D-FSPGR MR imaging had the sensitivity of 91.9%, the specificity of 84.4 and the accuracy of 87.5%. AOFAS Ankle-Hindfoot Score of preoperative state was 69.2, and the mean score of the last follow-up was 89.1. These were assessed as having 50% excellent(90-100) and 50% good(75-89). The presence of other associated disease didn't show the statistically significant difference(>0.05). Conclusion: Fat suppressed CE 3D-FSPGR MR imaging is useful method comparable to MR arthrography for diagnosis of synovitis or soft-tissue impingement, and arthroscopic debridement results in good clinical outcome.
Journal of the Korean Society of Clothing and Textiles
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v.36
no.2
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pp.194-205
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2012
Historically, garments have been spontaneously made with human instinct in order to warm and decorate the body using textiles that have been made and used by various peoples in different cultures. Contemporary garments have been used as a means of warming as well as express individual personality and a desire to pursue beauty. They have a unique formativeness and a symbolic nature according to cultural phenomena that reflect a cultural outcome that expresses contemporary thinking and ideology as well as their aesthetic consciousness. This study globally promotes Chinese opera mask culture and proposes the possibility of creative thinking through the introduction of Chinese opera mask elements into contemporary fashion, expressing them as patchworks. In order to endow artistic value (required in contemporary fashion) this study creates works by analyzing and applying a formative sense seen in patchwork techniques and the characteristics of Chinese opera masks; in addition, it sought the possibility of new expressions in garment designs. The results obtained from the research involve the following. First, the introduction of the traditional patchwork technique to contemporary garments may be a dynamic theme of garment expression and exceed stereotypical ideas that enable the creation of designs attuned to the globalization era. Second, it was possible to pursue independent formativeness which is in harmony with a modern sense through the restructuring of the harmony of colors and practical characteristics found in patchworks. Third, it was possible to demonstrate their artistry and unique effect in the expression of contemporary garments by the expression of the analyzed results of characteristic patterns of Chinese opera masks with a patchwork technique in creating works. Results show that it is necessary to conduct research into a patchwork technique that applies diverse materials as a new method to develop contemporary garment design also as a creative design. In addition, if the analyzed results of the characteristic patterns of Chinese opera masks can be expressed with a patchwork technique, they may be able to exhibit a genuine effect along with the artistry of expression in contemporary garments; thereby, relevant follow-up research should be further continued.
Proceedings of the Korean Statistical Society Conference
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2002.05a
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pp.79-83
/
2002
Since its introduction in 1995 by Schena et al. cDNA microarrays have been established as a potential tool for high-throughput analysis which allows the global monitoring of expression levels for thousands of genes simultaneously. One of the characteristics of the cDNA microarray data is that there is inherent noise even after the removal of systematic effects in the experiment. Therefore, replication is crucial to the microarray experiment. The assessment of reproducibility among replicates, however, has drawn little attention. Reproducibility may be assessed with several different endpoints along the process of data reduction of the microarray data. We define the reproducibility to be the degree with which replicate arrays duplicate each other. The aim of this note is to develop a novel measure of reproducibility among replicates in the cDNA microarray experiment based on the unprocessed data. Suppose we have p genes and n replicates in a microarray experiment. We first develop a measure of reproducibility between two replicates and generalize this concept for a measure of reproducibility of one replicate against the remaining n-1 replicates. We used the rank of the outcome variable and employed the concept of a measure of tracking in the blood pressure literature. We applied the reproducibility measure to two sets of microarray experiments in which one experiment was performed in a more homogeneous environment, resulting in validation of this novel method. The operational interpretation of this measure is clearer than Pearson's correlation coefficient which might be used as a crude measure of reproducibility of two replicates.
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