• Clinical and Experimental Pediatrics
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• v.56 no.2
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• pp.60-67
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• 2013

As chemotherapy and other sophisticated treatment strategies evolve and the number of survivors of long-term childhood cancer grows, the long-term complications of treatment and the cancer itself are becoming ever more important. One of the most important but often neglected complications is osteoporosis and increased risk of fracture during and after cancer treatment. Acquisition of optimal peak bone mass and strength during childhood and adolescence is critical to preventing osteoporosis later in life. However, most childhood cancer patients have multiple risk factors for bone mineral loss. Cancer itself, malnutrition, decreased physical activity during treatment, chemotherapeutic agents such as steroids, and radiotherapy cause bone mineral deficit. Furthermore, complications such as growth hormone deficiency and musculoskeletal deformity have negative effects on bone metabolism. Low bone mineral density is associated with fractures, skeletal deformity, pain, and substantial financial burden not only for childhood cancer survivors but also for public health care systems. Thus, it is important to monitor bone health in these patients and minimize their risk of developing osteoporosis and fragility fractures later in life.

• Journal of Chest Surgery
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• v.14 no.4
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• pp.369-380
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• 1981

In this department 504 cases of valve replacement were done since 1968 to the end of October 1981. Since October 31, 1978 to the end of October 1981 ,333 Ionescu-Shiley bovine pericardial xenograft bioprosthetic cardiac valves were replaced in 265 patients. There were 149 males and 116 female. Ages ranged from 2 to 63 years with 25 cases under 15 years of age. Among 265 cases of Ionescu valve replacement there were 157 MVR, 36 VAR, 6 TVR, 45 MVR+ AVR, 16 MVR+TVR and 5 MVR+AVR+TVR cases with mortality of 5.7%, 8.3%, 16.7%, 8.9%, 18.8% and 20% for each group respectively. Over all mortality rate in 265 Ionescu valve replacement cases was 7.9% with 21 total deaths. Main causes of operative deaths were due to LCOS in 7, bleeding in 5, arrhythmia in 3, air embolism in 2,and heart block in 2 cases. There were 12 late complications with 6 deaths. Over all long-term survival rate was 89.8%. MVR showed the highest long-term survival rate with 92.4%, and MVR+AVR+TVR the lower with 80% lower with 80%.Average follow-up period was 14 month duration. Twenty five congenital anomaly cases were operated with Ionescu-valve replacement that consisted of 7 VSD+AI, and 5 Ebstein anomaly cases with over all operative mortality of 16% and late mortality of 14.3% among 21 operative survivors. There were 25 Ionescu valve replacement cases in pediatric patients under the age of 15 years, with 4 operative deaths. Fourteen MVR, 7 AVR, and 3 TVR cases were found. Even though long-term follow-up study was short in postoperative period with total of 33~.0 months among 244 operative survivors ranging one to 36 months, the late survivors showed beneficial long-term results two thromboembolic episodes in 244 patients were found. More cases and longer term follow-up study are warranted for valve replacement in pediatric and TVR cases with Ionescu-valves which have advantageous hemodynamic structures compared with other bio-prosthetic heart valves.

• Clinical and Experimental Pediatrics
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• v.53 no.4
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• pp.477-480
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• 2010

Advances in research and medical and supportive care have contributed to a growing population of adults formerly treated for childhood cancer. History of cancer and its therapy can have significant life-long health implications. Late effects of cancer therapy can be insidious on onset, occur outside the pediatric age, and contribute to premature morbidity and mortality. In this review, I have focused on the key long-term effects of pediatric cancer therapy, particularly on the metabolic syndrome, including cardiopulmonary complications, infertility, and secondary neoplasm.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7229-7235
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• 2013

Background: To determine whether the Health Partner Program is effective in training long-term cancer survivors to be health coaches. Materials and Methods: We randomly assigned cancer survivors who were selected through a rigorous screening process to either the Health Partner Program or the waiting-list control group. The program consisted of 8 weeks of training in health management, leadership, and coaching. At baseline, 8, and 16 weeks, we measured primary outcomes using the Seven Habit Profile (SHP), the Korean Leadership Coaching Competency Inventory (KCCI), Ed Diner's Satisfaction with Life Scale (SWLS), and the Posttraumatic Growth inventory (PTGI) and secondary outcomes using the Hospital Anxiety and Depression Scale (HADS), the Impact of Event Scale-Revised (IES-R), and the Medical Outcomes Study (MOS) short form 36-item questionnaire (SF-36). Results: We recruited 70 subjects and randomly assigned 34 to the intervention group. The Sharpen the Saw habit of the SHP increased significantly more in intervention group than in the control group (p=0.049), as did most PTGI factors. The intervention group also showed a significantly greater enhancement of vitality (p=0.015) and mental health (p=0.049) SF-36 scores but no improvement in KCCI, SWLS, HADS, or IES-R scores. The intervention group also showed a greater clinically meaningful improvement in the "Think Win-Win" of SHP (p=0.043) and in the personal strength score (p=0.025) and total score (p=0.015) of the PTGI. Conclusions: Long-term cancer survivors can benefit from the Health Partner Program to become health coaches.

• Journal of Chest Surgery
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• v.17 no.2
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• pp.212-222
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• 1984

A total of and consecutive 291 patients underwent isolated mitral valve replacement using the Ionescu-Shiley bovine pericardial xenograft valve during the 5-year period between October 1978 and June 1983. Thirty-two patients were the children under 15 years of age. There were 15 deaths within 30 days after surgery [operative mortality, 5.2%]. All early survivors except 6 children were placed on the long-term oral anticoagulation longer than postoperative 3 months. A total follow-up period extended for 398.2 patient-years, and 12 patients died [late mortality, 4.1%, or 3.0%/patient- year]. Ten patients experienced the thromboembolic complication [2.51%/patient-year], occurring in 8 patients within the first 3 postoperative months, and 4 died. Three patients had the late prosthetic valve endocarditis [0.75%/patient-year] and 2 died. The incidence of overall valve failure according to the criteria was 3.01%/patient-year, or 12 patients, and 2 had replacement of the failed bioprostheses [primary tissue failure, 0.5%/patient-year]. The long-term survival rate was 87.8%\ulcorner2.6% at 5 years postoperatively, and 84% of the late survivors were in NYHA Class I at the end of the follow- up. The probability remaining free from thromboembolism and overall valve failure was 89.8%\ulcorner6.3% and 81.2%\ulcorner.8% at 5 years respectively. These clinical results confirm the safety of mitral valve replacement. The only remaining clinical problem is the structural and functional durability of the bovine pericardial xenograft valve, and its use in young patients may be stopped in preference to the mechanical prosthetic valves.

• Health Policy and Management
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• v.26 no.4
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• pp.305-314
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• 2016

Background: The purpose of this study is to examine the characteristics of and factors associated with long-term care (LTC) utilization under public long-term care insurance (LTCI) among end-of-life older adults in Korea. Methods: Using a 5% sample of older people aged 65 or older and their health and LTC insurance data, two-part model analyses were conducted. We compared LTC uses and their determinants during the last year of life among decedents in the year 2010 with those of survivors. We also compared the medical uses of the same sample with their LTC uses. Results: The end-of-life elderly were more likely to use LTC, and their expenditure on LTC was higher than their counterparts. Whether or not older people used LTC during their last year of life was significantly affected by age, sex, health insurance, household income, and living alone; however, LTC costs of the decedents were only affected by functional status, which may have been due to the reimbursement scheme of the current LTCI, which is mainly based on functional dependency level. For the survivors, having chronic diseases significantly increased the likelihood of LTC use, which was not the case for the decedents. End-of-life elderly with relatively low social economic status were more likely to use the LTC other than medical services, while the health conditions affected their medical uses most significantly. Conclusion: The study findings provide key information for predicting demand related to the increasing LTC needs of Korean older people at the end of life.

• Journal of Sasang Constitutional Medicine
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• v.28 no.3
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• pp.233-245
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• 2016

Objectives There is growing interest in the management of cancer survivors due to the increase in long-term survivors. But no literature research focusing on the management of cancer survivors has been done in Sasang Constitutional Medicine despite the superiority in comprehensive management of patients. Therefore, we planned to look into the perspective of health preservation in Sasang Constitutional Medicine.Methods We investigated the 『Donguisusebowon-Sasangchobongwon(東醫壽世保元 四象草本卷)』. We classified the contents which might be applicable to cancer patients. After classifying, we compared the contents with clinical experience and health preservation methods of Western Medicine.Results and Conclusions The health preservation is mentioned mostly as Joyang(調養). The Sasang Constitutional Medicine classifies the lives of people in 8 stages. Depending on the stages, there is a difference in the prognosis and management. Cancer patients can be regarded as being in the stages of Noeok(牢獄) and Wiegyeong(危傾). In these stages, patient's health preservation is important. In order to achieve long-term survival and to prevent disease progression, it is important to maintain requisite energy(保命之主). The attitudes that patient must have are simplicity(簡約), attentiveness(勤幹), vigilance(警戒), knowledgeability(聞見) for keeping one's own health and fulfilling the social obligations of human relations. The concept of health preservation in Sasang Constitutional Medicine covers the wide range of health. But detailed methods for patients to understand and practice are lacking. Moreover, it is hard for cancer patients to access the information. Therefore, further researches should be done to make the concept more specific and easy to access for cancer patients.

• Journal of Korean Critical Care Nursing
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• v.17 no.1
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• pp.30-43
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• 2024

Purpose : Post-intensive care syndrome (PICS) is characterized by a constellation of mental health, physical, and cognitive impairments, and is recognized as a long-term sequela among survivors of intensive care units (ICUs). The objective of this study was to explore the impact of intensive care experience (ICE) on the development of PICS in individuals surviving critical care. Methods : This secondary analysis utilized data derived from a prospective, multicenter cohort study of ICU survivors. The cohort comprised 143 survivors who were enrolled between July and August 2019. The original study's participants completed the Korean version of the ICE questionnaire (K-ICEQ) within one week following discharge from the ICU. Of these, 82 individuals completed the PICS questionnaire (PICSQ) three months subsequent to discharge from hospital. The influence of ICE on the manifestation of PICS was examined through Partial Least Squares-Structural Equation Modeling (PLS-SEM). Result : The R² values of the final model ranged from 0.35 to 0.51, while the Q² values were all greater than 0, indicating adequacy for prediction of PICS. Notable pathways in the relationship between the four ICE dimensions and the three PICS domains included significant associations from 'ICE-awareness of surroundings' to 'PICS-cognitive', from 'ICE-recall of experience' to 'PICS-cognitive', and from 'ICE-frightening experiences' to 'PICS-mental health'. Analysis found no significant moderating effects of age or disease severity on these relationships. Additionally, gender differences were identified in the significant pathways within the model. Conclusion : Adverse ICU experiences may detrimentally impact the cognitive and mental health domains of PICS following discharge. In order to improve long-term outcomes of individuals who survive critical care, it is imperative to develop nursing interventions aimed at enhancing the ICU experience for patients.

• Advances in pediatric surgery
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• v.4 no.2
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• pp.125-130
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• 1998

To assess the clinical and nutritional status of long-term survivors of biliary atresia, history taking, medical record review, physical examination (height, weight, MAC, TSF), blood tests (LFT, prothrombin time, platelet count, prealbumin, calcium) and liver needle biopsy were performed in 12 patients in whom Kasai procedure were performed more than 10 years ago at Department of Pediatric Surgery in Seoul National University Hospital. None were below the 5th percentile in height and weight. TSF was above the 75th percentile in all patients and showed good subcutaneous fat deposition. MAC was above the 5th percentile in all patients. Serum prealbumin level was abnormal in 2 patients with abnormal liver function and revealed visceral protein malnutrition. Serum calcium level was decreased below normal range in 4 patients with abnormal liver function. One patient had mild ascites. Five patients had abnormal liver function and 7 patients showed clinical manifestation of portal hypertension. Liver needle biopsy was performed in 5 patients and no cirrhotic change was observed. Although some patients who have survived for more than 10 years after Kasai procedure developed protein malnutrition and vitamin deficiencies, growth and development and nutritional status were generally satisfactory. Five patients(42%) showed normal liver function and no portal hypertension. In conclusion, Kasai procedure is satisfactory as a primary treatment in biliary atresia but significant portion of long-term survivors had abnormal liver function and portal hypertension. Continuous and careful follow-up is necessary to determine when liver transplantation may be indicated.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7685-7692
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• 2013

Background: Management of hypertension and diabetes in cancer survivors is an important issue; however, not much is known about the level of management of such chronic disease in Korea. This study therefore assessed the prevalence, awareness, control, and treatment of hypertension and diabetes in Korean cancer survivors compared to non-cancer survivors. Materials and Methods: A cross-sectional design was employed, wherein data were obtained from standardized questionnaires completed by 943 cancer survivors and 41,233 non-cancer survivors who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Surveys (2007-2011). We calculated adjusted proportions for prevalence and management of hypertension and diabetes in non-cancer survivors and cancer survivors. We also assessed the associated factors with prevalence and management of cancer survivors. Results: Cancer survivors are more likely than the general population to have higher prevalence, awareness, treatment, and control of hypertension. However, diabetic management was not significantly higher in cancer survivors than in non-cancer survivors, despite their having a higher prevalence. Several factors, such as, age, drinking, years since cancer diagnosis, self-perceived health status, and specific cancer types were found to affect to management of hypertension and diabetes. Conclusions: These data suggest that cancer survivors appear to be better than non-cancer survivors at management of hypertension, but not diabetes. There is a need for healthcare providers to recognize the importance of long-term chronic disease management for cancer survivors and for the care model to be shared between primary care physicians and oncologists.