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Clinical application of RapidArc volumetric modulated arc therapy as a component in whole brain radiation therapy for poor prognostic, four or more multiple brain metastases

  • Lee, Seung-Heon;Lee, Kyu-Chan;Choi, Jin-Ho;Kim, Hye-Young;Lee, Seok-Ho;Sung, Ki-Hoon;Kim, Yun-Mi
    • Radiation Oncology Journal
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    • v.30 no.2
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    • pp.53-61
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    • 2012
  • Purpose: To determine feasibility of RapidArc in sequential or simultaneous integrated tumor boost in whole brain radiation therapy (WBRT) for poor prognostic patients with four or more brain metastases. Materials and Methods: Nine patients with multiple (${\geq}4$) brain metastases were analyzed. Three patients were classified as class II in recursive partitioning analysis and 6 were class III. The class III patients presented with hemiparesis, cognitive deficit, or apraxia. The ratio of tumor to whole brain volume was 0.8-7.9%. Six patients received 2-dimensional bilateral WBRT, (30 Gy/10-12 fractions), followed by sequential RapidArc tumor boost (15-30 Gy/4-10 fractions). Three patients received RapidArc WBRT with simultaneous integrated boost to tumors (48-50 Gy) in 10-20 fractions. Results: The median biologically effective dose to metastatic tumors was 68.1 $Gy_{10}$ and 67.2 $Gy_{10}$ and the median brain volume irradiated more than 100 $Gy_3$ were 1.9% (24 $cm^3$) and 0.8% (13 $cm^3$) for each group. With less than 3 minutes of treatment time, RapidArc was easily applied to the patients with poor performance status. The follow-up period was 0.3-16.5 months. Tumor responses among the 6 patients who underwent follow-up magnetic resonance imaging were partial and stable in 3 and 3, respectively. Overall survival at 6 and 12 months were 66.7% and 41.7%, respectively. The local progression-free survival at 6 and 12 months were 100% and 62.5%, respectively. Conclusion: RapidArc as a component in whole brain radiation therapy for poor prognostic, multiple brain metastases is an effective and safe modality with easy application.

The Effects of Health Exercise Program on Walking ability, Depression and WHOQOL-BREF in the Fall experienced Women Elderly (건강체조 프로그램이 낙상경험 여성노인의 보행능력, 우울 및 삶의 질에 미치는 효과)

  • Kim, Young-Hee
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.11 no.10
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    • pp.3726-3732
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    • 2010
  • The purpose of this study was to investigate the effects of health exercise program to old Women's walking ability, depression and WHOQOL-BREF. Data were collected from April to June, 2007 from the falls experienced 70 women elderly. All subjects participated in 12 week health exercise program which was designed in order to develop walking ability. The data were analyzed using frequency, %, paired t-test. The results of this study were as followings; First, there was significant differences in the average time of chair stand (t=2.291, p=.025), one leg standing(Rt. leg)(t=2.236, p=.029), step length between before and after(t=4.015, p=.000) training of 12 week health exercise program. Second, there was non significant differences in depression(t=1.044, p=.300) but, significant differences in WHOQOL-BREF(t=3.528, p=.001). The WHOQOL-BREF in general quality of life(t=2.923, p=.005), physical(t=3.039, p=.003), psychological(t=2.481, p=.016), social(t=2.531, p=.014) and environment domain(t=4.259, p=.000) were significant differences. The results suggest that the 12 week health exercise program can improve the muscle endurance and balance, QOL.

Effects of health promotion education experience on present health status of elderly (건강증진 보건교육 경험이 노인의 현재 건강상태에 미치는 영향)

  • Lee, Heung Hun;Hwang, Eun Jeong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.20 no.11
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    • pp.106-114
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    • 2019
  • This study aims to identify the effects of experiencing health promotion education on the present health status of elderly people. The subjects of this study were a total 10,532 elderly people (aged 65 years or older), and who were selected from the data of the '2017 Community Health Survey'. The health promotion education experience consisted of handwashing education/campaign, a non-smoking campaign and non-smoking education. The chronic disease control education experience consisted of education on hypertension, diabetes mellitus and arthritis. Psychiatric counseling consisted of consultations on stress, depression and suicide. The present health status consisted of the patients' ability to exercise, their self-care ability, their activities of daily living, their pain/discomfort and their anxiety/depression. The data was analyzed utilizing the chi-square test, the Mann-Whitney test and multivariate logistic regression analysis. The general characteristics of the subjects were 4,075 males (38.69%) and 6,457 females (61.31%). The average age was 73.71(±6.18) years old. The significant factors influencing the elderly peoples' present health status were age (OR=0.909, 95% CI=0.886-0.933), handwashing education/campaign (OR=2.463, 95% CI=1.703-3.563), a stop smoking campaign (OR=1.624, 95% CI=1.146-2.301) and consultation for mental problems (OR=0.533, 95% CI=0.359-0.791). In conclusion, to modify the personal habits that the elderly have had for a long time and to show the effects of education, long-term continuous education that focuses on the characteristics of the people will be effective.

Concept Analysis of Health Inequalities using Hybrid Model (혼종 모형을 이용한 건강 불평등 개념분석)

  • Lee, Ha-na
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.19 no.3
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    • pp.520-534
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    • 2018
  • This study was conducted to understand the conceptual definition and characteristics of health inequality. To accomplish this, we analyzed data collected from 14 participants as well as from available literature regarding health inequality using the hybrid model introduced by Schwartz-Barcott and Kim. We categorized health inequality into nine attributes in three dimensions. These dimensions included "target", "precede", and "result," corresponding to the target, cause and consequence of health inequality, respectively. Specifically, we define health inequality as individuals, families, communities, socio-economic, or geographically distinct demographic groups that are treated unfairly and result in several problems such as loss of quality of life, reduction of survival rate, or aggravation of a disease due to (i) poor treatment by a hospital (ii) irregular meals, (iii) desperate need for work (for money), (iv) expensive medical care costs, (v) qualitative differences in medical care by regional groups (vi) the lack of knowledge regarding disease (vii) and inadequate health care because of lack of time. As a result of this unfair treatment, human rights violation occurs. The major contribution from this paper is that we provide a guideline for establishing strategies to reduce health inequality by identifying the concept of health inequality. Based on this study, we recommend development of an educational program to reduce health inequalities.

Research on the Interior Environment Planning of a Postpartum Care Center. (산후 조리원 실내 환경 계획에 관한 연구)

  • Lee, Jong-Hee
    • Archives of design research
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    • v.20 no.1 s.69
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    • pp.253-262
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    • 2007
  • The postpartum care center is a facility which made its debut only about 10 years ago but has now changed the nation's postpartum care culture. Women delivered of a child use the postpartum care center at this time since the low rate of childbirth has become a social phenomenon. However, while the postpartum care center is not supported legally and systematically, anybody can run it after they only file a report on businessman status with the tax office. So there are disordered wave of postpartum care startups which do not have basic facilities. Thus, this study is intended to suggest an interior environment plan considering an efficient space and users' benefits of a postpartum care center which has a characteristic difference from that of ordinary facilities in terms of targeted persons or operations but for which standards are not clear in terms of the Health and Welfare Law and the Medical Service Law. This study was conducted by investigating the actual condition of the entrance space, living space, common-use space, nursing space, administration and attached space in the six postpartum care centers selected from Seoul and Kyeonggi-do region and suggesting the direction of improvements, thus establishing the direction of interior designs and an interior environment plan. Hopefully, this study would be used as basic data on interior building plans, thus being helpful in enhancing the satisfaction of the postpartum care center user and operating the facility.

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Level of Obstructive Sleep Apnea of Patients with Ischemic Cardio-cerebrovascular Disease and Affecting Factors (허혈성 심뇌혈관질환자에서 폐쇄성 수면무호흡증 정도 및 영향요인)

  • Kim, Sun Hwa;Hwang, Seon Young
    • The Journal of the Korea Contents Association
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    • v.18 no.4
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    • pp.114-127
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    • 2018
  • This study aimed to investigate the levels of Obstructive Sleep Apnea (OSA), health behavior and sleep quality and to examine the predictors of OSA in patients with ischemic cardio-cerebrovascular disease. 141 patients who were admitted to the vascular unit were recruited and surveyed using structured questionnaires. Saturation of Peripheral Oxygen (SpO2) was measured at three time points using a pulse oximeter. Data were analyzed using SPSS/WIN 20.0. The mean age of the subjects was $64.4{\pm}11.1$ years and 61% was men. The 21.3%(n=30) of the subjects were classified as high-risk for OSA by the cut point and 71.6%(n=101) had low sleep quality. OSA high-risk group showed significant difference in SpO2 in the middle of sleep (p=.006) and at the end of sleep (p=.004) compared to the low-risk group. Multiple logistic regression analysis showed that perceived frequent snoring, smoking, obesity, lack of exercise among health behavior were found as predicting factors on OSA. OSA or persistent snoring should be recognized as a cardiovascular risk factor in the cardiovascular nursing practice. In addition to early treatment of OSA, education and counseling should be provided to patients and their family for prevention of secondary recurrence.

A Pilot Study for Development of the Serious Game Contents for Education in the Elderly Diabetes (노인 당뇨환자 교육용 기능성 게임 콘텐츠 개발을 위한 예비연구)

  • Kim, Yu Jeong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.7
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    • pp.184-192
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    • 2017
  • This study was a pilot test of serious educational game content(named Roly Poly 160) designed to enhance self-care by elderly diabetics. Roly Poly 160 was developed in eight steps (literature review, demand survey and consultation, extraction of serious content using games, development of Roly Poly 160, pretest for users, workshop for health care workers, final completion of Roly Poly 160 and user satisfaction survey of Roly Poly 160). Roly Poly 160 is intuitively structured in three modules (self-management, card games, and quiz games) that can be self-managed by the elderly and is designed based on six principles. First, we constructed an intuitive interface considering the age of users. Second, the menu was selected as the main menu for Koreans and calorie learning was made at the same time. Third, the calories and nutrients (carbohydrate, fat, protein, calcium, sodium) of selected foods are analyzed, and all test data recorded in the questionnaire chart are graphically displayed by year, month and week so that the change trends can be grasped at a glance. Fourth, necessary data were saved and output and used as educational data. Fifth, user data are made compatible and aggregated and up to 100 million members can be registered. Sixth, it is designed to be developed as a mobile app if necessary. Using Roly Poly 160, 119 diabetic patients were diagnosed with diabetes, and the satisfaction score was 4.26 out of 5. These findings indicate that Roly Poly 160 is appropriate as a diabetes self-care tool and suggests that there is a possibility to use it as a program to educate people about diabetes in public health centers, hospitals and clinics.

A survey on installation and management of automated external defibrillators (자동심장충격기 설치현황 및 관리 실태 조사)

  • Seo, Hye-Jin;Yoon, Susie;Kim, Hyo-Sik
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.19 no.7
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    • pp.245-251
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    • 2018
  • This study was conducted to investigate the status of the installation, maintenance and management of automatic external defibrillators (AEDs) in all mandatory institutions and buildings of the providence to be equipped with AEDs. The study was conducted from November 20, 2017 to December 20, 2017, during which time 169 AED units were surveyed. The collected data was analyzed by frequency analysis and the percentage was determined using the SPSS/WIN 20.0 program. A total of 168 units (99.41%) of AEDs were installed inside. Additionally, 47 units (27.80%) were available 24 hours a day, and 44 units (26.00%) were available outside business hours of the institution. Moreover, 87 units (51.43%) of the responsible managers received rescue and first aid training. Evaluation of the management status of the AEDs revealed two (1.20%) that had problems with their battery state of charge battery charge and seven (4.10%) for which the AED pads were past the expiration date. A management system for the manager of AEDs should be established and a regular training program for their systematic maintenance should be developed and applied. It is also suggested that awareness of the necessity of continuous management be raised through reinforcement of laws and legal system reorganization.

The Experience of Cancer Survivor's Return to Everyday Life (암 생존자의 일상생활 복귀 경험)

  • Kim, Seon-Young
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.21 no.5
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    • pp.327-336
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    • 2020
  • This study was undertaken to identify ways that enable a successful comeback to everyday life and improvement in the quality of life, by understanding the experiences of cancer survivors in returning to everyday life. Totally, 19 people diagnosed with complete cure after 5 years of cancer treatment, were recruited for the study. Data was collected through in-depth interviews from January 18 to February 25, 2017. One-time interviews took 90 to 120 minutes, and data analysis was achieved by applying the grounded theory. The central phenomenon of 'reality that cannot be escaped' and 'uncertain reality that cannot know tomorrow' was attributed to the causal conditions 'hard reality', 'physical exhaustion', 'psychological exhaustion' and 'economic exhaustion'. Depending on context conditions such as 'lack of family support', 'shift to a vulnerable working class', 'insufficient support system', 'hope for the societal support system', 'daunted gender', 'prejudice against cancer/cancer patients', 'information on life after rare full healing'. The strategy for a successful return was influenced by intervention conditions such as 'robust family fence' and 'effective cancer insurance', which resulted in 'building a new life' or 'enduring'. We conclude that for a successful return to daily lives, cancer survivors require comprehensive information, health and social-welfare interventions.

Recent Advances in Amino Acid and Energy Nutrition of Prolific Sows - Review -

  • Boyd, R.D.;Touchette, K.J.;Castro, G.C.;Johnston, M.E.;Lee, K.U.;Han, In K.
    • Asian-Australasian Journal of Animal Sciences
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    • v.13 no.11
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    • pp.1638-1652
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    • 2000
  • Prolific females require better nutrition and feeding practice because of larger litter size and the substantial decline in body fat. Life-time pig output will be compromised if body protein and fat are not properly managed. First litter females are especially vulnerable because they can loose ${\geq}15%$ of whole-body protein. Conservation of body protein mass during first lactation minimizes wean to estrus interval and increases second litter size (up to 1.2 pigs). The ability to influence litter-size by amino acid nutrition is a new dimension in our understanding. A P2 fat depth below 12 mm at farrow and below 10 mm at wean compromised wean to estrus interval (>2 d) and next litter size (0.5 to 1.5 pigs) in sows. It is now clear that a 'modest' excess of feed during the first 72 h of pregnancy decreases embryo viability so that the potential for an increased litter size at birth is not realized. The capacity for milk production by prolific young sows is 25% higher than the standard used previously (NRC, 1988). First litter females averaged 9.82 kg milk/d for a 21 d lactation. Second and third litter counterparts averaged 10.35 kg/d. Milk production was 95% of peak by 10 d of lactation and sows were in greatest negative energy and lysine balance during the first 6 d. Nearly 45% of the total loss in body protein occurred within the first 6 d, but this could reduced to 30-35% by using a more aggressive feeding strategy after parturition. There appear to be 2 phases in lactation for lysine need (d 2-12 vs 12-21). Feeding to the higher level alleviates the second litter size decline. The lysine requirement for lactation can be predicted with accuracy, but we are not able to predict the second limiting amino acid. Mammary uptake of valine relative to lysine and recent work with practical diets suggest that the recent NRC (1998) pattern is realistic and that threonine and valine could be co-limiting for corn-soy diets for prolific sows nursing 10-11 pigs. Empirical studies are needed to refine the ideal pattern so that synthetic lysine can be used with more confidence. Milk fat output for the elite sow is extraordinary and poses an unnecessarily high energetic cost. Methods that reduce mammary fat synthesis will benefit the sow and may enhance piglet growth.