• 제목/요약/키워드: patient compliance

검색결과 371건 처리시간 0.022초

Recanalization Rate and Clinical Outcomes of Intravenous Tissue Plasminogen Activator Administration for Large Vessel Occlusion Stroke Patients

  • Min-Hyung Lee;Sang-Hyuk Im;Kwang Wook Jo;Do-Sung Yoo
    • Journal of Korean Neurosurgical Society
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    • 제66권2호
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    • pp.144-154
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    • 2023
  • Objective : Stroke caused from large vessel occlusion (LVO) has emerged as the most common stroke subtype worldwide. Intravenous tissue plasminogen activator administration (IV-tPA) and additional intraarterial thrombectomy (IA-Tx) is regarded as standard treatment. In this study, the authors try to find the early recanalization rate of IV-tPA in LVO stroke patients. Methods : Total 300 patients undertook IA-Tx with confirmed anterior circulation LVO, were analyzed retrospectively. Brain computed tomography angiography (CTA) was the initial imaging study and acute stroke magnetic resonance angiography (MRA) followed after finished IV-tPA. Early recanalization rate was evaluated by acute stroke MRA within 2 hours after the IV-tPA. In 167 patients undertook IV-tPA only and 133 non-recanalized patients by IV-tPA, additional IA-Tx tried (IV-tPA + IA-Tx group). And 131 patients, non-recanalized by IV-tPA (IV-tPA group) additional IA-Tx recommend and tried according to the patient condition and compliance. Results : Early recanalization rate of LVO after IV-tPA was 12.0% (36/300). In recanalized patients, favorable outcome (modified Rankin Scale, 0-2) was 69.4% (25/36) while it was 32.1% (42/131, p<0.001) in non-recanalized patients. Among 133 patients, non-recanalized after intravenous recombinant tissue plasminogen activator and undertook additional IA-Tx, the clinical outcome was better than not undertaken additional IA-Tx (favorable outcome was 42.9% vs. 32.1%, p=0.046). Analysis according to the perfusion/diffusion (P/D)-mismatching or not, in patient with IV-tPA with IA-Tx (133 patients), favorable outcome was higher in P/D-mismatching patient (52/104; 50.0%) than P/D-matching patients (5/29; 17.2%; p=0.001). Which treatment tired, P/D-mismatching was favored in clinical outcome (iv-tPA only, p=0.008 and IV-tPA with IA-Tx, p=0.001). Conclusion : The P/D-mismatching influences on the recanalization and clinical outcomes of IV-tPA and IA-Tx. The authors would like to propose that we had better prepare IA-Tx when LVO is diagnosed on initial diagnostic imaging. Furthermore, if the patient shows P/D-mismatching on MRA after IV-tPA, additional IA-Tx improves treatment results and lessen the futile recanalization.

Genome-Wide Association Study of Medication Adherence in Chronic Diseases in the Korean Population

  • Seo, Incheol;Suh, Seong-Il;Suh, Min-Ho;Baek, Won-Ki
    • Genomics & Informatics
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    • 제12권3호
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    • pp.121-126
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    • 2014
  • Medication adherence is generally defined as the extent of voluntary cooperation of a patient in taking medicine as prescribed. Adherence to long-term treatment with chronic disease is essential for reducing disease comorbidity and mortality. However, medication non-adherence in chronic disease averages 50%. This study was conducted a genome-wide association study to identify the genetic basis of medication adherence. A total of 235 medication non-adherents and 1,067 medication adherents with hypertension or diabetes were used from the Korean Association Resource project data according to the self-reported treatment status of each chronic disease, respectively. We identified four single nucleotide polymorphisms with suggestive genome-wide association. The most significant single nucleotide polymorphism was rs6978712 (chromosome 7, $p=4.87{\times}10^{-7}$), which is located proximal to the GCC1 gene, which was previously implicated in decision-making capability in drug abusers. Two suggestive single nucleotide polymorphisms were in strong linkage disequilibrium ($r^2$ > 0.8) with rs6978712. Thus, in the aspect of decision-making in adherence behavior, the association between medication adherence and three loci proximal to the GCC1 gene seems worthy of further research. However, to overcome a few limitations in this study, defining the standardized phenotype criteria for self-reported adherence should be performed before replicating association studies.

신경계 치료를 위한 루프 프로브형 자기자극기의 시뮬레이터 (The simulator loop probe style magnetic stimulation design for a nervous system treatment)

  • 김휘영
    • 디지털산업정보학회논문지
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    • 제5권3호
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    • pp.29-37
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    • 2009
  • It is as result that study to apply mini magnet nerve curer in peripheral nervous system disease treatment. Simulator and embodied action power and Control Unit in cylinder form of magnet roof object firstly. Yielded service area about special quality of probe of loop object cylinder style and treatment area dimension and distance of treatment pulse secondly. Embody pulse forming course energy value by Probe's form by third, could embody treatment pulse by disease. Specially, through a special quality experiment, saved Damping pulse form and treatment digital forming etc. variously. Lately, embodied this to aid a little in disease treatment that follow that there is no invasion that there is no stimulation by medicine development. Neuralgia, muscular disease and Altzheimer, with stroke etc. is becoming the matter of concern and interest which disease of adult etc. it is same is important. And the melancholia in compliance with the modern direction of a ceremony which is complicated and garrulous, trillion it will cry and symptoms, it is a tendency where the emotional obstacle etc. nervous psychiatric disorder patient is increasing at class speed. But currently the applicator it will be able to treat like this disease almost it is a condition which is wholly lacking. Consequently like this disease it used magnetic stimulation and it diagnosed and the equipment it will be able to treat plan and it embodied.

EXTEMPORANEOUS MICELLAR SOLUBILIZATION OF TITRATED EXTRACT OF CENTELLA ASIATICA IN AQUEOUS MEDIA

  • Kim, Jae-Hyun;Kim, Chong-Kook
    • 한국응용약물학회:학술대회논문집
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    • 한국응용약물학회 1996년도 춘계학술대회
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    • pp.284-284
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    • 1996
  • Titrated Extract of Centella asiatica (TECA) is a poorly water-soluble extract from the Centella asiatica. Despite excellent wound preparation causes pain due to a low aqueous solubility and high hypertonicity and therefore, the patient's compliance of this drug is low. The objective of this study is to design a formulation of TECA with an improved therapeutic applicability via an adequate solubilization. A mixture of propylene glycol and ethoxylated hydrogenated caster oil achieved an acceptable solubilization of TECA (i.e. 10%) via a formulation of micelle. A preparation of extemporaneous TECA micelle was achieved by a dilution of the original micellar formulation with either water or saline. An estimated distribution of particle size was between 15.9 and 32.6 ㎜. The osmotic pressure of the formulation was found to be much lower than that found In a commercially available injectable (i.e. Madecassole). The erthrocytic hemolysis of micellar solution was lower than that with the conventional dosage form, consistent with the osmotic pressure data. Pain score after an injection of the micellar solution was assessed by the hind-paw writhing test using ICR mice and compared with that found with the conventional injectable. The data indicated that the injection of the micellar solution was a significantly less painful. These results indicated that a micellar solubilization, followed by an extemporaneous dilution, is a novel formulation of TECA with an improved therapeutic applicability.

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근경련의 신경생리학적 발생기전, 평가 및 치료기법에 관한 연구 (The Investigation of Neurophysiological Mechanisms, Assessment and Treatments on The Muscle Spasm)

  • 김진상;채윤원;최진호;김동대
    • The Journal of Korean Physical Therapy
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    • 제9권1호
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    • pp.185-193
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    • 1997
  • The purpose of this study was to investigate the neurophysiological mechanisms, assessment of muscle spasm and treatments that could apply to clinical field. Spasm is a painful pattern of contraction of muscle caused by chronic or acute trauma, excessive tension, or organic disorders. Aside from pain, muscle spasm creates shortenning of muscles and limits motion. Untreated spasm and protective immobility due to pain lead to decreased local blood flow in the muscles and result in a vicious cycle of muscle spasm and paul. The assessment of muscle spasm involve muscle tone assessment, tissue compliance, and joint ROM. Each of these aessessments utilize as a part of the patient's condition Clinical managements involve drug management and physical therapy. Expecially, physical therapy is one of the most important techniques to reduce muscle spasm. Physical therapy includes applying heat and cold, electrical stimulation, massage, and traction. This investigation should entourage phisical therapists to experiment further with various techniques to reduce muscle spasm.

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염산 탐스로신을 함유하는 방출제어형 제제의 제조 및 용출거동 (Preparation and Dissolution Profiles of Controled Release Formulations Containing Tamsulosin Hydrochloride)

  • 윤재남;김정수;김동우;이계원;지웅길
    • Journal of Pharmaceutical Investigation
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    • 제35권6호
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    • pp.445-451
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    • 2005
  • As a selective ${\alpha}_{1A}-adrenoreceptor$ antagonist, tamsulosin has been used clinically for urinary obstructed patients with benign prostatic hyperplasia. The single and multi-layered pellets containing tamsulosin hydrochloride were prepared in an effort to control the drug release, avoiding dose-dependent side effects of tamsulosin hydrochloride upon oral administration. The drug release from multi-layered pellets was substantially controlled, compared with single layered pellets. The drug release from coated pellets with single or multi layer was affected by the nature of coating agent, the percentage of coating level and the presence of hydrophilic material in coating layer. In conclusion, the controlled release oral delivery system using multi-layered pellet is very useful for tamsulosin hydrochloride, resulting in improvement of patient compliance and therapeutic drug levels for a longer period of time.

Multi-Layered Matrix Tablets with Various Tablet Designs and Release Profiles

  • Choi, Du-Hyung;Jeong, Seong-Hoon
    • Journal of Pharmaceutical Investigation
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    • 제41권5호
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    • pp.263-272
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    • 2011
  • Tablet dosage forms have been preferred over other formulations for the oral drug administration due to their low manufacturing costs and ease of administrations, especially controlled-release applications. Controlled-release tablets are oral dosage forms from which the active pharmaceutical ingredient (API) is released over an intended or extended period of time upon ingestion. This may allow a decrease in the dosing frequency and a reduction in peak plasma concentrations and hence improves patient compliance while reducing the risk of undesirable side effects. Conventional singlelayered matrix tablets have been extensively utilized to deliver APIs into the body. However, these conventional single-layered matrix tablets present suboptimal delivery properties, such as non-linear drug delivery profiles which may cause higher side effects. Recently, a multi-layered technology has been developed to overcome or eliminate the limitations of the singlelayered tablet with more flexibility. This technology can give a good opportunity in formulating new products and help pharmaceutical companies enhancing their life cycle management. In this review, a brief overview on the multi-layered tablets is given focusing on the various tablet designs, manufacturing issues and drug release profiles.

Mandibular Advancement Devices for Treating Snoring and Obstructive Sleep Apnea

  • Byun, Jin-Seok;Jung, Jae-Kwang
    • Journal of Oral Medicine and Pain
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    • 제39권2호
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    • pp.35-45
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    • 2014
  • Many therapeutic modalities including continuous positive airway pressure, surgery, and oral appliances are used to treat patients with sleep-disordered breathing. However, there are no definitive treatment modalities for individual patients due to various causes of sleep-disordered breathing. Clinicians should have select best options for individual patients and it is quite challenging process. Oral appliances attracted clinical attention for its convenience and safety. Several designs of oral appliances are introduces such as soft palate lifter, tongue retaining device, and various appliances which aimed to mandibular advancement. Among these oral appliances, mandibular advancement devices (MADs) are considered the most excellent based on their effectiveness and patient tolerance. Although MADs are not guarantee dramatic outcome and less consistent than continuous positive airway pressure, they offer several advantages over continuous positive airway pressure and surgical methods, including non-invasiveness, silence, portability, and tolerability, simplicity. Therefore, general dental practitioner who had passed sleep dental curriculum or coursework can treat the patients with sleep problems. This article reviews the history, clinical indications, suggested mechanism of actions, various positive effects and several side effects, factors predicting a favorable outcome, determining amounts of mandibular advancement, compliance and long-term efficacy of MADs use.

치의학분야 3D 프린팅 기술이 적용된 의료기기의 인·허가전략과 과제 (Licensing strategies and tasks for medical devices utilizing 3D printing technology in dentistry)

  • 신은미;양승민
    • 대한치과의사협회지
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    • 제56권9호
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    • pp.479-490
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    • 2018
  • 3D printing technology supporting the specific patient medical services is actively being implemented in dentistry. The purpose of this study is to introduce the legal and institutional considerations to the medical practitioners in dentistry who must observe when they manufacture medical devices using 3D printers, and to provide a ways to activate and enhance their utilization in the domestic approval point of view for medical devices. Through the public data of government agencies and related organizations, the statutory system and compliance matters related to the manufacture of 3D printing medical devices have been examined and reviewed for the government's improvement efforts. Through the study, the government has been actively improving the system and making policy, but the active interest and participation of medical professionals and related workers are continually required to solve the problems which are scattered. 3D printing technology is expected to be more frequently utilized in the field of dentistry in near future. Therefore, it is essential to establish measures to improve the regulation through continuous cooperation with the related ministries with the long-term point of view enhancing smooth entry to the market for the medical devices by taking data from the continued research.

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뇌졸중 환자를 위한 G-AP 기반 목표설정 자기관리프로그램의 효과 (Effectiveness of a Self-management Program using Goal Setting based on a G-AP for Patients after a Stroke)

  • 박민경;하영미
    • 대한간호학회지
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    • 제44권5호
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    • pp.581-591
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    • 2014
  • Purpose: This study was conducted to develop a self-management program using goal setting for patients after a stroke. The program was based on a theory-based Goal setting and Action Planning framework (G-AP), and the effectiveness of the program was examined. Methods: A non-equivalent control group pretest-posttest design was used. The experimental group (n=30) received the self-management program using goal setting based on the G-AP over 7 weeks. The education was delivered individually with a specifically designed stroke workbook. The control group (n=30) received only patient information leaflets about stroke. Results: There were significant differences between the two groups. Stroke knowledge, self-efficacy, and health behavior compliance were significantly higher (all p<.001), and hospital anxiety (p<.001) and depression (p<.001) were significantly lower in the experimental group compared to the control group. Conclusion: This self-management program using goal setting based on a G-AP was found to be useful and beneficial for patients in stroke rehabilitation settings.