• Title/Summary/Keyword: safety outcomes

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The Failure of Initial Treatment for TNM Stage I & II Squamous Cell Carcinomas of the Oral Cavity (조기(TNM Stage I & II) 구강 편평세포암종의 초치료 실패)

  • Lee Hyun-Seok;Jeong Han-Sin;Kim Tae-Wook;Son Young-Ik;Baek Chung-Hwan
    • Korean Journal of Head & Neck Oncology
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    • v.21 no.1
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    • pp.26-31
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    • 2005
  • Backgrounds and Objectives: Squamous cell carcinomas of the oral cavity(SCOC) in TNM stage I & II have relatively high chance to be cured compared to those in the advanced stage, but sometimes result in the treatment failure with poor prognosis. There have been few reports on the patterns of failure and the clinical courses for SCOC in stage I & II after the failure of initial treatment. This study is directed at identifying the clinical outcomes of stage I & II SCOC and the salvage rate after initial treatment and suggesting an optimal level of treatment by analyzing the patterns of failure. Material and Methods: The medical records of 36 patients with SCOC, initially diagnosed between 1995 and 2001 as TNM stage I & II were reviewed retrospectively. The patterns of failure, salvage treatment, clinical courses, and the survival of these subjects were analyzed. The minimum follow-up period of no-evidence of disease(NED) was 12 months with an average of 32.2 months. Results: Overall rate of the treatment failure in SCOC of stage I & II was 41. 7%(15/36 cases). Most of the treatment failure in the subjects with stage I tumors occurred in regional lymph node. Local failure was the most frequent form of failure in the subjects with stage II tumors after wide excision of primary tumor with elective neck dissection and/or radiation therapy. No significant correlation was noted between the safety margin and the local failure. Elective neck dissections in stage I & II SCOC had a tendency to reduce regional failure (p=0.055). The salvage rates at 24 months were 85.7% in stage I, and 37.5% in stage II. The 3-year survival rate after the failure of initial treatment was 55.0%. Conclusion: SCOC of stage I & II after the failure of initial treatment showed poor prognosis despite of the salvage treatments. This study implies that the elective neck dissections for regional lymph node should be required for SCOC of stage I & II to reduce the treatment failure.

The Impact of Nurse Staffing Level on In-hospital Death and Infection in Cancer Patients Who Received Surgery (간호사 확보수준이 수술한 암환자의 원내 사망 및 감염에 미치는 영향)

  • Kim, Myo-Gyeong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.4
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    • pp.408-417
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    • 2017
  • This study was conducted to examine the influence of the nurse staffing level on the level of in-hospital death and infection in cancer patients who received surgery. Secondary data were used and the subjects of this study were 24,510 patients who received surgery for six types of cancer with a high postoperative mortality rate in the first half of 2012 at 260 hospitals. Simple logistic and GEE multiple logistic regression analyses were used. After adjusting for the patient and hospital characteristics, a greater likelihood of dying was found in the nurse staffing level 2-3 group (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.00-2.11) and in the level 6-7 group (OR, 3.28; 95% CI, 1.87-5.74) compared to the level 0-1 group. The likelihood of in-hospital infection increased with each additional bed per nurse, being 6.63 times higher (95% CI, 3.00-14.62) in the level 2-3 group, 5.79 times higher (95% CI, 1.88-17.78) in the level 4-5 group, and 8.4 times higher (95% CI, 1.82-38.84) in the level 6-7 group, as compared to the level 0-1 group. A lower nurse staffing level was associated with higher in-hospital death and infection levels. This shows that an appropriate nurse staffing level is associated with superior postoperative cancer patient outcomes. Policies for providing adequate nurse staffing should be maintained for the sake of ensuring improved care quality and patient safety.

Mediating Roles of Perceived Money Importance and Gratitude in the Effects of Social Support on Pleasure in Spending for Other-gift (사회적 지원과 돈의 중요성 및 고마움, 그리고 선물구매에서 지불의 기쁨)

  • Choi, Nak-Hwan
    • Journal of Distribution Science
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    • v.14 no.4
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    • pp.111-116
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    • 2016
  • Purpose - A lot of preceeding studies have focused on the pains that might be felt in spending money, that is an important role in getting psychological safety. Money and social resources can be all for consumers, and they are likely to form a substituting relationship with one another. Being motivated by the idea that spending money for others can come with joy if one's objective is accomplished by social support, this paper aimed to explore the mediating role of the perceived money importance and gratitude in the relationship between social support and pleasure in spending for other-gift. Research Design, Data, and Methodology - In this empirical study, the experimental group is expected to receive social support while the control group is composed of those who are usually indulged in reminiscences of their sweethearts. From the college students, 160 experiment participants were selected and 80 participants of them were assigned to control group as well as to experimental group respectively at random. Empirical study for each of the two groups was performed respectively by means of questionnaire survey. Experimental group data and control group data were combined together to be used for testing hypotheses. Linear structural equation model in Amos was used to verify the hypotheses, and Bootstrap was also used to examine whether there were the mediating roles of the perceived money importance and gratitude or not. Results - From the empirical study, following conclusions could be drawn: First, social support of others makes one perceive the importance of money less; Second, social support of others makes one perceive gratitude to others; Third, less perceived importance of money and gratitude to others can make one feel pleasure in spending for other-gift; and Fourth, less perceived importance of money and gratitude to others can partially mediate the effect of social support from others on the pleasure in spending for other-gift. Conclusions - The outcomes of this study might offer theoretic and managerial implications as follow: Even though many hitherto studies have asserted that spending money usually comes with pains, this study discovered that social support might reduce perceived the importance of money but make others feel gratitude and, thus, one would feel joy in spending money to buy gift for others, and made a contribution to the progress of the theory of pleasure in spending for other-gift. This paper also made contributions toward the development of emotion marketing theory by showing that the effect of social support on the pleasure in spending for other-gift could be partially mediated by the perceived the importance of money and gratitude to others. Based on the above conclusions, it may be affirmed that marketers should help consumers perceive the importance of money less, and help feel gratitude to others by pointing up the support of others to consumers in an attempt to accelerate spending for other-gift.

Bus-only Lane and Traveling Vehicle's License Plate Number Recognition for Realizing V2I in C-ITS Environments (C-ITS 환경에서 V2I 실현을 위한 버스 전용 차선 및 주행 차량 번호판 인식)

  • Im, Changjae;Kim, Daewon
    • Journal of the Institute of Electronics and Information Engineers
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    • v.52 no.11
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    • pp.87-104
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    • 2015
  • Currently the IoT (Internet of Things) environments and related technologies are being developed rapidly through the networks for connecting many intelligent objects. The IoT is providing artificial intelligent services combined with context recognition based knowledge and communication methods between human and objects and objects to objects. With the help of IoT technology, many research works are being developed using the C-ITS (Cooperative Intelligent Transport System) which uses road infrastructure and traveling vehicles as traffic control infrastructures and resources for improving and increasing driver's convenience and safety through two way communication such as bus-only lane and license plate recognition and road accidents, works ahead reports, which are eventually for advancing traffic effectiveness. In this paper, a system for deciding whether the traveling vehicle is possible or not to drive on bus-only lane in highway is researched using the lane and number plate recognition on the road in C-ITS traffic infrastructure environments. The number plates of vehicles on the straight ahead and sides are identified after the location of bus-only lane is discovered through the lane recognition method. Research results and experimental outcomes are presented which are supposed to be used by traffic management infrastructure and controlling system in future.

Abdomino-perineal Organ Injuries Caused by Cultivators (경운기 사고에 의해 발생한 복부 및 회음부 장기 손상)

  • Yeo, Kwang Hee;Park, Chan Yong;Kim, Ho Hyun;Park, Soon Chang;Yeom, Seok Ran
    • Journal of Trauma and Injury
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    • v.28 no.2
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    • pp.60-66
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    • 2015
  • Purpose: Cultivator accidents are frequent and often lead to abdomino-perineal organ injury and, if severe, to death. This study presents the clinical characteristics, outcomes, and factors associated with mortality in patients who sustained an abdomino-perineal organ injury in cultivator accidents. Methods: We retrospectively analyzed the records of 53 patients who visited the emergency department of a tertiary hospital with abdomino-perineal organ injuries caused in cultivator accidents from April 2005 to March 2010. Results: All 53 patients had visited other medical institutions before visiting our hospital. Their mean age was $64.0{\pm}11.1$ (range, 20-80) years and 32 (60.4%) patients were 65 or older. The male-to-female ratio was 46:7. The chief complaint was abdominal pain (38 cases, 71.7%). The 53 patients included 41 cultivator operators (77.4%), 11 passengers (20.8%), and 1 passerby (1.9%). The causes of the injuries included a direct impact of the handlebar in 20 cases (37.7%), a rollover in 21 cases (39.6%), a fall in 10 cases (18.9%), and a wheel in two cases (3.8%). Several of the 53 patients had injuries to multiple abdomino-perineal organs, and the injured organs included the liver (23 cases, 26.4%), spleen (16 cases, 18.4%), pancreas (7 cases, 8.0%), small bowel (7 cases, 8.0%), mesentery (6 cases, 6.9%), adrenal gland (5 cases, 5.8%), and other organs. According to the abbreviated injury scale (AIS) dictionary, a thoracic injury was the most frequent co-injury (33 of 53 cases, 62.3%). Abdomino-perineal surgery was performed in 31 cases (58.8%) and angio-embolization was performed for six liver and two kidney injuries. Thirteen patients died (24.5%); all were males. The Injury Severity Scale (ISS) was lower in the survivors ($17.8{\pm}8.5$ vs. $27.0{\pm}16.0$; p=0.010). Conclusion: With the aging of agricultural workers, safety education programs should be implemented. Furthermore, the patient transfer system in agricultural areas must be improved.

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The Ethnicized Stigma against Women Escaped from North Korea and Their Community Building and Coping Strategies toward it in Contemporary South Korea (탈북여성들에 대한 남한 사회의 '종족화된 낙인(ethnicized stigma)'과 탈북여성들의 공동체 형성 및 활동)

  • Sung, JungHyun
    • Korean Journal of Family Social Work
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    • no.53
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    • pp.79-115
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    • 2016
  • The purpose of this study is to understand the women's experiences of negative perception, discrimination and 'ethnicized stigma' in South Korea. For this purpose, data were collected through in-depth interviews from 8 women escaped from North Korea and 4 professionals. The findings of this study are as follows: Almost of them experienced negative perception and discrimination caused by language, pronunciation intonation, and differences of ways to express their emotions. And they experienced the disapproval as the native perception and confusion of ethnic identity. Several participants in this study try to build or organize their communities to give emotional and instrumental support for them. However, in these processes, they experience emotional conflicts and crises feelings of disorganization of their communities because of they didn't have experience to involve communities, and didn't have ideas of membership and their roles. And they were learned to criticize with each other in North Korea. They worry about their families' safety in North Korea. For this reason, they can't have trustful personal relationships among Koreans including people escaped from North Korea in South Korea. They want to participate in Korean's community activities, and learn to adjust to everyday lives in South Korea. In conclusion, based upon the outcomes of this study, it is expected that any practical implications or solutions for North Korean defector's welfare would be suggested.

Principles for evaluating the clinical implementation of novel digital healthcare devices (첨단 디지털 헬스케어 의료기기를 진료에 도입할 때 평가원칙)

  • Park, Seong Ho;Do, Kyung-Hyun;Choi, Joon-Il;Sim, Jung Suk;Yang, Dal Mo;Eo, Hong;Woo, Hyunsik;Lee, Jeong Min;Jung, Seung Eun;Oh, Joo Hyeong
    • Journal of the Korean Medical Association
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    • v.61 no.12
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    • pp.765-775
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    • 2018
  • With growing interest in novel digital healthcare devices, such as artificial intelligence (AI) software for medical diagnosis and prediction, and their potential impacts on healthcare, discussions have taken place regarding the regulatory approval, coverage, and clinical implementation of these devices. Despite their potential, 'digital exceptionalism' (i.e., skipping the rigorous clinical validation of such digital tools) is creating significant concerns for patients and healthcare stakeholders. This white paper presents the positions of the Korean Society of Radiology, a leader in medical imaging and digital medicine, on the clinical validation, regulatory approval, coverage decisions, and clinical implementation of novel digital healthcare devices, especially AI software for medical diagnosis and prediction, and explains the scientific principles underlying those positions. Mere regulatory approval by the Food and Drug Administration of Korea, the United States, or other countries should be distinguished from coverage decisions and widespread clinical implementation, as regulatory approval only indicates that a digital tool is allowed for use in patients, not that the device is beneficial or recommended for patient care. Coverage or widespread clinical adoption of AI software tools should require a thorough clinical validation of safety, high accuracy proven by robust external validation, documented benefits for patient outcomes, and cost-effectiveness. The Korean Society of Radiology puts patients first when considering novel digital healthcare tools, and as an impartial professional organization that follows scientific principles and evidence, strives to provide correct information to the public, make reasonable policy suggestions, and build collaborative partnerships with industry and government for the good of our patients.

A comparison and prediction of total fertility rate using parametric, non-parametric, and Bayesian model (모수, 비모수, 베이지안 출산율 모형을 활용한 합계출산율 예측과 비교)

  • Oh, Jinho
    • The Korean Journal of Applied Statistics
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    • v.31 no.6
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    • pp.677-692
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    • 2018
  • The total fertility rate of Korea was 1.05 in 2017, showing a return to the 1.08 level in the year 2005. 1.05 is a very low fertility level that is far from replacement level fertility or safety zone 1.5. The number may indicate a low fertility trap. It is therefore important to predict fertility than at any other time. In the meantime, we have predicted the age-specific fertility rate and total fertility rate by various statistical methods. When the data trend is disconnected or fluctuating, it applied a nonparametric method applying the smoothness and weight. In addition, the Bayesian method of using the pre-distribution of fertility rates in advanced countries with reference to the three-stage transition phenomenon have been applied. This paper examines which method is reasonable in terms of precision and feasibility by applying estimation, forecasting, and comparing the results of the recent variability of the Korean fertility rate with parametric, non-parametric and Bayesian methods. The results of the analysis showed that the total fertility rate was in the order of KOSTAT's total fertility rate, Bayesian, parametric and non-parametric method outcomes. Given the level of TFR 1.05 in 2017, the predicted total fertility rate derived from the parametric and nonparametric models is most reasonable. In addition, if a fertility rate data is highly complete and a quality is good, the parametric model approach is superior to other methods in terms of parameter estimation, calculation efficiency and goodness-of-fit.

Analysis of Existing Guidelines and Randomized, Controlled, Clinical Trials for Development of [Guideline of Clinical Trial with Herbal Medicinal Product for Lung Cancer] (폐암 한약제제 임상시험 가이드라인 개발을 위한 한약제제 무작위배정 대조군 임상시험 고찰)

  • Han, Gajin;Cho, Minji;Park, Eunjoo;Seong, Sin;Kim, Sungsu;Kim, Kwan-Il;Jung, Hee-Jae;Lee, Beom-Joon;Leem, Jungtae
    • The Journal of Korean Medicine
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    • v.40 no.1
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    • pp.153-173
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    • 2019
  • Objectives: This study aimed to ascertain what should be considered in the "Guideline for Clinical Trials with Herbal Medicinal Products for Lung Cancer" by analyzing the existing guidelines and clinical trials. Methods: The committee searched guidelines and clinical trials about herbal medicine for lung cancer. The searched trials were analyzed in terms of inclusion and exclusion of participants, intervention, comparator, outcomes and trial design. Then, we compared the results of our analysis with the guidelines to identify the issues we will have to consider when making the "Guideline for Clinical Trials with Herbal Medicinal Products for Lung Cancer". Several guidelines for anti-tumor agents and clinical trials with herbal medicine were searched on the national institution homepage. The search terms were as follows: 'lung neoplasm', 'herbal medicine', 'Medicine, Korean traditional', 'Medicine, Chinese Traditional' etc. Results: There was no guideline for clinical trial with herbal medicine for lung cancer. In addition, 7 articles were searched through database searching. All the participants had non-small cell lung cancer. The type of intervention was decoction. Comparators included conventional treatments such as chemotherapy. The outcome measurements used in the studies were quality of life, tumor response, and survival duration, etc. Safety was evaluated by recording adverse events and blood test. Conclusions: Findings were made by reviewing existing guidelines and comparing them with clinical trials for lung cancer and herbal medicinal products. These results will be utilized in the development of "Guideline for Clinical Trials with Herbal Medicinal Products for Lung Cancer".

Feasibility, Safety, and Follow-up Angiographic Results of Endovascular Treatment for Non-Selected Ruptured Intracranial Aneurysms Under Local Anesthesia with Conscious Sedation

  • Kang, Jongsoo;Kang, Chul-Hoo;Roh, Jieun;Yeom, Jeong A;Shim, Dong-Hyun;Kim, Young Soo;Lee, Sang Won;Kim, Young-Soo;Park, Kee Hong;Kim, Chang-Hun;Kim, Soo-Kyoung;Choi, Nack-Cheon;Kwon, Oh-Young;Kang, Heeyoung;Baik, Seung Kug
    • Journal of Neurocritical Care
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    • v.11 no.2
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    • pp.93-101
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    • 2018
  • Background: At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS). Methods: We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score. Results: EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was $55.5{\pm}12.6$ years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Follow-up angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients. Conclusion: Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.