• Title/Summary/Keyword: 환자평가

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A Phase I/II Trial of $DCVac/IR^{(R)}$ Dendritic Cell Immunotherapy Combined with Irradiation in Cases of Refractory Colorectal Cancer with Multiple Liver Metastases (기존의 치료에 반응하지 않는 다발성 간전이 대장암 환자에서 방사선조사와 병합한 수지상세포 면역치료의 1, 2상 임상시험)

  • Choi, Young-Min;Lee, Hyung-Sik;Kwon, Hyuk-Chan;Han, Sang-Young;Choi, Jong-Cheol;Chung, Ju-Seop;Kim, Chang-Won;Kim, Dong-Won;Kang, Chi-Duk
    • Radiation Oncology Journal
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    • v.26 no.2
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    • pp.104-112
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    • 2008
  • Purpose: To assess the toxicity and tumor response induced by $DCVac/IR^{(R)}$ dendritic cell(DC) immunotherapy combined with irradiation for refractory colorectal cancer patients with multiple liver metastases. Materials and Methods: Between May 2004 and November 2006, applicants from a pool of refractory colorectal cancer patients with multiple liver metastases were enrolled. The patients were registered after having signed the informed consent form, which had been approved by the Institutional Review Board from the Dong-A University and Busan National University Hospital. DCs were obtained from peripheral blood of each patient, and then cultured in vitro. A total of $6{\times}10^6$ DCs were packed into a vial($DCVac/IR^{(R)}$, 0.5 ml) at the convenience of each patient's schedule. On the day before and on the day of each vaccination, each patient received a 4 Gy radiation dose to the target tumor. On the day of vaccination, the indicated dose of autologous DCs was injected into the irradiated tumor using ultrasound-guided needle injection procedures. A total of four vaccinations were scheduled at three 2-week intervals and one 4 week interval at the Dong-A University and Busan National University Hospital. If the tumor status was deemed to be stable or responding to therapy, an additional vaccination dose or two was approved at 4 week intervals beyond the fourth immunization. A tolerance test for DCs was conducted by injecting a range of doses($3{\times}10^6\;to\;12{\times}10^6$ DCs) after the 3rd injection. Moreover, the maximal tolerable dose was applied to additional patients. Treatment safety was evaluated in all patients who had at least one injection. Treatment feasibility was evaluated by the 10th week by assessing the response of patients having at least 4 injections. For systemic toxicities, the evaluation was performed using the National Cancer Institute Common Toxicity Criteria, whereas adverse effects were recorded using common WHO toxicity criteria. Results: Of the 24 registered patients, 22 received the DCs injections. Moreover, of the 14 patients that applied for the tolerance test, only 11 patients completed it because 3 patients withdrew their testing agreement. A grade 3 or more side effect, which was possibly related to the DC injection, did not occur in additional patients. The $12{\times}10^6$ DC injection was identified as the maximum tolerable dose, and was then injected in an additional 8 patients. Patients tolerated the injection fairly well, with no fatal side effects. In order to assess the feasibility of DC immunotherapy, the response was evaluated in other hepatic lesions outside of the targeted hepatic lesion. The response evaluation was performed in 15 of the 17 patients who received at least 4 injections. Stable and progressive disease was found in 4 and 11 patients, respectively. Conclusion: The DC-based immunotherapy and radiotherapy is theoretically synergistic for the local control and systemic control. The $DCVac/IR^{(R)}$ immunotherapy combined with irradiation was tolerable and safe in the evaluated cases of refractory colorectal cancer with multiple liver metastases. Future work should include well designed a phase II clinical trials.

The Evaluation of Usefulness of the Manufactured DTAB (Double Tilt Angle Board) System (Double Tilt Angle Board (DTAB)의 자체 제작에 관한 유용성 평가)

  • Lee, Joung-Jin;Jang, In-Gi;Kim, Wan-Sun
    • The Journal of Korean Society for Radiation Therapy
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    • v.18 no.1
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    • pp.43-51
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    • 2006
  • Purpose: To resolution of A hospital-handmade modification double tilt angle immobilization system (DTAB immobilization system) and to report the clinical results of it. Material and Methods: It was developed in conjunction with the breast board for patients unable to achieve and maintain the desired uncomfortable respiration and position of set-up needed in the treatment of RT (This custom design provides an alternative to accomplishing this desired head angle needed to relax position treatment area, realizing that the lenses totally protected eye-ball out) By using the angled breast board and SBDD(small bowel device), reproducibility of set-up and patient comfort were addressed throughout the simulation, computed tomography planning and treatment process. Results: Usually patients the error range-within 5 mm. When use of Aqua patients error range-within 3 mm. Conclusion: It was constructed in tandem with a unique custom-built double tilt angle board (DTAB). It was designed to eliminate clinical set-up problems with head immobilization and instability during treatment, thus providing for a more comfortable head rest for the patient.

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The Assessment Tools in Palliative Medicine (완화 의학에서의 평가도구)

  • Gwak, Jung-Im;Suh, Sang-Yeon
    • Journal of Hospice and Palliative Care
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    • v.12 no.4
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    • pp.177-193
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    • 2009
  • The assessment of patient status in palliative medicine is essential for determining treatments and for clinical outcomes. The objective of assessment tools is to raise the quality of care for individual patients and their families. There are a number of tools available to assess pain, non-pain symptoms and quality of life. The tools are either uni-dimensional or multi-dimensional measures. Unfortunately, however, no single tool is recommended to be a superior to others in symptoms or quality of life assessment. Therefore, to select an appropriate assessment tool, one should consider the time frame and unique characteristics of tools depending on purpose and setting. The combination of prognostic index is highly recommended in prognostication, and web-based prognostic tools are available. Recently, a new objective prognostic score has been constructed through multicenter study in Korea. It does not include clinicalestimates of survival, but includes new objective prognostic factors, therefore, anyone can easily use it. For beginners in palliative medicine, relatively easy-to-use tools would be convenient. We recommend Eastern Cooperative Oncology Group performance status to assess functional status, numeric rating scale for pain assessment and the Korean version of brief pain inventory for initial pain assessment. Asking directly with numeric rating scale or the Korean version of MD Anderson Symptom Inventory would be desirable to assess various symptoms together. We think that European Organization Research and Treatment Quality of Life Questionnaire Core 15 for Palliative Care is good to assess the quality of life, while Objective Prognostic Score is convenient as prognostic index for beginners.

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Spatial Analysis Modeling for the Development of Evaluating Model for Hospital Location (공간분석모델링을 이용한 병원의 적지평가 모형 개발)

  • Lee, Kwang-Soo;Lee, Jung-Soo
    • The Journal of the Korea Contents Association
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    • v.9 no.10
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    • pp.258-267
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    • 2009
  • This study purposed to develop GIS model for evaluating hospital location in a metropolitan city. Secondly, the suitability score of hospital was compared with the number of outpatient/inpatients of hospitals. This study used administrative data collected from the annual report of the 5 ward offices from Daejeon in Korea in 2004. 7 Acute care hospitals operated in Daejeon in 2004 were selected for the analysis. The suitability of hospitals in a metropolitan city was evaluated by the economic factors which were assumed to influence the health care demand. Each criterion was measured from each Dong. Correlation coefficients between the suitability score of hospital and the number of patients were varied depending on the buffering size. The relationship showed positive relationship with the number of inpatient (0.15) and outpatients (0.10) on the 0.5km buffering size. However, the correlation coefficients were changed to a negative direction or decreased when the buffering size was increased to 1.0km, 1.5km, and 2.0km.

Effects of Visual Perception Skills on Driving Performance of Patients With Stroke (뇌졸중 환자의 시지각 능력이 운전수행에 미치는 영향)

  • Kwak, Ho-Soung
    • Therapeutic Science for Rehabilitation
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    • v.9 no.1
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    • pp.45-55
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    • 2020
  • Objective : The purpose of this study was to investigate the effects of visual perception on driving performance and the importance of visual training for improving driving performance in patients with stroke. Methods : The evaluations, using MVPT(Motor-free Visual Perception Test), TMT A&B(Trail Making Test A & B), UFOV(Useful Field Of View test), and a driving simulator, were carried out with patients in department of physical medicine and rehabilitation in a rehabilitation hospital from October 2014 to November 2014. Results : Driving performance was related to the ability of various visual perceptions of patients with stroke, and the highest correlation was found in the UFOV subtest 2, TMT B, and MVPT. The results of discriminant analysis indicated a sensitivity of 100.0%, specificity of 80.0%, and predicted the results of the driving simulator with 89.5% accuracy. Conclusion : This study found that visual-perception skills influence driving performance and suggested the importance of visual-perception skill training for driving.

Analysis on Vowel and Consonant Sounds of Patent's Speech with Velopharyngeal Insufficiency (VPI) and Simulated Speech (구개인두부전증 환자와 모의 음성의 모음과 자음 분석)

  • Sung, Mee Young;Kim, Heejin;Kwon, Tack-Kyun;Sung, Myung-Whun;Kim, Wooil
    • Journal of the Korea Institute of Information and Communication Engineering
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    • v.18 no.7
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    • pp.1740-1748
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    • 2014
  • This paper focuses on listening test and acoustic analysis of patients' speech with velopharyngeal insufficiency (VPI) and normal speakers' simulation speech. In this research, a set consisting of 50-words, vowels and single syllables is determined for speech database construction. A web-based listening evaluation system is developed for a convenient/automated evaluation procedure. The analysis results show the trend of incorrect recognition for VPI speech and the one for simulation speech are similar. Such similarity is also confirmed by comparing the formant locations of vowel and spectrum of consonant sounds. These results show that the simulation method for VPI speech is effective at generating the speech signals similar to actual VPI patient's speech. It is expected that the simulation speech data can be effectively employed for our future work such as acoustic model adaptation.

성대폴립 환자를 대상으로 한 GRBAS 척도와 MDVP 측정치 간의 상관관계 연구

  • 표화영;최성희;임성은;심현섭;최홍식;김광문
    • Proceedings of the KSLP Conference
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    • 1999.11a
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    • pp.180-180
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    • 1999
  • 배경 : 음성평가시 그 음질을 파악하기 위한 검사 중 주관적 검사로서 많이 쓰이는 것은 GRBAS 척도에 의한 청인지적 4단계 평정이고, 객관적 검사로서 널리 쓰이고 있는 검사 도구는 CSL 중 MDVP이다. 이중 GRBAS 검사는 평가자의 고도의 숙련도를 요구하며, MDVP에 의한 음성평가는, 나타난 결과에 대한 정확한 해석을 요구한다. 목적 : 이에, 1차적으로 음성과용 환자를 대상으로 하여, GRBAS 척도에 의한 청인지적 음성평가 결과와 CSL 중 MDVP에 의한 객관적 음성평가 결과에 대한 상관성을 비교, 분석해 보고, 이를 통하여 청인지적 음성평가에 숙련되지 못한 평가자가 객관적 검사도구를 통하여 음성평가를 하고자 할 때 주목해야 할 변인들에 관하여 알아보고자 한다. (중략)

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The Evaluation of Musculoskeletal Symptom and Patient Transport Work of 119 EMTs by Ergonomics Tools (119구급대원의 근골격계 증상과 환자운반 작업의 인간공학적 평가)

  • Hong, Sung-Gi
    • Fire Science and Engineering
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    • v.28 no.4
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    • pp.81-88
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    • 2014
  • This study identified the complaint ratio of musculoskeletal symptom by 119 EMTs and investigated the work risk extent through ergonomics evaluation about the patient transport works, which cause work-related musculoskeletal disorders (WMSDs) to 119 EMTs. For this, the complaint ratio of musculoskeletal symptom utilized questionnaire tool based on KOSHA Code H-30-2008 and the risk extent about the patient transport work evaluated by using ergonomics evaluation tools such as OWAS, RULA and REBA. According to the study result, 60.9% of 119 EMTs experienced musculoskeletal symptom. Among them, the symptom on back was the most common (36.1%). The work, which mostly causes WMSDs, has been found as patient transport work (48.4%). Among the patient transport motion, loading/unloading of ambulance cot to/from ambulance and the lifting of patient by stretcher were OWAS risk-level 3 and RULA/REBA risk-level 3 to 4. Among the patient transport environment, carrying patient on stairway using emergency mini-stretcher, moving patient in vehicle using spine board and piggy-back carrying or cradle carrying patient on stairway or slope way were OWAS, RULA, REBA risk level 3 to 4. It is suggested that immediate improvement in work postures for these works should contribute to prevention against WMSDs to 119 EMTs.

Diagnostic Performance Using a Combination of MRI Findings for Evaluating Cognitive Decline (인지기능 저하평가를 위한 MR 영상 소견 조합의 진단능)

  • Jin Young Byun;Min Kyoung Lee;So Lyung Jung
    • Journal of the Korean Society of Radiology
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    • v.85 no.1
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    • pp.184-196
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    • 2024
  • Purpose We investigated potentially promising imaging findings and their combinations in the evaluation of cognitive decline. Materials and Methods This retrospective study included 138 patients with subjective cognitive impairments, who underwent brain MRI. We classified the same group of patients into Alzheimer's disease (AD) and non-AD groups, based on the neuropsychiatric evaluation. We analyzed imaging findings, including white matter hyperintensity (WMH) and cerebral microbleeds (CMBs), using the Kruskal-Wallis test for group comparison, and receiver operating characteristic (ROC) curve analysis for assessing the diagnostic performance of imaging findings. Results CMBs in the lobar or deep locations demonstrated higher prevalence in the patients with AD compared to those in the non-AD group. The presence of lobar CMBs combined with periventricular WMH (area under the ROC curve [AUC] = 0.702 [95% confidence interval: 0.599-0.806], p < 0.001) showed the highest performance in differentiation of AD from non-AD group. Conclusion Combinations of imaging findings can serve as useful additive diagnostic tools in the assessment of cognitive decline.

Needs and Related Factors for Return-to-Work Support in Cancer Survivors (암 경험자의 직장복귀지원에 대한 요구도 및 관련 요인)

  • Lee, Sungwon;Lee, Kwang-Min;Oh, Gyu-Han;Yeom, Chan-Woo;Jung, Sanghyup;Hahm, Bong-Jin
    • Korean Journal of Psychosomatic Medicine
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    • v.28 no.2
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    • pp.126-134
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    • 2020
  • Objectives : The purpose of this study was to investigate the needs for return-to-work support of cancer survivors and related factors in patients with cancer and their caregivers. Methods : 182 patients and 114 caregivers were recruited. Distress Thermometer and Problem List and scale ranging 0~10 measuring the degree of needs for return-to-work support were utilized. The needs for return-to-work support between the patient group and caregiver group (patient's needs evaluated by the caregiver) were compared, and related factors were investigated using logistic regression analysis. Results : 34.6% and 28.1% of patients and caregivers reported return-to-work support of cancer survivors is "very necessary". The degree of needs was 6.60±3.365 points in the patient group and 6.17±3.454 points in the caregiver group, with no significant difference (p=0.282). The needs for return-to-work support evaluated by patients was high when they underwent surgery (OR=2.592, p=0.007), has fertility problems (OR=6.137, p=0.025), has appearance problems (OR=2.081, p=0.041), or has fatigue (OR=2.330, p=0.020). The needs for return-to-work support of patients evaluated by caregivers was high when patients treated with breast cancer (vs respiratory cancer, OR=13.038, p=0.022 ; vs leukemia/lymphoma, OR=4.517, p=0.025 ; vs other cancer, OR=13.102, p=0.019), has work/school problems (OR=4.578, p=0.005), or has depression (OR=3.213, p=0.022). Conclusions : The degree of needs for return-to-work support of cancer survivors was high, and factors related to the needs were different between the two groups. This suggests that return-to-work support of cancer survivors is required, and clinical characteristics, the distress of patients, and differences between patients and their caregivers should be considered in establishing a support plan.