• Title/Summary/Keyword: Clinical response

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Effects of Aggressive Stress Response Mediation on Clinical Practice Stress and Satisfaction (적극적 스트레스 대처매개 중재가 임상실습 스트레스와 만족도에 미치는 영향)

  • Lee, Jeong-Yun;Hwang, Hye-Kyung
    • Journal of Korean Clinical Health Science
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    • v.7 no.2
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    • pp.1345-1354
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    • 2019
  • Purpose: This study aimed to determine the mediating effects of aggressive stress response on the association between clinical practice stress and clinical practice satisfaction in ophthalmic optics majors and provide basic data that could help form opticians' professionalism and make clinical practice more effective. Methods: This study was conducted in 236 sophomores and juniors in Daegu and North Gyeongsang Province who had finished clinical practice. Hierarchical regression analysis and mediating effect testing were performed to determine the associations among clinical practice stress, clinical practice satisfaction, and aggressive stress response and determine the mediating effects of aggressive stress response on the association between clinical practice stress and clinical practice satisfaction. Results: Clinical practice stress was significantly negatively correlated with clinical practice satisfaction and aggressive stress response (p<0.01), and aggressive stress response was significantly positively correlated with clinical practice satisfaction (p<0.01). The association between clinical practice stress and clinical practice satisfaction was more likely to be explained by the addition of clinical practice stress than by being aggressive stress response controlled, which statistically significantly met the criteria for mediating effects (p<0.001). Conclusions: It is necessary to pay more attention to program development and teaching methods within the department of ophthalmic optics so that ophthalmic optics majors can utilize aggressive stress response to overcome clinical practice stress effectively and improve clinical practice satisfaction.

Relationship between Plasma Concentrations of Haloperidol and Its Metabolite, Reduced Haloperidol, and Clinical Response in Schizophrenia (정신분열증 환자에서의 Haloperidol 및 Reduced Haloperidol의 혈장농도와 임상반응과의 상관성)

  • Park, Kyung-Ho;Kim, Mu-Jin;Lee, Myung-Gul;Shim, Chang-Koo;Lee, Min-Hwa
    • Journal of Pharmaceutical Investigation
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    • v.23 no.3
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    • pp.165-177
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    • 1993
  • The relationship between the plasma haloperidol (HP) concentration and clinical response, and the effects of its active metabolite, reduced haloperidol (RH) on clinical response of HP were investigated in schizophrenic patients. In clinical study I, with 17 schizophrenic patients (male 8, fermale 9) who were administered with three different fixed doses of HP (15, 30 and 50 mg/day) for 3 weeks, the concentrations of HP and RH in plasma and blood and clinical response had been checked before and every week during the study. The clinical response was evaluated by the method of brief psychiatric rating scale (BPRS), and relative improvement of clinical response based on baseline BPRS (before drug treatment) was calculated. The concentrations of HP and RH in plasma and blood were assayed by HPLC. In clinical study II, the plasma RH/HP concentration ratios were checked in 11 patients who were administered with high doses of HP, over 60 mg a day, because of the poor clinical response at usual doses of HP. Plasma HP concentration and relative improvement of BPRS at 3 week in schizophrenic patients showed a 'curvilinear' relationship, and the clinical response was improved relatively over 50% based on the baseline BPRS in the range of $5{\sim}57\;ng/ml $ of HP in plasma. Also, the plasma RH concentrations were increased nonlinearly as the plasma HP concentration increased, and in high plasma HP concentration, over 30 ng/mI, clinical response gradually decreased, while the plasma RH/HP concentration ratio increased nonlinearly. Blood partition coefficients of HP and RH were not changed according to daily HP dose and duration of drug therapy. From these results, it is noted that the higher plasma RH/HP concentration ratio, resulted from the accumulation of RH as HP concentration increased, might explain the 'curvilinear' decrease of HP clinical response.

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The Exercise Capacity and Cardiovascular Factors in Patients with Exaggerated Blood Pressure Response during Treadmill Exercise Testing

  • Bae, Hyung-Joon;Shin, Kyung A
    • Korean Journal of Clinical Laboratory Science
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    • v.43 no.4
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    • pp.138-144
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    • 2011
  • Exaggerated blood pressure response during exercise has been found to increase the risk of future hypertension, left ventricular hypertrophy, cerebrovascular stroke, and CVD (cardiovascular disease) death. The aim of this study was to evaluate exercise capacity, cardiovascular factors in exaggerated blood pressure response during treadmill exercise testing. For research subjects, 72 subjects (normal blood response: 49 subjects, exaggerated blood response: 23 subjects) who received treadmill exercise test at J General Hospital were selected in this study. Exaggerated SBP (systolic blood pressure) response was defined as an SBP of 210 mmHg or greater during a maximal treadmill exercise test. The group with an exaggerated SBP response showed significantly higher values for RPP (rate pressure product) compared with the group with a normal SBP response. Subjects with METs (metabolic equivalents) had lower exaggerated SBP response than normal SBP response group. Subjects with recovery SBP had delayed exaggerated SBP response than normal SBP response group. Exaggerated SBP response to exercise is negative correlation with METs.

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Impaired Response Inhibition in Patients with Obsessive-Compulsive Disorder (강박장애 환자의 반응억제 결함)

  • Boo, Young Jun;Kim, Se Joo;Kang, Jee In
    • Anxiety and mood
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    • v.11 no.1
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    • pp.33-37
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    • 2015
  • Objective : Impaired response inhibition has been suggested to play an important role in the pathophysiology of obsessive-compulsive disorder (OCD). The aim of this study was to evaluate the response inhibition in patients with OCD, by using the Go/NoGo paradigm, and to better understand its associations with clinical symptoms. Methods : The participants included 63 OCD patients and 80 healthy volunteers matched in age and sex. response inhibition was evaluated using computerized Go/NoGo task, in which their commission error rates, omission error rates, and mean response times were measured. The severity of clinical symptoms in the OCD patients was assessed using Montgomery-Asberg Depression Scale and Yale-Brown Obsessive Compulsive Scale. Result : OCD patients showed significantly impaired inhibition and higher omission errors rates despite their slower response time, compared to normal controls. Clinical symptoms were not correlated with commission errors and omission errors. Conclusion : The present results indicate that impairment in response inhibition may play a critical role in the pathophysiology of OCD as a trait. These findings suggest that deficit of response inhibition may contribute to developing and maintaining clinical symptoms such as compelling need to repeat certain actions in patients with OCD.

The feasibility of percutaneous transhepatic gallbladder aspiration for acute cholecystitis after self-expandable metallic stent placement for malignant biliary obstruction: a 10-year retrospective analysis in a single center

  • Akihisa Ohno;Nao Fujimori;Toyoma Kaku;Masayuki Hijioka;Ken Kawabe;Naohiko Harada;Makoto Nakamuta;Takamasa Oono;Yoshihiro Ogawa
    • Clinical Endoscopy
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    • v.55 no.6
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    • pp.784-792
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    • 2022
  • Background/Aims: Patients with acute cholecystitis (AC) after metallic stent (MS) placement for malignant biliary obstruction (MBO) have a high surgical risk. We performed percutaneous transhepatic gallbladder aspiration (PTGBA) as the first treatment for AC. We aimed to identify the risk factors for AC after MS placement and the poor response factors of PTGBA. Methods: We enrolled 401 patients who underwent MS placement for MBO between April 2011 and March 2020. The incidence of AC was 10.7%. Of these 43 patients, 37 underwent PTGBA as the first treatment. The patients' responses to PTGBA were divided into good and poor response groups. Results: There were 20 patients in good response group and 17 patients in poor response group. Risk factors for cholecystitis after MS placement included cystic duct obstruction (p<0.001) and covered MS (p<0.001). Cystic duct obstruction (p=0.003) and uncovered MS (p=0.011) demonstrated significantly poor responses to PTGBA. Cystic duct obstruction is a risk factor for cholecystitis and poor response factor for PTGBA, whereas covered MS is a risk factor for cholecystitis and an uncovered MS is a poor response factor of PTGBA for cholecystitis. Conclusions: The onset and poor response factors of AC after MS placement were different between covered and uncovered MS. PTGBA can be a viable option for AC after MS placement, especially in patients with covered MS.

Clinical Application of the Adenosine Triphosphate-based Response Assay in Intravesical Chemotherapy for Superficial Bladder Cancer

  • Ge, Wen-Qing;Pu, Jin-Xian;Zheng, Shi-Ying
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.2
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    • pp.689-692
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    • 2012
  • Objective: To investigate correlations between adenosine triphosphate chemotherapy response assay (ATP-CRA) and clinical outcomes after ATP-CRA-based chemotherapy for drug selection in patients receiving intravesical chemotherapy to prevent recurrence of superficial bladder cancer after surgery. Methods: The chemosensitivities of 12 anticancer drugs were evaluated, including 5-Fu ADM, and EPI, using ATP-CRA and primary tumor cell culture in 54 patients. In addition, a further 58 patients were treated according to clinical experience. Differences in post-chemotherapeutical effects between drug sensitivity assay and experience groups were compared. Results: The evaluable rate of the test was 96.3%, the clinical effective rate was 80.8%, the sensitivity rate was 97.6% (41/42), the specificity was 20%, the total predicting accuracy was 74.3%, the positive predictive value was 83.7% (41/49), the negative predictive value was 66.7% (2/3); in the drug sensitivity test group, the clinical effective rate was 80.8%, the experience group response rate was 63.8%, with a significant difference in clinical effects between the ATP-based sensitivity and experience groups (${\chi}^2$=7.0153, P<0.01). Conclusion: ATP-CRA is a stable, accurate and potentially practical chemosensitivity test providing a predictor of chemotherapeutic response in patients with superficial bladder cancer.

Long-Term Treatment Response to Lithium and Valproate in Patients with Bipolar 1 Disorder Treated More Than 2 Years : A Retrospective Study (1형 양극성 장애 환자에서 리튬과 발프로산의 장기간 치료 효과에 대한 후향적 평가 : 2년 이상 치료받은 환자의 효과 비교)

  • Ahn, Sung Woo;Yang, So-Yung;Choi, Yujin;Hong, Kyung Sue
    • Korean Journal of Biological Psychiatry
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    • v.23 no.4
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    • pp.185-192
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    • 2016
  • Objectives Treatment response of bipolar disorders (BDs) to long-term mood stabilizers maintenance has not been well explored because of complicated clinical and treatment courses. This study aims at investigating long-term clinical response of BDs to lithium and/or valproate in a naturalistic setting of a tertiary-care university-affiliated hospital. Methods Subjects were 65 patients with bipolar I (BD-I) disorders who had been treated with lithium and/or valproate for more than two years at single bipolar disorder clinic. Long-term response to the best treatment based on treatment algorithms and the current clinical standard of care was retrospectively evaluated using the Alda Scale and the Clinical Global Impression Scale for use in bi-polar illness (CGI-BP). Patients were classified into full responder and partial/non responder groups based on the total score of the Alda Scale with the cut-off score generated from the frequentist mixture analysis of the authors' previous study. Results The mean duration of treatment with the index medication was 69.2 months. Baseline demographic and clinical characteristics were not different among three mood stabilizer groups (valproate, lithium, and combination groups). Twenty-one subjects were classified into full responder group (32.3%). Treatment response assessed by the Alda Scale and CGI-BP scores was not different between lithium and valproate groups. The Alda Scale scores were well correlated with the CGI-BP scores (p < 0.05). Conclusions One third of the patients showed a full response to the long-term lithium and/or valproate treatment in BD-I. The degree of response was similar between lithium and valproate groups.

Comparison of WHO and RECIST Criteria for Evaluation of Clinical Response to Chemotherapy in Patients with Advanced Breast Cancer

  • Khokher, Samina;Qureshi, Muhammad Usman;Chaudhry, Naseer Ahmad
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.7
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    • pp.3213-3218
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    • 2012
  • When patients with advanced breast cancer (ABC) are treated with neoadjuvant chemotherapy (NACT), efficacy is monitored by the extent of tumor shrinkage. Since their publication in 1981, World Health Organization (WHO) guidelines have been widely practiced in clinical trials and oncologic practice, for standardized tumor response evaluation. With advances in cancer treatment and tumor imaging, a simpler criterion based on one-dimensional rather than bi-dimensional (WHO) tumor measurement, named Response Evaluation Criteria in Solid Tumors (RECIST) was introduced in 2000. Both approaches have four response categories: complete response, partial response, stable disease and progressive disease (PD). Bi-dimensional measurement data of 151 patients with ABC were analysed with WHO and RECIST criteria to compare their response categories and inter criteria reproducibility by Kappa statistics. There was 94% concordance and 9/151 patients were recategorized with RECIST including 6/12 PD cases. RECIST therefore under-estimates and delays diagnosis of PD. This is undesirable because it may delay or negate switch over to alternate therapy. Analysis was repeated with a new criteria named RECIST-Breast (RECIST-B), with a lower threshold for PD (${\geq}10%$ rather than ${\geq}20%$ increase of RECIST). This showed higher concordance of 97% with WHO criteria and re-categorization of only 4/151 patients (1/12 PD cases). RECIST-B criteria therefore have advantages of both ease of measurement and calculations combined with excellent concordance with WHO criteria, providing a practical clinical tool for response evaluation and offering good comparison with past and current clinical trials of NACT using WHO guidelines.

Clinical application of anti-M$\ddot{u}$llerian hormone as a predictor of controlled ovarian hyperstimulation outcome

  • Lee, Jae Eun;Lee, Jung Ryeol;Jee, Byung Chul;Suh, Chang Suk;Kim, Ki Chul;Lee, Won Don;Kim, Seok Hyun
    • Clinical and Experimental Reproductive Medicine
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    • v.39 no.4
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    • pp.176-181
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    • 2012
  • Objective: In 2009 anti-M$\ddot{u}$llerian hormone (AMH) assay was approved for clinical use in Korea. This study was performed to determine the reference values of AMH for predicting ovarian response to controlled ovarian hyperstimulation (COH) using the clinical assay data. Methods: One hundred sixty-two women who underwent COH cycles were included in this study. We collected data on age, basal AMH and FSH levels, total dose of gonadotropins, stimulation duration, and numbers of oocytes retrieved and fertilized. Blood samples were obtained on cycle day 3 before gonadotropin administration started. Serum AMH levels were measured at a centralized clinical laboratory center. The correlation between the AMH level and COH outcomes and cut-off values for poor and high response after COH was analyzed. Results: Concentration of AMH was significantly correlated with the number of oocytes retrieved (OPU; r=0.700, p<0.001). The mean${\pm}$SE serum AMH levels for poor ($OPU{\leq}3$), normal ($4{\leq}OPU{\leq}19$), and high ($OPU{\geq}20$) response were $0.94{\pm}0.15$ ng/mL, $2.79{\pm}0.21$ ng/mL, and $6.94{\pm}0.90$ ng/mL, respectively. The cut-off level, sensitivity and specificity for poor and high response were 1.08 ng/mL, 85.8%, and 78.6%; and 3.57 ng/mL, 94.4%, and 83.3%, respectively. Conclusion: Our data present clinical reference values of the serum AMH level for ovarian response in Korean women. The serum AMH level could be a clinically useful predictor of ovarian response to COH.

Clinical predictive factors of pathologic tumor response after preoperative chemoradiotherapy in rectal cancer

  • Choi, Chi Hwan;Kim, Won Dong;Lee, Sang Jeon;Park, Woo-Yoon
    • Radiation Oncology Journal
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    • v.30 no.3
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    • pp.99-107
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    • 2012
  • Purpose: The aim of this study was to identify clinical predictive factors for tumor response after preoperative chemoradiotherapy (CRT) in rectal cancer. Materials and Methods: The study involved 51 patients who underwent preoperative CRT followed by surgery between January 2005 and February 2012. Radiotherapy was delivered to the whole pelvis at a dose of 45 Gy in 25 fractions, followed by a boost of 5.4 Gy in 3 fractions to the primary tumor with 5 fractions per week. Three different chemotherapy regimens were used (5-fluorouracil and leucovorin, capecitabine, or tegafur/uracil). Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and pathologic complete response (ypCR). Statistical analyses were performed to identify clinical factors associated with pathologic tumor response. Results: Tumor downstaging was observed in 28 patients (54.9%), whereas ypCR was observed in 6 patients (11.8%). Multivariate analysis found that predictors of downstaging was pretreatment relative lymphocyte count (p = 0.023) and that none of clinical factors was significantly associated with ypCR. Conclusion: Pretreatment relative lymphocyte count (%) has a significant impact on the pathologic tumor response (tumor downstaging) after preoperative CRT for locally advanced rectal cancer. Enhancement of lymphocyte-mediated immune reactions may improve the effect of preoperative CRT for rectal cancer.