• Title, Summary, Keyword: Noncompliance

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Markov's Modeling for Screening Strategies for Colorectal Cancer

  • Barouni, Mohsen;Larizadeh, Mohammad Hassan;Sabermahani, Asma;Ghaderi, Hossien
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.10
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    • pp.5125-5129
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    • 2012
  • Economic decision models are being increasingly used to assess medical interventions. Advances in this field are mainly due to enhanced processing capacity of computers, availability of specific software to perform the necessary tasks, and refined mathematical techniques. We here estimated the incremental cost-effectiveness of ten strategies for colon cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and profit of chemotherapy in Iran. We used a Markov model to measure the costs and quality-adjusted life expectancy of a 50-year-old average-risk Iranian without screening and with screening by each test. In this paper, we tested the model with data from the Ministry of Health and published literature. We considered costs from the perspective of a health insurance organization, with inflation to 2011, the Iranian Rial being converted into US dollars. We focused on three tests for the 10 strategies considered currently being used for population screening in some Iranians provinces (Kerman, Golestan Mazandaran, Ardabil, and Tehran): low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 39%, 60% and 76%, and mortality by 50%, 69% and 78%, respectively, compared with no screening. These approaches generated ICER (incremental cost-effectiveness ratios) of $9067, $654 and $8700 per QALY (quality-adjusted life year), respectively. Sensitivity analyses were conducted to assess the influence of various scales on the economic evaluation of screening. The results were sensitive to probabilistic sensitivity analysis. Colonoscopy every ten years yielded the greatest net health value. Screening for colon cancer is economical and cost-effective over conventional levels of WTP8.

Risk Factors Affecting the Graft and Patient Survival in Kidney Transplant Patients (신이식환자에서 이식과 환자의 생존에 영향을 끼치는 위험요인 분석)

  • Kim, Joo-Young;Han, Duck-Jong;Shin, Hae-Young;Shin, Whan-Gyun;Oh, Jung-Mi
    • Korean Journal of Clinical Pharmacy
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    • v.16 no.1
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    • pp.14-22
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    • 2006
  • Purpose: To determine the short (1 year of transplant) and long-term (1-5 years of transplantation) risk factors affecting the graft and patient survival in kidney transplantation recipients. Methods: Records of 149 patients who received kidney transplantation in 1996 from Asan Medical Center were followed for 5 years retrospectively. Results: All patients initiated triple immunosuppressive therapy with cyclosporine, prednisone and azathioprine. One, two, three, four, five year patient and graft survival rates were 98.7%, 98.0%, 98.0%, 97.3%, 97.3%, and 96.6%, 95.2%, 94.6%, 92.5%, 91.8%, respectively. There were 30 cases of acute rejection (AR) and 6 cases of chronic rejection (CR) within $2.1{\pm}3.2$ months and $42.1{\pm}13.2$ months of transplantation, respectively. The risk factors for AR were donor's age older than 30 years (p=0.02) and cardiovascular disease (p=0.05). The risk factors for CR were AR (p=0.0169) and episode of complications (p=0.0330). Increasing period of dialysis (p=0.0473), episodes of AR (p<0.0001) and complication (p=0.0317) were significant factors for graft loss. Seven grafts were lost from noncompliance during 1-5 year period. The most com- mon cause of the graft loss for both periods was the graft rejection. The graft survival rate was significantly lower in patients with than without rejection episodes (77.4% vs. 90.0%, p=0.002). Conclusions: Survival rate of the graft with rejection was significantly lower. The risk factors affecting AR were donor's age older than 30years and CVD. AR and episode of complications within 1year were the risk factors for CR and graft loss.

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EFFECT OF COMPLIANCE ON NEWMARK-TYPE RIGID BLOCK DEFORMATION ANALYSIS (Newmark-방식 강체블럭 변위해석에 대한 유연도의 영향)

  • Kim, Jin-Man
    • Journal of the Korean Geotechnical Society
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    • v.23 no.12
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    • pp.117-124
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    • 2007
  • This study investigates the effect of spatial averaging and compliance taken account of in the analysis of earthquake-induced permanent deformation of slopes. At present, the rigid block analysis originally proposed by Newmark is widely used in the deformation analysis, mainly because of its computational efficiency. This type of approach, however, adopts the so-called decoupled approach, in which seismic response and deformation analyses are carried out separately. Original Newmark block analysis assumes the potential sliding mass to be noncompliant, and has been criticized to be potentially unconservative. This paper reviews the impact of the noncompliance assumption of the potential sliding mass in the Newmark-type analysis. The gross effects of earthquake shaking on the potential sliding mass are estimated by spatial averaging method and analyzed in frequency domain. The results indicate that there is a simple criterion that can be used to determine the level of compliance of the potential sliding mass.

A Clinical Analysis of Surgical Treatment for Spontaneous Spinal Infection

  • Lee, Dong-Geun;Park, Kyung-Bum;Kang, Dong-Ho;Hwang, Soo-Hyun;Jung, Jin-Myung;Han, Jong-Woo
    • Journal of Korean Neurosurgical Society
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    • v.42 no.4
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    • pp.317-325
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    • 2007
  • Objective : The purpose of the study was to determine the clinical effects of anterior radical debridement on a series of patients with spontaneous spinal infection. Methods : We retrospectively analyzed the clinical characteristics of 32 patients who underwent surgical treatment from January 2000 to December 2005 in our department. The average follow-up Period was 33.4 months (range, 6 to 87 months). Thirty-two patients presented with the following : 23 cases with pyogenic spondylitis, eight with tuberculous spondylitis and one with fungal spondylitis. The indications for surgery were intractable pain, failure of medical management, neurological impairment with or without an associated abscess, vertebral destruction causing spinal instability and/or segmental kyphosis. Results : The study included 15 (46.9%) males and 17 (53.1%) females ranging in age from 26 to 75 years (mean, 53.1 years). Diabetes mellitus (DM) and pulmonary Tbc were the most common predisposing factors for pyogenic spondylitis and tuberculous spondylitis. Staphylococcus aureus (13%) was the main organism isolated. The most prevalent location was the lumbar spine (75%). Changes in the pain score, Frankel's classification, and laboratory parameters demonstrated a significant clinical improvement in all patients. However, there were recurrent infections in two patients with tuberculous spondylitis and inappropriate debridement and intolerance of medication and noncompliance. Autologous rib, iliac bone and allograft(fibular) were performed in most patients. However, 10 patients were grafted using a titanium mesh cage after anterior radical debridement. There were no recurrent infections in the 10 cases using the mesh cage with radical debridement. Conclusion : The findings of this study indicate that surgery based on appropriate surgical indications is effective for the control of spinal infection and prevention of recurrence with anterior radical debridement, proper drug use and abscess drainage.

Hospital Nurses' Knowledge and Compliance on Multidrug-resistant Organism Infection Control Guideline (일 대학병원 간호사의 다약제 내성균 감염관리지침에 대한 지식과 수행정도)

  • Kang, Ji-Yeon;Cho, Jin-Wan;Kim, Yu-Jung;Kim, Dong-Hee;Lee, Ji-Young;Park, Hey-Kyung;Jung, Sung-Hee;Lee, Eun-Nam
    • Journal of Korean Academy of Nursing
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    • v.39 no.2
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    • pp.186-197
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    • 2009
  • Purpose: This study was done to investigate nurses' knowledge of, and compliance with the multidrug-resistant organism (MDRO) infection control guidelines. Methods: A survey questionnaire was developed based on the institutional and national guidelines and was administered to a convenience sample of 306 nurses in a university hospital. Results: The mean score for knowledge was 33.87 (percentage of correct answers: 82.61%). The percentages of correct answers for basic concepts, route of transmission, hand washing/protective devices and environment management were 74.27%, 94.29%, 92.90% and 75.54% respectively. The mean compliance score was 4.15 (range: 1-5). The compliance scores for education, communication, contact precaution, disinfection, surveillance culture, and hand washing were 3.29, 4.05, 4.20, 4.50, 4.40 and 4.48 respectively. Nurses indicated "lack of time (30.06%)", "lack of means (10.78%)" and "lack of knowledge (9.48%)" as reasons for noncompliance. Conclusion: While most educational programs have focused on hand washing or use of protective devices to prevent transmission of MDRO in acute care settings, hospital nurses' knowledge of the basic concepts of MDRO and environmental management has remained insufficient. Nurses are relatively non-compliant to the guidelines in the areas of education (staff, patient, family) and communication. Comprehensive educational programs are needed to decrease hospital infection rates and to improve the health of patients.

A study on the Compliance and Educational Demand of Renal Transplantation Patient (신장이식 환자의 치료지시 이행정도와 교육 요구도에 관한 연구)

  • Ryu, Jeong-Ha;Kim, Myung-Hee;Kang, In-Soon
    • The Korean Journal of Rehabilitation Nursing
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    • v.6 no.2
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    • pp.226-238
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    • 2003
  • This study was started for the purpose of providing the basic data for continous managment of kidney transplantation patients after discharge. This study was conducted on 180 patients who received renal transplants at three hospital( B, M, P) pusan, korea. The data collection was done for june 1, to August 31, 2002. General characteristics, renal transplantaton characteristics, physical characteristics, the level of compliance and the degree of educational demand were done by the number and percentage, the mean, standard deviation. The level of compliance and educational demand followed by the characteristics of general and kidney transplantation were analyzed by t-test and ANOVA. The result were as fallows; 1. Man was higher than woman such as 60.0%, Mean age was 42.5 years old, Average total duration of after operation was 5.5 years. 2. Cases of systolic blood pressure over 140mmHg were 10.0%, cases of diastolic blood pressure over 90mmHg were 22.8% and obesity factor in BMI was 15.6%. The person who daily water intake amount is 5000cc was 0.6%, the case that daily urine output is below 1000cc was 8.9%, and the case that urine output is zero was 0.6%. 3. The mean score of compliance was 77.47 point, The score in medication part was highest such as 4.67 point, that in stress situation was lowest such as 3.50 point. 4. The average score of educational demand was 154.02 point, and physical state part was 4.36 points highest, activation part was 3.48 points lowest. As a role of nurse Confirmation of compliance is very important encourage to make good through regular hospital visitation, point out the noncompliance part and then increase compliance of renal transplantation patient As well there will be maintain the normal kidney function to satisfy educational demand through continous education.

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A Study of Home Care Needs of Patients at Discharge and Effects of Home Care -Centered on Patients Discharged from a Rural General Hospilal- (퇴원환자의 가정간호요구와 가정간호사업의 효과 분석 - 일 종합병원을 중심으로)

  • Choi, Yun Soon;Kim, Dai Hyun;Storey, Margaret;Kim, Cho Ja;Kang, Kyu Sook
    • The Korean Nurse
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    • v.31 no.4
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    • pp.77-99
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    • 1992
  • The study was carried out at W. hospital, an affiliated hospital of Y university, involved a total of 163 patients who were discharged from the hospital between May 1990 und March 199J. Data collection was twice, just prior to discharge and a minimum of three months post discharge. Thirty patients who lived within a hour travel time of the hospital received home care during the three months post discharge. Nursing diagnoses and nursing interventions For these patients were analyzed in this study. The results of the study are summarized as follows : 1. Discharge needs for the subjects of the study were analyzed using Gordon's eleven Functional categories and it was found that 48.3% of the total sample had identified nursing needs. Of these, the needs most frequently identified were in the categories of sexuality, 79.3 %, health perception, 68.2 % self concept, 62.5 %, and sleep and rest 62.5 %. Looking ut j he nursing diagnosis that were made for the 30 patients receiving home care, the following diagnoses were the most frequently given; alteration in sexual pattern 79.3%, alterations in health maintenance, 72.6%, alteration in comfort, 68.0%, depression, 64.0%, noncompliance with diet therapy, 6.3.7%, alteration in self concept, 55.6%, and alteration in sleep pattern, 53%. 2. In looking at the effects of home nursing care as demonstrated by changes in the functional categories over the three month period, it was Found that of the 11 functional categories, the need level for health perception, nutrition, activity and self concept decreased slightly over the three month period. On the average sleep patterns improved, but restfulness was slightly less and bowel elimination patterns improved but satisfaction with urinary elimination was slightly less. On the other hand, role enactment, sexuality, stress management and spirituality decreased slightly. The only results that were statistically significant at the 0.05 level were improvement. in digestion and decrease in pain. No statistically significant changes were found in ability related to ADL, the total ADL Score at discharge was $19.78{\pm}8.234, and after 3 months $19.01{\pm}8.12$. Considering that a majority of the patients were over 60 years of age and that many had brain or spinal cord injuries, the fact that their ADL ability did nor deteriorate after discharge can be interpreted as related to a positive impact by the home health care nurses. Similarly there was a slight be not statistically significant decrease in the quality of life scores between the two lest times(l47.83 at discharge and 113.02 at the three month period). Again, when the chronic nature of thee problems facing these patients is considered this maintenance of quality of life can be interpreted as a positive impact by the home health care nurses. 3. One of the home care nursing activities was diagnosis. For this activity it was found that for nine functional health categories(sexuality and spirituality excepted) there were 20 nursing diagnoses. The most frequent were noncompliance, alteration in skin integrity both actual and potential, and impaired physical mobility in that order. 4. Delivery of home health care by the home health nurses included the following nursing activities; assessment, patient education, demonstration of care activities, counselling, direct care to the patient and referrals. Direct care included changing dressings, bladder irrigations, changing Foley catheters, measurement of residual urine, perineal care, position change, back care, oral hygiene, exercise and massage of motion exercises, cleansing enemas, tracheostomy suctioning and tracheostomy care, care of dentures, applications of heat and other similar nursing activities. In conclusion almost 50% of (he sample indicated a need for continued nursing care at the time of discharge and for the patients in the sample who received home care there was a slight decrease in nursing needs but while the patients had chronic and debilitation problems there was ill decrease in ADL abilities or in quality of life. Further study needs Lo be done La increase the reliability and validity of the tool that was used to measure home health care needs. It is also recommended that study by done using a randomized sampling with a control group to compare patients who receive home care with those who do not.

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Medication Errors in Chemotherapy Preparation and Administration: a Survey Conducted among Oncology Nurses in Turkey

  • Ulas, Arife;Silay, Kamile;Akinci, Sema;Dede, Didem Sener;Akinci, Muhammed Bulent;Sendur, Mehmet Ali Nahit;Cubukcu, Erdem;Coskun, Hasan Senol;Degirmenci, Mustafa;Utkan, Gungor;Ozdemir, Nuriye;Isikdogan, Abdurrahman;Buyukcelik, Abdullah;Inanc, Mevlude;Bilici, Ahmet;Odabasi, Hatice;Cihan, Sener;Avci, Nilufer;Yalcin, Bulent
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.5
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    • pp.1699-1705
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    • 2015
  • Background: Medication errors in oncology may cause severe clinical problems due to low therapeutic indices and high toxicity of chemotherapeutic agents. We aimed to investigate unintentional medication errors and underlying factors during chemotherapy preparation and administration based on a systematic survey conducted to reflect oncology nurses experience. Materials and Methods: This study was conducted in 18 adult chemotherapy units with volunteer participation of 206 nurses. A survey developed by primary investigators and medication errors (MAEs) defined preventable errors during prescription of medication, ordering, preparation or administration. The survey consisted of 4 parts: demographic features of nurses; workload of chemotherapy units; errors and their estimated monthly number during chemotherapy preparation and administration; and evaluation of the possible factors responsible from ME. The survey was conducted by face to face interview and data analyses were performed with descriptive statistics. Chi-square or Fisher exact tests were used for a comparative analysis of categorical data. Results: Some 83.4% of the 210 nurses reported one or more than one error during chemotherapy preparation and administration. Prescribing or ordering wrong doses by physicians (65.7%) and noncompliance with administration sequences during chemotherapy administration (50.5%) were the most common errors. The most common estimated average monthly error was not following the administration sequence of the chemotherapeutic agents (4.1 times/month, range 1-20). The most important underlying reasons for medication errors were heavy workload (49.7%) and insufficient number of staff (36.5%). Conclusions: Our findings suggest that the probability of medication error is very high during chemotherapy preparation and administration, the most common involving prescribing and ordering errors. Further studies must address the strategies to minimize medication error in chemotherapy receiving patients, determine sufficient protective measures and establishing multistep control mechanisms.

Minimally Invasive Marsupialization for Treating Odontogenic Cysts: Case Reports (최소 침습적 조대술을 이용한 치성낭종의 치료 증례 보고)

  • Ryu, Jiyeon;Shin, Teo Jeon;Hyun, Hong-Keun;Kim, Youngjae;Kim, Jungwook;Kim, Chong-Chul;Jang, Ki-Taeg;Lee, Sang-Hoon
    • JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DENTISTRY
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    • v.44 no.2
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    • pp.235-242
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    • 2017
  • Marsupialization and decompression constitute a well-established procedure for treating cavitary bone lesions of the jaw. The technique can be a primary treatment option, especially for pediatric patients with large cysts or lesions involving vital anatomical structures, such as a developing tooth germ. In this procedure, a decompression stent, such as a customized acrylic obturator or space-maintaining appliance, silicone tube, or nasal cannula, is inserted to maintain the patency of the cyst. However, this may cause clinical problems, such as irritation or trauma to the adjacent tissues, as well as discomfort to the patient, or failure of the stent due to cyst shrinkage. It can also be a reason for patient noncompliance. In the cases described here, a minimally invasive marsupialization technique using a metal tube made from a 16-gauge needle was used for odontogenic cysts in pediatric patients associated with unerupted teeth. Through this method, the lesions were removed, with patient cooperation, and the cyst-associated teeth erupted spontaneously.

Influence of Non-compliance of Treatment and Family Support on Depression in Diabetic Patients with Hypoglycemia (저혈당을 경험한 당뇨병 환자의 치료지시 불이행, 가족지지가 우울에 미치는 영향)

  • Son, Hye Gyeong;Jeong, Kyeong-Sook
    • The Journal of the Korea Contents Association
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    • v.18 no.6
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    • pp.518-528
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    • 2018
  • This study was to identify the effective factors on the Depression in Diabetic patients with hypoglycemia. This study used 119 questionnaires from Diabetic patients with hypoglycemia in B city to collect data from October 1, 2015 to March 15, 2016. Data were analyzed by SPSS 20.0 program using descriptive statistics, t-test, ANOVA, Scheffe's test. Pearson's correlation coefficient and Stepwise Multiple Regression. The Depression in Diabetic patients with hypoglycemia showed a positive correlation with Non-Compliance of Treatment(r=42, p<.001), a negative correlation with Family support(r=-.38, p<.001). According to the result of multiple regression analysis, the significant factors influencing depression were Family support(${\beta}=-.29$, p<.001), Drug therapy(${\beta}=.21$, p=.020), Dietetic therapy(${\beta}=.23$, p=.014), Monthly average income over 3,000,000won (${\beta}=-.20$, p=.014), Monthly average income 2,000-3,000 thousand(${\beta}=-.17$, p=.033), it was explained by 30.0%. Based on these findings, it is suggested to develop and apply a family support program to reduce the depression of diabetic patients with hypoglycemia.