• Asian Pacific Journal of Cancer Prevention
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• v.17 no.10
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• pp.4729-4733
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• 2016

Objectives: Lung cancer is a major public health problem and one of the most costly illnesses. The study aimed to estimate the economic burden of lung cancer in Iran in 2014. Methods: A cross-sectional study was conducted to estimate the direct and indirect costs for patients with lung cancer using a prevalence-based approach. A human capital approach was employed to estimate the indirect costs. Data were obtained from several sources such as through patient interview using structured questionnaire, medical records, the GLOBOCAN databases, the Iranian Statistical Center, the Iranian Ministry of Cooperation, Labor and Social Welfare, and the Institute for Health Metrics and Evaluation (IHME). Results: The economic burden of lung cancer in Iran in the year 2014 was 3,225,998,555,090 IR. The main components of the cost were associated with mortality (81.9 %) and hospitalization (7.6 %). The costs of direct medical care, non-medical aspects, patient time, and mortality accounted for 10.8%, 2.7%, 4.5%, and 81.5% of the total cost, respectively. Conclusion: Findings from this study indicated that the economic burden of lung cancer is substantial both to Iran's health system and to society as a whole. Early diagnosis, strengthening cancer prevention, implementing new cancer therapy and medical technology, and effective smoking-cessation interventions could offset some of the costs associated with lung cancer in Iran.

• Journal of the Korean Society of Safety
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• v.29 no.6
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• pp.125-131
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• 2014

The purpose of this study is to investigate the effect of high quality CPR using the 4 types of rescue device equipment and chest compressions energy measurement in pre-hospital settings. So, we used the mode to insert load cell in ALS Skill master Manikin to develop CFMM(Compression Force Measurement Manikin) on main stretcher, CPR board, long spine board, scoop stretcher and floor. And, our research team could know that the main stretcher needed average force of 32.55 (${\pm}1.01$) kg, CPR board of 27.23 (${\pm}1.08$) kg, long spine board of 27.13 (${\pm}1.18$) kg, Scoop Stretcher of 27.38 (${\pm}1.05$) kg and Floor of 27.24 (${\pm}0.93$) kg. CPR board must be necessary in the case of CPR on main stretcher in a moving ambulance. But if the condition of patient's back surface is the removable stretcher and the long spine plate, the patient doesn't have to be spent time to use a CPR board. Furthermore, this research suggests to consider that how to take advantage of the education to students for the equipment to check in real time the energy(kg) requirement of chest compressions.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.6
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• pp.2647-2650
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• 2014

Background: Colorectal cancers(CRC) are the third most common cancer in the western world, with surgery preferred for management of non-metastatic disease and post surgical treatment usually arranged according to the TNM staging system. However, there is still prognostic variation between patients who have the same stage. It is increasingly recognized that variations within disease course and clinical outcome in colorectal cancer patients are influenced by not only oncological characteristics of the tumor itself but also host response factors. Recent studies have shown correlation between the inflammatory response and clinical outcomes in various cancers. The neutrophil/lymphocyte ratio (NLR) has been described as a marker for immune response to various stimuli including cancer. Material-Methods: Two hundred eighty-one CRC patients were included in our retrospective analysis, separated into two groups according to a cut-off value for the NLR. Patient data including age, gender, vertical penetration, anatomic location, and differentiation of the tumor, TNM stage, survival rate, and disease-free survival were analyzed for correlations with the NLR. Results: Using ROC curve analysis, we determined a cut-off value of 2.2 for NLR to be best to discriminate between patient survival in the whole group. In univariate analysis, high pretreatment NLR (p=0.001, 95%CI 1.483-4.846), pathologic nodal stage (p<0.001, 95%CI 1.082-3.289) and advanced pathologic TNM stage (p<0.001, 95%CI 1.462-4.213) were predictive of shorter survival. In multivariate analysis, advanced pathologic TNM stage (p=0.001, 95%CI 1.303-26.542) and high pretreatment NLR (p=0.005, 95%CI 1.713-6.378) remained independently associated with poor survival. Conclusions: High pre-treatment NLR is a significant independent predictor of shorter survival in patients with colorectal cancer. This parameter is a simple, easily accessible laboratory value for identifying patients with poorer prognosis.

• Quality Improvement in Health Care
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• v.7 no.2
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• pp.204-216
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• 2000

Background : There has been a concern that the quality of care provided to end-stage renal disease (ESRD) patients in the United States may not be as good as recommended. This paper illustrates a composite measure to assess, the quality of care received by ESRD patients undergoing in-center hemodialysis by incorporating outcomes for 4 major treatment areas. The 4 treatment areas are: dialysis treatments, anemia control, nutritional management, and blood pressure control. Methods : The major data source for the study was the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study Wave 1 (DMMS-1) d Sixteen categories of a composite quality indicator were constructed by combining 4 dichotomous variables (16=2*2*2*2). representing the optimal vs. less than optimal level of outcome for each of the 4 treatment outcome measure respectively. Optimal outcome level for each treatment area was defined based on the recommendation from the National Kidney Foundation: (a) delivered dialysis doses (Kt/V) ${\geq}$ 1.2; (b) hematocrit level ${\geq}$ 30%; (c) serum albumin concentration ${\geq}$ 3.8g/dl ; and (d) blood pressure of <140 / <90mmHg. The 16 quality indicator were ranked according to their relative quality weights, which were estimated from its association with the relative risk of survival, adjusting for patient's baseline severity and dialysis facility characteristics. Results : Out of the entire sample of 2,179 patients, only 229 (10%) meet th recommended outcome levels for all 4 treatment areas. Overall, the study patients were distributed evenly over the 16 quality indicators, indicating a great variation in the quality of ESRD care. It appears that the rank of the 16 quality-indicators is driven by serum albumin concentration, suggesting that serum albumin concentration may be the most powerful predictor of ESRD patient survival among the 4 outcome measures. Conclusion : The developed quality indicator has the advantage of describin a range of care for dialysis patients and thus providing a more complete picture of care as compared to previous studies that have focused on only single or few components of the ESRD care.

• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.772-777
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• 2000

Objectives : After lumbar microdiscectomy there are relatively higher incidence of readmission because of various postoperative discomfort. Analyzing these readmitted patients in our private hospital where the patients can be readmitted more easily, we expect to find out which factors are associated with improvement of the surgical outcome. Patients and Methoes : After discharge all significant patient's clinical data were registered to our computerized data bank system and periodic follow-up were performed. The authors analysed 651(97.7%) cases followed up over 2 years(average 3 years) out of 666 patients who underwent a initial lumbar microdiscectomy from May, 1994 to April, 1997. Among them, 63 patients(9.7%) were readmitted. Results : Among the patients readmitted, 29 patients(4.5%) were reoperated because of recurred disc herniation, 17 patients were myofascial pain syndrome, 4 patients were discitis, 3 patients were adhesion and one patient was epidural abscess. Treatment results of these readmitted patients showed that success rate of all readmitted patients was 68.3%, reoperation was 58.6% and myofascial pain syndrome was 82.4%. Conclusion : Treatment results of the patients readmitted because of a continuous lumbago or leg pain after microdiscectomy were acceptable through the careful analysis of the causes of the recurrent symptom. Therefore, the incidence of the chronic failed back syndrome can be reduced by efforting a more active management through readmission.

• Journal of the Korea Convergence Society
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• v.7 no.5
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• pp.117-125
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• 2016

Implementation of patient feedback is considered as a critical part of effective and efficient management. This study is a retrospective survey after to ensure the medical convergence analysis of contents on customer dissatisfaction using medical services. The data were collected from dissatisfaction 319 case at a affiliated hospital. The result indicate that a repeat visit than the initial visit, outpatients were more dissatisfied than the inpatients. The type of dissatisfaction were more dissatisfied of the in communication and explanation of medical service, nursing service and procedure of administrative services. In the classification of disease the percentages of dissatisfaction in the digestive system and neoplasm were high in both groups(p<0.05). Based on the study to improve the quality of medical service. Prevent the recurrence of dissatisfaction and to establish a customer-oriented business strategy. Characterized by dissatisfaction factors and contents of each patient and should be structured to specific disease types of services through continuous medical convergence research.

• Tuberculosis and Respiratory Diseases
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• v.59 no.3
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• pp.306-310
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• 2005

Hyponatremia which is due to excessive sodium loss in the urine and decrease in extracellular fluid volume following an acute or chronic central nervous system injury, has been conjunctively described as cerebral salt wasting syndrome (CSWS). This syndrome is often confused with dilutional hyponatremia due to inappropriate secretion of antidiuretic hormone. Accurate diagnosis and management are mandatory for improvement of the course of the disease. This report describes a case of a 31-year-old male patient with CSWS associated with tuberculous meningitis. The patient exhibited hyponatremia, polyuria, excessive natriuresis, volume depletion, and hypotension. He was diagnosed to manifest CSWS and was treated by administration of fluids, salt, and fludrocortisone. After the respective treatments, symptoms of polyuria and hypotension were gradually resolved and hyponatremia was corrected.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.9
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• pp.4457-4461
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• 2016

Purpose: To determine the prevalence of abnormal cervical cytology, as diagnosed using a liquid-based cytology technique, in pregnant women attending the Antenatal Care (ANC) clinic at Siriraj Hospital. Materials and Methods: This cross-sectional study included 655 first-visit pregnant women who attended ANC clinic at Siriraj Hospital during June to November 2015 study period. After receiving routine antenatal care, cervical cytology screening was performed with the Siriraj liquid-based cytology technique. All specimens were reviewed by a certified cytopathologist using Bethesda System 2001 criteria. Patients with abnormal PAP results characterized as epithelial cell abnormalities were referred to a gynecologic oncologist for further management according to ASCCP Guidelines 2012. Results: Mean age of participants was $28.9{\pm}6.2$ years. Prevalence of abnormal cervical cytology was 3.4% (95% CI: 2.0-4.7). Among this group, there were ASC-US, ASC-H, LSIL, HSIL for 12(1.8%), 2(0.3%), 7(1.1%) and 1(0.2%), respectively. In 633 specimens of the normal group, infection was identified in 158 specimens (24.1%) which were caused by Candida spp. and Trichomonas vaginalis. Regarding patient perception about the importance of cervical cancer screening, although most women perceived screening to be important, 54% of participants had never been screened for cervical cancer. Rate of loss to follow-up in the postpartum period was as high as 41.8%. Conclusions: Prevalence of abnormal cervical cytology in pregnant women attending the ANC clinic at Siriraj Hospital was 3.4%. Inclusion of cervical cancer screening as part of antenatal assessment can help to identify precancerous lesions or cervical cancers in patients who might otherwise not be screened, thereby facilitating early treatment and improved patient outcomes.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.2
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• pp.713-716
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• 2013

Social and behavioral scientists have proposed that a person's belief system crucially influences his or her behaviour, and therefore may affect outcomes of pain management. The purpose of this study was to explore the relationship between analgesic beliefs, analgesic adherence and pain experience amongst Taiwanese cancer outpatients. The cross-sectional study included 92 oncology outpatients in two teaching hospitals in the Taipei area of Taiwan. The research instruments included the Pain Opioid Analgesic Beliefs Scale-Cancer (POABS-CA), opioid adherence, and the Brief Pain Inventory-Chinese (BPI-Chinese). Beliefs about pain and opioids demonstrated a significant relationship with patients' opioid adherence (r = -0.30, p < 0.01). The more negative beliefs regarding opioids and pain the patient had, the worse their adherence to around the clock (ATC) analgesic regimen. However, there was no significant correlation between opioid belief and pain experience. As well, there were no significant relationships between adherence to opioid regimen and any of the measures of pain experience. The study highlights the potential importance of a patient's pain and opioid beliefs in adherence to pain medication.

• Journal of Oral Medicine and Pain
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• v.39 no.3
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• pp.96-99
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• 2014

Purpose: The objective of this retrospective pilot study was to evaluate the effectiveness of Gabapentin in patients with primary burning mouth syndrome (BMS). Methods: Ten subjects were diagnosed with primary BMS (8 women and 2 men). The mean age was 60.1 years. They had clinical examination to exclude local factors such as the presence of Candida species, xerostomia, lichen planus, etc. They also underwent hematological examination to exclude secondary BMS due to systemic disorders. Pain was assessed by patients on an 11-point numerical rating score system (0 to 10). Gabapentin was administered at a starting dose of 300 mg/day, slowly titrated up to maximum of 1,800 mg/day. All patients were treated for 4 weeks. Results: One half of the patients (n=5) obtained reduction in pain over the treatment period. Four patients reported no reduction in pain symptoms. One patient reported that symptoms were worsening. The average pain score before the treatment was 6.3 and after the treatment was 5.25. No significant relationship was detected between pretreatment and posttreatment pain score. Only one patient noted mild side effect (dizziness). Conclusions: This retrospective pilot study provides no preliminary evidence that Gabapentin has effect in the management of BMS. However, further research (well-designed, randomized, and controlled trial with large sample) would be needed to investigate the efficacy of Gabapentin in treatment of BMS.