Concurrent chemo-radiation (CRT) has been established as the standard of care for non-metastatic loco-regionally advanced nasopharyngeal carcinoma (NPC) but recently the addition of induction chemotherapy in the already established regimen has presented an attractive multidisciplinary approach. This retrospective study was carried out to evaluate the efficacy of induction chemotherapy (IC) followed by CRT for the management of loco-regionally advanced NPC. Between July 2005 and September 2010, 99 patients were treated with cisplatin based IC followed by CRT. Induction chemotherapy included a 2 drug combination; intravenous gemcitabine $1000mg/m^2$ on day 1 and 8 and cisplatin $75mg/m^2$ on day 1 only. Radiotherapy (RT) was given as a phase treatment to a total dose of 70 Gy in 35 fractions. Concurrent cisplatin ($75mg/m^2$) was administered to all patients on days 1, 22 and 43. All patients were evaluated for tumor response and adverse effects after IC and 6 weeks after the completion of the treatment protocol. Statistical analysis was performed using SPSS version 17 and Kaplan Meier estimates were applied to project survival. Median follow-up duration was 20 months. The 5-year overall survival (OS), loco regional control (LRC) and relapse free survival (RFS) rates were 71%, 73% and 50%respectively. Acute grade 4 toxicity related to induction chemotherapy and concurrent chemo-radiation was 4% and 2% respectively, with only 3 toxicity-related hospital admissions. We conclude that induction gemcitabine and cisplatin followed by chemo-radiation is a safe and effective regimen in management of nasopharyngeal carcinoma, meriting further investigation in randomized clinical trials.
A nutrition education program for teachers and caregivers of the preschool children can be most effective when it is based on a comprehensive needs assessment dealing with sociodemographic factors, dietary habits, and nutrition. The purpose of the present study was to investigate current dietary habits and nutrition knowledge of the teachers and caregivers of the day-care centers. Two hundred forty two teachers and caregivers were administered a questionnaire which was designed to ascertain informations on sociodemographic data, dietary habits and nutrition knowledge. Dietary habits of the teachers were found to be significantly different by sociodemographic variables; breakfast skipping/meal irregularities (age, p=0.011); frequency of snacking (education level p=0.031); preference for salty taste(age, p = 0.000, marital status p=0.038); preference for sweet tarte (age p=0.009); preference for vegetables (income level p=0.050); frequency of eating out (age p=0.028, marital status p=0.001); frequency of coffee drinking (age p=0.019). Daycare center teachers' nutrition knowledge level was found to be less than adequate expecially on nutrients that are liable to be deficient in young growing children and their food sources. Proportions of the teachers who answered correctly to the questions on foods rich in vitamin A, iron content of milk, bioavailability of calcium in plant foods were as low as 20.2%-54.5%. The most frequently used sources of nutrition information were mass media such as TV, radio, newspaper and magazines. Only 2.9% of the subjects reported that they obtain nutrition information from health professionals such as nutritionists/dietitians, physicians, and nurses. These findings are applicable at the planning and implementation stages of various nutrition programs for the improvement of dietary habits and nutrition knowledge of the teachers and caregivers of the daycare centers. Further studies are needed to investigate the effects of teachers' dietary of habits and nutrition knowledge on food habits of young growing children.
This ethnography explored the construction of a social network and its function in a classroom of toddlers in a day-care center located in Vermont. The classroom activities of 9 two-year-old toddlers were observed for about two months, compiled and categorized. Then, the themes of psychological functions were reconstructed in data analysis. Results showed that toddlers constructed multiple relations with all peers beyond the dyadic. They also transmitted information to teachers as well as peers in indirect ways. These direct-multiple interactions as well as indirect interactions reflect the social network of Lewis' (2005) theory. In the construction of social networks, the toddlers developed communication skills, turn-taking skills, leadership, and imitation.
This research is based on two cases study of brother and sister who experienced difficulties due to their parent's abuse. The brother and sister play therapy was conducted for sixteen sessions. Each of the therapy and the activity sessions ran 90 minutes weekly. The purpose of this study is to decrease problematic behaviors and to improve self-confidence of abused brother and sister. As a result, the brother's and sister's self-confidence lowered by past negative experiences has been improved, poor social relationship patterns have changed and need for growth as a good person has arisen. The results of research indicate the effectiveness of play therapy to abused brother and sister.
The purpose of the present study was to develop a community-based intensive health care program for the community dwelling elderly to strength their functional status and to verify the effect on their geriatric syndrome. A one-group pretest-posttest design was used for the study. A total of 69 frail elderly, who lived in the area within 20 minutes by car, were committed themselves to the day care center(Sangikjae), and had the ability of verbal communication were selected from G city in Kyunggi province. The participants completed a set of questionnaires to measure the sub-score of frailty, fall, urinary incontinence, malnutrition, and mild cognitive disorder domain, using the Otasha-Kensin through the physical examinations and interviews. After 4 weeks of intervention, the outcome was measured to evaluate the effects of the program, and the data obtained were analyzed using descriptive statistics, paired t-test and McNemar test. The results showed that the sub-score of frailty, fall, urinary incontinence, and malnutrition domain were statistically significantly decreased after intervention except those of urinary incontinence and mild cognitive disorder domain, implying that the risk of frailty, fall, and malnutrition was decreased. These findings indicated that community-based the intensive health care program is effective for relieving geriatric syndrome of the community dwelling elderly.
This study examines factual facilites safety of long-term care facilities for eldery, for improvement of Korean policy. So, This study reviewed policies of facilites safety of long-term care facilities on main OECD countries. We analyzed factual survey of facilites safety of long-term care facilities in Seoul metropolitan area. The results of the study were as follows: First, There were differences of law and rule of facilites safety of long-term care facilities in comparison with those of social welfare facilities, child day-care center, hospital. Second, it was the result of location condition analysis. Long-term care facilities in the Seoul metropolitan area were located on more than six floors of buildings. The location conditions of private facilities are weak compared to those of corporations and local governments. Third, there were the result of internal structure of facilities. Overall, the placement status was insufficient. For instance, there are smokeproof masks/fireproof blankets, smoke windows(fire safety windows), smoke smothering. In addition, there were places where legal essential installation structures were insufficient. Private facilities were generally insufficient in facility structures compared to those of local governments and welfare corporations. Fourth, there were the result of safety management. It was confirmed that private facilities were insufficient compared to local government facilities. For instance, there are safety management analysis, response manuals, fire preparedness training, etc. Finally, implications and future directions policies of facilites safety of long-term care facilities were discussed based on the finding of the study.
Purpose: This study was conducted in order to explore self-perceived objectives, effects, determinant factors of satisfaction and demands on home-based rehabilitation service (HBRS) based on a community-based rehabilitation (CBR) model in community-dwelling disabilities. Methods: This research was conducted through in-depth interview. HBRS was conducted by four physical therapists for one hour a day, once a week, for eight weeks. After an eight-week intervention period, in-depth interviews were conducted using a semi-structured questionnaire for five recipients of HBRS and six care givers. Results: For the physical effect, some participants experienced positive effects, whereas others did not due to the short-term intervention period. For the social and emotional effects, 'occurrence of motivation for exercise', 'change of surroundings' and 'sorriness for the therapist' emerged as keywords. For the determinant factors of satisfaction, 'movement-inducing therapy', 'therapy from the specialist', 'development of friendship & social network', and 'learning the way of self-rehabilitation' emerged as keywords. For further demands on HBRS, participants stated that 'sufficient time for therapy', 'user opinion-reflected therapy', 'additional instructions for therapeutic exercise & activities of daily living', and 'active promotion for HBRS' were necessary. Conclusion: Participants were satisfied with the physical, social, emotional, and educational aspects of HBRS. In particular, the participants regarded educational aspects as the significant factor throughout self-perceived objectives, determinant factors of satisfaction and the demands. This result suggests that when providing HBRS to community-dwelling persons with disabilities, therapists should recognize the necessity and significance not only of the physical, but also the educational aspect of HBRS.
Kim, Seulki;Jeong, Ji Hye;Shin, Hye Kyeong;Choi, Sun Joo
Journal of Korean Clinical Nursing Research
/
v.29
no.1
/
pp.107-120
/
2023
Purpose: The purpose of this program is to develop an educational program to improve the nursing management competency of middle-level nursing managers. Methods: The program outline is based on the results of the Importance Performance Analysis (IPA) and Systematic Review (SR). Also performed the content validity accordingly. Results: The result of the concepts are derived from 6 competencies for planning process, 4 competencies for organizing process, 4 competencies for staffing process, 26 competencies for directing process, and 12 competencies for controlling process by integrating IPA and SR. This outline of the program was constructed according to the derived integrated concept and both content validity and structured outline were interpreted as valid. Conclusion: This suggests that middle-level managers need a systematic program and support to effectively lead the organization by recognizing the importance rather than performance.
Cho, Ju Yeon;Choi, Jeong Myung;Kim, Hee Gerl;Lee, Jong Chul;Choi, Young Ock
Korean Journal of Occupational Health Nursing
/
v.17
no.2
/
pp.155-165
/
2008
Purpose: The purpose of this study was to investigate the condition, recognition of breast feeding of 273 nurses. Method: Data was collected using a structured questionnaire form April to June 2007. The subjects were 273 nurses in Kyunggido. The data analysis was done with descriptive statistics, $x^2$-test procedures using SPSS/WIN 12.0 PC. Result: There are 23.9% of child day care center, 5.2% of rest room for women, 16.8% of breast feeding room in workplace. Rate of breast-feeding practice was 78.4% of nurses. The reasons why they could not perform the breast-feeding include mother's job(45.4%), lacking breast milk(25.8%). The characteristics of nurses found to be related breast-feeding include age, number of employers. Conclusion: The results showed that the rest supports of the work environment was insufficient to perform breast-feeding in the workplace. These results suggest that nursing intervention for employed mother's breast-feeding practice behavior promotion should focus on characteristics influencing factors on workplace. Also, efficient breast-feeding education program for employed mothers should be developed by continuous qualitative researches based on breast-feeding experiences of employed mothers.
Lee, Jae Jun;Kim, Young Su;Chung, Suryeun;Jeong, Dong Seop;Yang, Ji-Hyuk;Sung, Kiick;Kim, Wook Sung;Jun, Tae-Gook;Cho, Yang Hyun
Journal of Chest Surgery
/
v.54
no.2
/
pp.99-105
/
2021
Background: The number of heart transplantations (HTx) is increasing annually. Due to advances in medical and surgical support, the outcomes of HTx are also improving. Extracorporeal circulatory life support (ECLS) provides patients with decompensated heart failure a chance to undergo HTx. A medical approach involving collaboration among experienced experts in different fields should improve the outcomes and prognosis of ECLS-bridged HTx. Methods: From December 2003 to December 2018, 1,465 patients received ECLS at Samsung Medical Center. We excluded patients who had not undergone HTx or underwent repeated transplantations. Patients younger than 18 years were excluded. We also excluded patients who received an implantable durable left ventricular assist device before HTx. In total, 91 patients were included in this study. A multidisciplinary team approach began in March 2013 at our hospital. We divided the patients into 2 groups depending on whether they were treated before or after implementation of the team approach. Results: The 30-day mortality rate was significantly higher in the pre-ECLS team group than in the post-ECLS team group (n=5, 18.5% vs. n=2, 3.1%; p=0.023). The 1-year survival rate was better in the post-ECLS team group than in the pre-ECLS team group (n=57, 89.1% vs. n=19, 70.4%; p=0.023). Conclusion: We found that implementing a multidisciplinary team approach improved the outcomes of ECLS-bridged HTx. Team-based care should be adapted at HTx centers that perform high-risk HTx.
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