• Title/Summary/Keyword: clinical questions

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Novel biological strategies to enhance the radiation therapeutic ratio

  • Kim, Jae Ho;Jenrow, Kenneth A.;Brown, Stephen L.
    • Radiation Oncology Journal
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    • v.36 no.3
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    • pp.172-181
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    • 2018
  • Successful anticancer strategies require a differential response between tumor and normal tissue (i.e., a therapeutic ratio). In fact, improving the effectiveness of a cancer therapeutic is of no clinical value in the absence of a significant increase in the differential response between tumor and normal tissue. Although radiation dose escalation with the use of intensity modulated radiation therapy has permitted the maximum tolerable dose for most locally advanced cancers, improvements in tumor control without damaging normal adjacent tissues are needed. As a means of increasing the therapeutic ratio, several new approaches are under development. Drugs targeting signal transduction pathways in cancer progression and more recently, immunotherapeutics targeting specific immune cell subsets have entered the clinic with promising early results. Radiobiological research is underway to address pressing questions as to the dose per fraction, irradiated tumor volume and time sequence of the drug administration. To exploit these exciting novel strategies, a better understanding is needed of the cellular and molecular pathways responsible for both cancer and normal tissue and organ response, including the role of radiation-induced accelerated senescence. This review will highlight the current understanding of promising biologically targeted therapies to enhance the radiation therapeutic ratio.

Educational Needs Based on Analysis of Importance, Frequency and Difficulty of ICU Nursing Practice for ICU Nurses (중환자실 간호실무의 중요도, 수행 빈도 및 난이도 분석을 통한 중환자실 간호사의 교육요구도)

  • Kim, Keum-Soon;Kim, Jin-A;Park, Young-Rye
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.18 no.3
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    • pp.373-382
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    • 2011
  • Purpose: The purpose of this study was to assess the educational needs of ICU nurses based on an analysis of importance, frequency, and difficulty for ICU nursing practice. Method: A cross-sectional survey was conducted using a questionnaire with 80 questions in 14 ICU nursing categories. Data were collected from August to October 2009. A total of 295 ICU nurses from five hospitals who had minimum of one year clinical experience participated. Data were analyzed with using descriptive statistics. Results: For importance, emergency care had the highest score, followed by physical assessment, communication, cardiovascular care, and ICU basic nursing. Regarding the frequency, physical assessment had the highest score, followed by communication, medication, ICU basic nursing, and respiratory care. Cardiovascular care was the most difficult task, followed by neurological care, emergency care, other ICU related nursing care, diagnostic test, and communication. Conclusion: The findings indicate a high educational need in the areas of communication, medication, physical assessment, diagnostic test, emergency care, and cardiovascular care. Thus the development of educational programs on communication, medication, physical assessment, diagnostic test, emergency care, and cardiovascular care are needed for ICU nurses.

Development of National Liscensing Examinaion for Improvement of Pharmacist (약사직능수행 향상을 위한 약사국사시험 개선에 관한 연구)

  • Moon Sang Whang;Chang Jong Kim
    • Proceedings of the PSK Conference
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    • 1999.06a
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    • pp.2-22
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    • 1999
  • To maximize the services of phatmacists, we studied the best national liscensing examination for improvement of pharmacist. Among 650 Pharmacist who are posed the questions, 282 pharmacist such as professor in college of pharmacy(46), pharmacists in drug store and hospital (136), administrators in The Ministry of The Health and Welfare(48) and researchers and phamacists in pharmaceutical company (52) replied it. By analyzing these questionares, the results were as follows: In the Korean national liscensing examination for medial care team, pharmacist has been examed over two times the subjects as compared with another national examinations for medical and public health liseneses and 6-year curriculum of medical school. Now, the national examination for pharmacy liscence have been tested the basic subjects such as pharmaceutical analytical chem-istry, medicinal chemistry, biochemistry, etc., but almost demander, pharmacist who has been engaged about over 80% in the drug stores and hospital pharmacy, want to have exam pharmacy practics which are clinical pharmacy, pathohysiology and pharma-cotherapy of diseases like The United State of America, but not basic chemisty and biology. If the Korean liscensing examination for pharmacy will be changed like America, pharmacy education in the college of phar-macy will be progressed in detail. There are no clerkships and internships in the pharmaceutical education program in Korea, and so most of pharmacist want to have 6-year curriculum for pharmacy education and to test the pharmacy practice for Doctor of Pharmacy(Pharm. D.) but not basic science.

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Application of Counseling in Sasang Constitutional Medicine (사상의학진료에서 상담기법의 활용)

  • Yu, Jun-Sang
    • Journal of Sasang Constitutional Medicine
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    • v.29 no.4
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    • pp.311-316
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    • 2017
  • Objectives The purpose of this study was to investigate the relationship between counseling skills and Sasang constitutional medicine(SCM). Methods Reviewing the texts relevant to SCM, comparison between counseling skills and the excerpt from the relating books was conducted in terms of the attitude of the counselor, the observation method, the evaluation of the counselee, the relationship between the counselor and counselee, and the counseling method. Results As the attitude of the counselor, many kinds of attitudes and skills including respecting the counselee and reciprocal belief were needed. The excerpt from "Gyeokchigo" meant that the counselor or a doctor should have the virtue of Truth. To evaluate the patient's problems in SCM and the counseling, diet, digestion, and sleep could be asked, but questions about the emotions such as Joy, Anger, Sorrow and Pleasure should be more carefully modified in a modern way, when applying clinical practices. Empathy as the main principle of the counseling could be attributed to the main idea of Dongmu Lee Jema, in which all the people could be in the same status in a natural way reflecting that they like the virtue and dislike the evil. Recommendations of regimen and directives could be followed according to SCM Conclusions Several items of counseling skills and SCM coincide but some of the modern counseling skills are still needed to apply SCM to make the patients with psychiatric problems treated efficiently.

The Cognition Level on Patient Safety and Safe Nursing Activities According to Nurse-patient Ratios (간호관리료 등급별 환자안전 및 안전간호활동 인식 비교)

  • Nam, Mun Hee;Choi, Sook Hee
    • Journal of Korean Clinical Nursing Research
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    • v.17 no.2
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    • pp.138-149
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    • 2011
  • Purpose: The objective of this research was to explore levels of patient safety and safe nursing activities depending on the level of nurse staffing, in order to provide effective management of nurse personnel. Methods: The research was conducted with 455 nurses from eight hospitals in B city. Data were collected according to the level of nurse personnel from second (nurse vs. patient ratio of 2.0-2.5) to fifth (ratio of 3.5-4.0) rank. The survey tools were, 'Questionnaire on Patient Safety, a Hospital Survey on Patient Safety Culture developed by AHRQ (2007), and 'Questionnaire on Patient Safety Nursing Act, in which the questions were selected from nursing-related items (Medication 6 & Safety Nursing Assurance Act 4) in the Safety Evaluation developed by Evaluation Institute of Medical Institution. Data were analyzed with SPSS PC 12.0 program using descriptive statistics, $x^2$ test, ANCOVA and $Scheff{\grave{e}}$. Results: The nurses' overall cognition level on patient safety and safe nursing activities showed that nurses who are in the second and third rank had higher scores than those in lower ranks. Conclusion: The results of this study indicate that hospitals need a higher ratio level for nurse personnel in order to assure patient safety and safe nursing activities.

The Chinese Black Box - A Scientific Model of Traditional Chinese Medicine

  • Theodorou, Matthias;Fleckenstein, Johannes
    • Journal of Acupuncture Research
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    • v.36 no.1
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    • pp.1-11
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    • 2019
  • Models of traditional Chinese medicine (TCM) are still difficult to grasp from the view of a Western-cultural background. For proper integration into science and clinical research, it is vital to think "out of the box" of classical sciences. Modern sciences, such as quantum physics, system theory, and information theory offer new models, that reveal TCM as a method to process information. For this purpose, we apply concepts of information theory to propose a "Chinese black box model," that allows for a non-deterministic, bottom-up approach. Considering a patient as an undeterminable complex system, the process of getting information about an individual in Chinese diagnostics is compared to the input-process-output principle of information theory and quantum physics, which is further illustrated by Wheeler's "surprise 20 questions." In TCM, an observer uses a decision-making algorithm to qualify diagnostic information by the binary polarities of "yang" (latin activity) and "yin" (latin structivity) according to the so called "8 principles" (latin 8 guiding criteria). A systematic reconstruction of ancient Chinese terms and concepts illuminates a scattered scientific method, which is specified in a medical context by Latin terminology of the sinologist Porkert [definitions of the Latin terms are presented in Porkert's appendix [1] (cf. Limitations)].

Neuro-cognitive Ramifications of Fasting and Feeding in Obese and Non-obese Cases

  • Mostafavi, Seyed-Ali;Khaleghi, Ali;Vand, Safa Rafiei;Alavi, Seyyed Salman;Mohammadi, Mohammad Reza
    • Clinical Psychopharmacology and Neuroscience
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    • v.16 no.4
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    • pp.481-488
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    • 2018
  • Preliminary studies have claimed that short term fasting would negatively affect school performance and cognition. In contrast some other studies have reported not important decline in cognition and executive function as a result of fasting. Also limited attention was generally devoted to dietetic regimens, nutritional status and body weight. Yet neuroscience and neuro-cognitive aspects of acute hunger on the electroencephalogram and differences between obese and non-obese cases is not well understood. Hence, we decided to design and perform a case study in a more controlled situation similar to reality. Therefore, we performed several examinations including subjective tests (for eating status) and objective tests (cognitive tests such as Stroop effect and Sternberg search and electroencephalogram measures such as steady-state visual evoked potential and auditory steady-state responses) for an obese and a non-obese academic case before and after a simple breakfast. The results showed that the breakfast effects on the neuro-cognitive functions depend on either obesity status, nutritional status of the case or the type of cognitive task (visual or auditory). This paper would open a new insight to answer some important questions about the neuro-cognitive implications of fasting and feeding in obese and non-obese human cases.

Dental Implants in Patients with Gingival Oral Lichen Planus

  • Shim, YoungJoo
    • Journal of Oral Medicine and Pain
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    • v.44 no.3
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    • pp.77-82
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    • 2019
  • Purpose: With the popularity of implant therapy, clinicians need to know about treating the dental implant in patients with gingival involvement of oral lichen planus (OLP). The aim of this study is to evaluate the survival and success rates of dental implant and propose of clinical guidelines for implant treatment in OLP patient with gingival involvement. Methods: A literature search was performed in PubMed/Medline, and Cochrane database. Papers in English language published between 1990 and 2019 were evaluated. The focused questions were following; 1) Dose gingival OLP affect the survival and success rates of dental implants? 2) The management of OLP patients with gingival involvement receiving dental implant. Results: There was no study about the evaluation of dental implant only in gingival OLP patient. Five studies evaluating dental implants in OLP patients were included in this review. Implant survival rate was 100.0% in well-controlled OLP patients in all included studies. The use of topical/systemic corticosteroid in OLP patients was performed before and/or after implant placement in all included studies. Conclusions: The implant survival and success rates in well-controlled OLP patients did not different from that of non-OLP healthy subjects. The gingival OLP is associated with higher rate of peri-implant mucositis. Adequate management of gingival OLP lesions before and after implant insertion is required to reduce inflammation and associated bone loss.

Mutation Hotspots in the β-Catenin Gene: Lessons from the Human Cancer Genome Databases

  • Kim, Sewoon;Jeong, Sunjoo
    • Molecules and Cells
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    • v.42 no.1
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    • pp.8-16
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    • 2019
  • Mutations in the ${\beta}-catenin$ gene (CTNNB1) have been implicated in the pathogenesis of some cancers. The recent development of cancer genome databases has facilitated comprehensive and focused analyses on the mutation status of cancer-related genes. We have used these databases to analyze the CTNNB1 mutations assembled from different tumor types. High incidences of CTNNB1 mutations were detected in endometrial, liver, and colorectal cancers. This finding agrees with the oncogenic role of aberrantly activated ${\beta}-catenin$ in epithelial cells. Elevated frequencies of missense mutations were found in the exon 3 of CTNNB1, which is responsible for encoding the regulatory amino acids at the N-terminal region of the protein. In the case of metastatic colorectal cancers, in-frame deletions were revealed in the region spanning exon 3. Thus, exon 3 of CTNNB1 can be considered to be a mutation hotspot in these cancers. Since the N-terminal region of the ${\beta}-catenin$ protein forms a flexible structure, many questions arise regarding the structural and functional impacts of hotspot mutations. Clinical identification of hotspot mutations could provide the mechanistic basis for an oncogenic role of mutant ${\beta}-catenin$ proteins in cancer cells. Furthermore, a systematic understanding of tumor-driving hotspot mutations could open new avenues for precision oncology.

A Delphi Study on Plans to Revitalize Occupational Health Nursing at Industrial Worksites (직업건강간호 활성화 방안에 관한 델파이 연구)

  • Lee, Young Joo;Noh, Gyeongmin
    • Korean Journal of Occupational Health Nursing
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    • v.30 no.3
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    • pp.90-100
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    • 2021
  • Purpose: The study aimed to identify plans to revitalize occupational health nursing at industrial worksites. Methods: First, a literature review was conducted to derive the questions. Next, we used the Delphi method with two rounds to obtain experts' opinions. The 15 expert participants were seven occupational health nurses and eight professors from nursing colleges. Results: The analysis of opinions indicated that occupational health nurses should be competent in clinical nursing care to perform health management and health promotion activities of workers. It is necessary to develop high-quality occupational nursing services that can prevent and manage occupational diseases and work-related illnesses. Moreover, an improved system for stable employment of these nurses should be implemented. Conclusion: This study confirmed that occupational health nursing is an independent and important area for improving workers' disease prevention and health promotion. It will provide basic data for initiating occupational health nursing and expanding the role of the occupational health nurses.