• Title/Summary/Keyword: poor elderly

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Curative Radiation Therapy for T2N0M0 Non-small Cell Lung Cancer (T2N0M0 비소세포성 폐암의 근치적 방사선치료)

  • Park, In-Kyu;Kim, Jae-Choel
    • Radiation Oncology Journal
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    • v.13 no.1
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    • pp.19-26
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    • 1995
  • Purpose : Surgery is the treatment of choice for resectable non-small cell lung cancer. For patients who are medically unable to tolerate a surgical resection or who refuse surgery, radiation therapy is an acceptable alternative. A retrospective analysis of Patients with stage I non-samll cell lung cancer treated with curative radiation therapy was performed to determine the results of curative radiation therapy and patterns of failure, and to identify factors that may influence survival. Materials and Methods : From 1986 through 1993, 39 Patients with T2N0M0 non-small cell lung cancer were treated with curative radiation therapy at department of radiation oncology, Kyungpook national university hospital. All Patients were not candidates for surgical resection because of either Patient refusal (16 patients), poor pulmonary function (12 patients), old age (7 patients), Poor Performance (2 patients) or coexisting medical disease (2 patients). Median age of patients was 67 years. Histologic cell type was squamous cell carcinoma in 36, adenocarcinoma in 1, large cell carcinoma in 1 and mucoepidermoid carcinoma in 1. All patients were treated with megavoltage irradiation and radiation dose ranged from 5000cgy to 6150cGy with a median dose of 6000cGy. The median follow-up was 17 months with a range of 4 to 82 months, Survival was measured from the date therapy initiated. Results : The overall survival rate for entire Patients was $40.6\%$ at 2 years and $27.7\%$ at 3 years, with a median survival time of 21 months. The disease-free survival at 2 and 3 years was $51.7\%$ and $25.8\%$, respectively. Of evaluable 20 patients with complete response, 15 patients were considered to have failed. Of these, 13 patients showed local failure and 2 patients failed distantly. Response to treatment (p=0.0001), tumor size (p=0.0019) and age (p=0.0247) were favorably associated with overall survival. Only age was predictive for disease-free survival (p = 0.0452). Conclusion : Radiation therapy is an effective treatment for small (less than 3cm) tumors, and should be offered as an alternative to surgery in elderly or infirm patients. Since local failure is the prominent Patterns of relapse, potential methods to improve local control with radiation therapy are discussed.

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A Study on the Determinants of Private Long-Term Care Insurance and First Home Care Use in the United States: Using Discrete Time Model (미국의 민간장기요양보험 가입과 재가요양서비스 이용의 결정요인에 관한 연구: 이산시간모델을 사용하여)

  • Kim, So-Yun;Hong, Gong-Soog;Montalto, Catherine P.
    • Survey Research
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    • v.11 no.2
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    • pp.97-121
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    • 2010
  • Using the 1998-2004 Health and Retirement Study(HRS), this study explored the determinants of private long-term care insurance(LTCI) ownership and the first home care use. To account for the interaction between LTCI purchase and home care use, this study used two-period utility model as theoretical framework. Discrete time model was used as an empirical model to incorporate the time-dependent feature of LTCI ownership. And this study accounted for the endogeneity of LTCI ownership and home care use by employing full information maximum likelihood estimation. This study indicated insignificant effects of private LTCI ownership and Medicaid eligibility on the home care use. Also, the effects of income and assets on home care utilization were negligible. Those who have poor health condition and who do not have potential informal caregivers were more likely to use home care. For private LTCI ownership, income and assets have positive relationship with LTCI purchase, and poor health status and age were negatively related to LTCI purchase. The elderly living with children and those who have more siblings were less likely to have private LTCI, and those who lived with spouses with no children were more likely to buy private LTCI. Based on the findings, this study provides implications to design long-term care(LTC) policies in the U.S. and to develop LTC planning education programs.

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Unplanned Readmission to Intensive Care Unit during the same Hospitalization at a Teaching Hospital (계획에 없던 중환자실 재입실 실태 및 원인)

  • Song, Dong-Hyun;Lee, Sun-Gyo;Kim, Chui-Gyu;Choi, Dong-Ju;Lee, Sang-Il;Park, Su-Kil
    • Quality Improvement in Health Care
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    • v.10 no.1
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    • pp.28-41
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    • 2003
  • Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1) The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2) Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3) Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4) The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5) About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6) Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7) Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%) (P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

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A Case of Complete Remission to Advanced Esophageal Cancer by a Palliative Chemotherapy (고식적 항암화학요법으로 완치가 된 진행성 식도암 환자 1예)

  • Dae Hyun Tak;Hee Seok Moon;Hyun Yong Jeong;Jae Kyu Sung;Sun Hyung Kang
    • Journal of Digestive Cancer Research
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    • v.2 no.2
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    • pp.64-67
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    • 2014
  • Esophageal cancer has a poor prognosis, because the progression rate is faster compared to that of other cancers, Up to 30-40% of cases are inoperable at diagnosis, and most cases occur in the elderly. By this time, surgery has been regarded as the treatment of choice in patients suffering esophageal cancer and recent improvements in surgical techniques and perioperative management have significantly increased the resection rate and reduced the operative mortality. And Although the combination of chemotherapy and radiation therapy has been reported to be an effective treatment for esophageal cancer, most cases show only partial remission. Moreover, radiation therapy alone or chemotherapy alone has limited efficacy. We report a rare case of an 80-year-old man who presented with a chief complaint of dysphasia and was diagnosed with advanced esophageal cancer, with a review of the literature. Considering his advanced age, generally poor performance status, and the risk of fistula development after radiation therapy due to indentation of esophageal cancer into the main bronchus, palliative, rather than therapeutic, chemotherapy was performed, and complete remission was obtained.

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Actual Condition Survey for Thermal Functionality Improvement of Female Student's Winter Uniforms (여고생 동복의 보온기능성 개선을 위한 실태조사)

  • Kim, Yu Mi;Lee, Jeong Ran
    • Fashion & Textile Research Journal
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    • v.16 no.6
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    • pp.954-960
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    • 2014
  • This study surveyed high school girls in the Busan, Ulsan, and Gyeongnam areas to study how they wear school uniforms along with their satisfaction levels and demands in regards to functional school uniforms. This study presents data on the requirements for the development of winter school uniforms for high school girls with improved warmth functions. The findings are: First, high school girls purchased school uniforms of different brands and the purchase rates for three brands were 25% to 30% approximately. Most of them spent more than 300,000 KRW and less than 400,000 KRW on school uniforms purchases. Second, the greatest complaints by students about winter school uniforms were the ability to conduct routine activities and poor thermal insulation. The most popular bottom underwear for girls was underpants and leggings. The most popular top underwear was half-sleeved round neck t-shirts and running shirts. Third, a survey about uniform functionality showed that most students used and 'arm pit sweat absorbing pad', 'Waist size adjusting function, and 'inside pockets with zippers'. Satisfaction with functional uniforms was low: less than 3.5 in all questions. Fourth, students were favorable to develop functional uniforms to keep warm in the winter. The bottom needs to be warmer than the top and it is necessary to keep legs warm, especially the thighs and calves.

Effects of Lavandula angustifolia Aroma on Electroencephalograms in Female Adults with Sleep Disorders (라벤더향이 수면장애가 있는 여자 성인의 뇌파에 미치는 영향)

  • Jung, Han-Na;Choi, Hyun-Ju
    • Journal of Life Science
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    • v.22 no.2
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    • pp.192-199
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    • 2012
  • This study investigated the effects of Lavandula angustifolia (L. angustifolia) aroma on the brain electrical activity evaluated by electroencephalogram (EEG) in female adults with sleep disorders. The subjects were 28 healthy female adults and their sleep disorders were classified by the Pittsburgh Sleep Quality Index. EEG electrodes were attached at the frontal (F3, F4), temporal (T3, T4), occipital (O1, O2), parietal (P3, P4), reference, and ground regions according to the International 10-20 system. Subjects were exposed to the L. angustifolia aroma for 3 min. Results showed that L. angustifolia aroma decreased the occipital and parietal alpha powers, and increased the frontal theta power and occipital beta power in subjects with good sleep quality. On the other hand, L. angustifolia aroma increased the theta power in the all cranial regions after aroma treatment in subjects with poor sleep quality. In conclusion, L. angustifolia aroma diminishes a state of wakefulness in the brain and helps individuals to fall asleep. Therefore, L. angustifolia aroma may have beneficial effect for female adults with sleep disorders.

Trends in Ischemic Heart Disease Mortality in Korea, 1985-2009: An Age-period-cohort Analysis

  • Lee, Hye-Ah;Park, Hye-Sook
    • Journal of Preventive Medicine and Public Health
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    • v.45 no.5
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    • pp.323-328
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    • 2012
  • Objectives: Economic growth and development of medical technology help to improve the average life expectancy, but the western diet and rapid conversions to poor lifestyles lead an increasing risk of major chronic diseases. Coronary heart disease mortality in Korea has been on the increase, while showing a steady decline in the other industrialized countries. An age-period-cohort analysis can help understand the trends in mortality and predict the near future. Methods: We analyzed the time trends of ischemic heart disease mortality, which is on the increase, from 1985 to 2009 using an age-period-cohort model to characterize the effects of ischemic heart disease on changes in the mortality rate over time. Results: All three effects on total ischemic heart disease mortality were statistically significant. Regarding the period effect, the mortality rate was decreased slightly in 2000 to 2004, after it had continuously increased since the late 1980s that trend was similar in both sexes. The expected age effect was noticeable, starting from the mid-60's. In addition, the age effect in women was more remarkable than that in men. Women born from the early 1900s to 1925 observed an increase in ischemic heart mortality. That cohort effect showed significance only in women. Conclusions: The future cohort effect might have a lasting impact on the risk of ischemic heart disease in women with the increasing elderly population, and a national prevention policy is need to establish management of high risk by considering the age-period-cohort effect.

Clinicopathological Study of Gall Bladder Carcinoma with Special Reference to Gallstones: Our 8-year Experience from Eastern India

  • Hamdani, Nissar Hussain;Qadri, Sumyra Khurshid;Aggarwalla, Ramesh;Bhartia, Vishnu Kumar;Chaudhuri, Sumit;Debakshi, Sanjay;Baig, Sarfaraz Jalil;Pal, N.K.
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.11
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    • pp.5613-5617
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    • 2012
  • Gallbladder carcinoma (GBC) is the commonest cancer of the biliary tree and the most frequent cause of death from biliary malignancies. The incidence of GBC shows prominent geographic, age, race, and gender-related differences and is 4-7 times higher in patients with gallstones. This prompted us to study the clinicopathological aspects of the disease and the incidence of gallstones in gallbladder carcinoma patients, in this part of India. In this, combined retrospective (Jan 2004-March 2010) and prospective study (April 2010-Dec 2011) of eight years, 198 patients of gallbladder carcinoma (50 males and 148 females), (range 28-82 years; mean 55 years) were studied. Most of the patients were poor and presented with abdominal pain and mass, with abnormal lab parameters. Gallstones were present in 86% of patients. Surgical exploration was performed in 130, with gallbladder resection in 60 (including 7 incidental GBC). Adenocarcinoma (87.7%) was the commonest histological type. The study indicates that GBC is common in our scenario. It is a disease of elderly females, has a strong association with gallstones and every cholecystectomy specimen should be examined histopathologically.

A Study on the Road Facilities Use Characteristics of the Transportation Vulnerable by AHP Analysis (AHP분석을 통한 교통약자의 도로시설 이용특성에 관한 연구)

  • KIM, Min Je;LEE, Young Woo
    • Journal of Korean Society of Transportation
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    • v.33 no.3
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    • pp.276-283
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    • 2015
  • Pedestrians have been exposed to dangerous traffic environments, in which walking spaces in a city decrease without improved facilities even though cars increase. Such poor walking environments are deadly dangerous to the vulnerable as well as the non-vulnerable. This study analyzed the road facilities use characteristics according to a type of vulnerability in order to improve traffic safety and walking environment for vulnerable pedestrians. This study surveyed the vulnerable in terms of issues that they encountered on existing walkways and conducted the analytic hierarchy process (AHP), which took all quantitative and qualitative variables into account. The results of Level-3 analysis were showed that the elderly and the disabled were partially similar; both felt most inconvenient at enter-exit sections, steep walkway and bad paved walkway. Unlike those results, people with children and/or infants answered that overpass or underpass walkways without lifting facilities were most inconvenient walking environments.

Sarcopenia: Nutrition and Related Diseases

  • Du, Yang;No, Jae Kyung
    • Culinary science and hospitality research
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    • v.23 no.1
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    • pp.66-78
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    • 2017
  • "Sarcopenia", sarcopenia is an old age syndrome, and used to describe the reduction of skeletal muscle. Initially, it was thought that sarcopenia was only a senile disease characterized by degeneration of muscle tissue. However, its cause is widely regarded as multifactorial, with neurological decline, hormonal changes, inflammatory pathway activation, declines in activity, chronic illness, fatty infiltration, and poor nutrition, all shown to be contributing factors. Skeletal muscle mass can be measured by a variety of methods, currently, the commonly used methods are dual-energy X-ray scanning (DXA), computer tomography (CT), magnetic resonance imaging (MRI), etc. Muscular skeletal disorders can also be assessed by measuring appendicular skeletal muscle (ASM), particularly muscle tissue content. At the same time, sarcopenia refers to skeletal muscle cell denervation, mitochondrial dysfunction, inflammation, hormone synthesis and secretion changes and a series of consequences caused by the above process and is a progressive loss of skeletal muscle syndrome, which can lead to the decrease of muscle strength, physical and functional disorders, and increase the risk of death. Sarcopenia is mainly associated with the aging process, but also related to other causes such as severe malnutrition, neurodegenerative diseases, and disuse and endocrine diseases associated with muscular dystrophy, and it is the comprehensive results of multi-factors, so it is difficult to define that sarcopenia is caused by a specific disease. With the aging problem of the population, the incidence of this disease is increasingly common, and seriously affects the quality of the life of the elderly. This paper reviews the etiology and pathogenesis of myopathy, screening methods and diagnosis, the influence of eating habits, etc, and hopes to provide reference for the diagnosis and treatment of this disease. At present, adequate nutrition and targeted exercise remain the gold standard for the therapy of sarcopenia.