Real-World Treatment Intensity and Patterns in Patients With Myopic Choroidal Neovascularization: Common Data Model in Ophthalmology

Bui Manh-Hung,Lee Da Yun,Park Sang Jun,Park Kyu Hyung 대한의학회 2023 Journal of Korean medical science Vol.38 No.23

Background: A paucity of data addressing real-world treatment of myopic choroidal neovascularization (mCNV) in the era of anti-vascular endothelial growth factor (VEGF) drugs led us to investigate real-world treatment intensity and treatment patterns in patients with mCNV. Methods: This is a retrospective, observational study using the Observational Medical Outcomes Partnership-Common Data Model database of treatment-naïve patients with mCNV over the 18-year study period (2003–2020). Outcomes were treatment intensity (time trends of total/average number of prescriptions, mean number of prescriptions in the first year and the second year after initiating treatment, proportion of patients with no treatment in the second year) and treatment patterns (subsequent patterns of treatment according to the initial treatment). Results: Our final cohort included 94 patients with at-least 1-year observation period. Overall, 96.8% of patients received anti-VEGF drugs as first-line treatment, with most of injections from bevacizumab. The number of anti-VEGF injections in each calendar year showed an increasing trend over time; however, there was a drop in the mean number of injections in the second year compared to the first year from 2.09 to 0.47. About 77% of patients did not receive any treatment in their second year of treatment regardless of drugs. Most of patients (86.2%) followed non-switching monotherapy only and bevacizumab was the most popular choice either in the first-line (68.1%) or in the second-line (53.8%) of treatment. Aflibercept was increasingly used as the first-line treatment for patients with mCNV. Conclusion: Anti-VEGF drugs have become the treatment of choice and second-line treatment for mCNV over the past decade. Anti-VEGF drugs are effective for the treatment of mCNV as the non-switching monotherapy is the main treatment regimen in most cases and the number of treatments decreases significantly in the second year of treatment.

뇌성마비 아동의 신체 기능수준과 재활 목적 치료 강도가 신체 기능향상에 미치는 영향: 6개월간 추적연구

김부영 ( Bu-young Kim ),윤영주 ( Young-ju Yun ),신용범 ( Yong-beom Shin ),김수연 ( Soo-yeon Kim ),오태영 ( Tae-young Oh ) 대한물리의학회 2018 대한물리의학회지 Vol.13 No.1

PURPOSE: The purpose of this study was to find out the treatment patterns of Children with cerebral palsy, and to analyze the effect of physical function level and treatment intensity on improvement of physical function in children with cerebral palsy for six months. METHODS: Participants were 126 children (boys 83, girls 43) diagnosed cerebral palsy that the mean age was at 33months, ranged from 8 months to 77 months. We collected data related on demography and disable characteristic, treatment pattern using by questionnaire constructed ourselves for six months on caregivers. The treatment pattern includes, type, frequency, and institute of treatment. We performed the evaluation of Gross Motor Function Measurement (GMFM) and Pediatric Evaluation of Disability Inventory (PEDI) between pre and post for six months in order to find out improvement of physical function. We analyzed the effect of physical functional level measured by Gross Motor Functional Classification system, age, treatment intensity on physical function using by repeated measures ANOVA for SPSS PC ver. 22.0. RESULTS: The average of treatment frequency for physical therapy was 5.74 times per week, occupational therapy was 3.96 times, speech therapy was 2.96 times, treatment for accompanying disability was 3.12 times. Physical function level and age was significantly factors affecting improvement of physical function, there was no significant difference according to treatment intensity. CONCLUSION: We suggest that physical function and age might be important factors on improvement of physical function and professional rehabilitation team must consider the appropriate treatment type customized to each children.

Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study

이서인,홍경숙,박진,이영주 대한중환자의학회 2020 Acute and Critical Care Vol.35 No.3

Background: This study examined the experience of withholding or withdrawing life-sustaining treatment in patients hospitalized in the intensive care units (ICUs) of a tertiary care center. It also considers the role that intensivists play in the decision-making process regarding the withdrawal of life-sustaining treatment. Methods: We retrospectively analyzed the medical records of 227 patients who decided to withhold or withdraw life-sustaining treatment while hospitalized at Ewha Womans University Medical Center Mokdong between April 9 and December 31, 2018. Results: The 227 hospitalized patients included in the analysis withheld or withdrew from life-sustaining treatment. The department in which life-sustaining treatment was withheld or withdrawn most frequently was hemato-oncology (26.4%). Among these patients, the most common diagnosis was gastrointestinal tract cancer (29.1%). A majority of patients (64.3%) chose not to receive any life-sustaining treatment. Of the 80 patients in the ICU, intensivists participated in the decision to withhold or withdraw life-sustaining treatment in 34 cases. There were higher proportions of treatment withdrawal and ICU-to-ward transfers among the cases in whom intensivists participated in decision making compared to those cases in whom intensivists did not participate (50.0% vs. 4.3% and 52.9% vs. 19.6%, respectively). Conclusions: Through their participation in end-of-life discussions, intensivists can help patients’ families to make decisions about withholding or withdrawing life-sustaining treatment and possibly avoiding futile treatments for these patients.

Lee Silverman Voice Treatment(LSVT)프로그램이 파킨슨병의 음강 개선에 미치는 효과

김윤경(Yoon Kyoung Kim),최예린(Yaelin Choi),김윤정(Yunjung Kim),최은희(Eunhee Choi) 한국언어치료학회 2012 言語治療硏究 Vol.21 No.1

It is experiencing the difficulty of communication in daily life degrading the clarity of speech by the reduced intensity of sound that is speech characteristics of patients with Parkinson’s disease. Lee Silverman Voice Treatment is a program developed taking notice that the reduced intensity of sound with the characteristics of Parkinson’s disease is the main reason to degrade the clarity of speech. This program will increase the intensity of the voice with intensive care and is focusing on maximizing the phonation and respiration effort. Precedent research on whether the effects of LSVT program being used much in clinical practice currently is actively taking place, but it is difficult state to generalize because most of the studies have been made under limited samples. Therefore this study was integrate the results by collecting the existing precedent studies on whether the intensity improvement effects of Parkinson’s disease by LSVT program in each task of vowel phonation, reading, monologue and doing meta analysis for these.Research methods was selected 10 units of study systematically depending on the inclusion and exclusion criteria of the study after reviewing the relevant literature of domestic and foreign in the subject of “parkinson & LSVT. It was calculated the overall effect size of studies selected using random effects model. The analysis results of the vowel phonation, reading, monologue task, first, the result performed homogeneity test in the vowel phonation task is p-value=0.99609 and each study is homogeneity with each other, test result of the overall treatment effect is p-value<.0001 and can be considered significant. Second, the result performedhomogeneity test in the reading task is p-value=0.99909 and each study is homogeneity with each other, test result of the overall treatment effect is p-value<.0001 and can be considered significant. Third, he result performed homogeneity test in the monologue task is p-value=0.99115 and each study is homogeneity with each other, test result of the overall treatment effect is p-value<.0001 and can be considered significant. In the analysis results, it can be confirmed that it was improved all the intensity of vowel phonation, reading,monologue. Therefore the result verified the overall effect of LSVT program by each variable is that because p-value for all the variable is smaller than statistical significance level 0.05, LSVT program may be effective in promoting intensity. And in order to see the risk of each study of vowel phonation, reading, monologue,average distribution was appeared by drawing point chart.This study has a great significance that the intensity improvement effect of LSVT program was integrated systematically through the way called meta analysis. It can be considered that this study can be utilized highly in clinical that do not have enough time to collect raw data by providing information compressed systematically in many academic information.

세기조절방사선치료의 정도관리

김성규 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

Intensity-modulated radiation therapy (IMRT) is believed to be one of the best radiation treatment techniques. IMRT is able to deliver fatal doses of radiation to the tumor region with minimal exposure of critical organs, It is essential to have a comprehensive quality assurance program to assure precision and accuracy in treatment, due to the character of IMRT. We applied quality assurance technique to the Eclipse treatment planning system and sought to determine its effectiveness in patient treatment planning. An acrylic phantom, film, and an ionization chamber were used in this study.

회분식 고강도 광원 처리에 의한 막걸리 효모의 살균

김보라 ( Bo Ra Kim ),김애진 ( Ae Jin Kim ),홍희정 ( Hee Jung Hong ),신정규 ( Jung Kue Shin ) 한국산업식품공학회 2013 산업 식품공학 Vol.17 No.2

UV 파장이 차단된 고강도 광원을 활용한 광펄스 시스템을 이용하여 막걸리로부터 분리한 효모의 살균 효과에 대하여 연구하였다. 광펄스 처리의 주요 변수인 빛의 세기와 처리시간 그리고 frequency에 따른 효모의 사멸 효과를 살펴본 결과 광원의 빛의 세기(전압의 세기)가 높아질수록 그리고 처리시간이 길어질수록 높은 사멸율을 나타내어 1000V, 50 sec 처리 후 모든 균(약 7 log CFU/mL) 이 사멸하였으며, 처리시간에 따라 직선적으로 사멸하는 경향을 보였다. 일정한 빛의 세기와 처리시간에서는 frequency가 증가할수록 사멸 효과가 증가하였지만 실제 처리시간(처리시간×펄스수)이 같으면 frequency에 상관없이 같은 사멸효과를 보여 frequency에 따른 사멸율의 영향은 없었다. 시료내에 초기 균수 농도가 높을수록 투명도의 감소에 의해 광원의 투과력이 떨어져 사멸효과는 감소하였으며, 시료의 깊이가 증가할수록 사멸효과는 감소하여 시료의 깊이가 5 mm이상일 경우 사멸효과가 급격히 떨어졌다. 광펄스 처리 중 시료의 온도는 변화가 없었다. 이상의 결과로 미루어 볼 때 광펄스 처리가 실제 공정에 적용될 경우 온도의 변화없이 시료 내의 미생물을 사멸하는데 효과는 있으나 이를 위해서는 시료의 탁도와 초기균수 그리고 깊이를 고려하여 설계되어야 할 것으로 보인다. Intense pulsed light (IPL) treatment is one of the emerging non-thermal techniques being investigated as an alternative to conventional thermal treatment because it has been proven to be effective for microbial inactivation in air, water, and foods. The aim of this study was to evaluate the possibility of using IPL treatment for the effective inactivation of isolated yeast in makgeolli. The key parameters of intense pulsed light are light intensity (input voltage), treatment time, frequency of pulse, and depth of sample. The results show that there is a significant reduction of population along with an increase of light intensity and IPL treatment duration. The highest level of inactivation achieved in this study was approximately a 7 log CFU/mL reduction. In addition, the inactivation rates of yeast cells decrease with increasing initial cell population and depth of samples. But pulse frequency did not affect the inactivation of yeast. Temperature was not changed during IPL treatment.

회분식 고강도 광원 처리에 의한 막걸리 효모의 살균

김보라,김애진,홍희정,신정규 한국산업식품공학회 2013 산업 식품공학 Vol.17 No.2

UV 파장이 차단된 고강도 광원을 활용한 광펄스 시스템을 이용하여 막걸리로부터 분리한 효모의 살균 효과에 대하여 연구하였다. 광펄스 처리의 주요 변수인 빛의 세기와 처리시간 그리고 frequency에 따른 효모의 사멸 효과를 살펴본 결과 광원의 빛의 세기(전압의 세기)가 높아질수록 그리고 처리시간이 길어질수록 높은 사멸율을 나타내어 1000V, 50 sec 처리 후 모든 균(약 7 log CFU/mL) 이 사멸하였으며, 처리시간에 따라 직선적으로 사멸하는 경향을 보였다. 일정한 빛의 세기와 처리시간에서는 frequency가 증가할수록 사멸 효과가 증가하였지만 실제 처리시간(처리시간×펄스수)이 같으면 frequency에 상관없이 같은 사멸효과를 보여 frequency에 따른 사멸율의 영향은 없었다. 시료내에 초기 균수 농도가 높을수록 투명도의 감소에 의해 광원의 투과력이 떨어져 사멸효과는 감소하였으며, 시료의 깊이가 증가할수록 사멸효과는 감소하여 시료의 깊이가 5 mm이상일 경우 사멸효과가 급격히 떨어졌다. 광펄스 처리 중 시료의 온도는 변화가 없었다. 이상의 결과로 미루어 볼 때 광펄스 처리가 실제 공정에 적용될 경우 온도의 변화없이 시료 내의 미생물을 사멸하는데 효과는 있으나 이를 위해서는 시료의 탁도와 초기균수 그리고 깊이를 고려하여 설계되어야 할 것으로 보인다. Intense pulsed light (IPL) treatment is one of the emerging non-thermal techniques being investigated as an alternative to conventional thermal treatment because it has been proven to be effective for microbial inactivation in air, water, and foods. The aim of this study was to evaluate the possibility of using IPL treatment for the effective inactivation of isolated yeast in makgeolli. The key parameters of intense pulsed light are light intensity (input voltage), treatment time, frequency of pulse, and depth of sample. The results show that there is a significant reduction of population along with an increase of light intensity and IPL treatment duration. The highest level of inactivation achieved in this study was approximately a 7 log CFU/mL reduction. In addition, the inactivation rates of yeast cells decrease with increasing initial cell population and depth of samples. But pulse frequency did not affect the inactivation of yeast. Temperature was not changed during IPL treatment.

수술 후 일반 내외과계 중환자실로 입실한 환자들에 대한 후향적 분석

윤준로,임춘학,김미정 대한중환자의학회 2008 Acute and Critical Care Vol.23 No.1

Background: The present study was designed to examine the purpose of intensive care unit (ICU) admission and the prevalence of disease in postoperative patients admitted to general surgical-medical ICU. Methods: Between 1 January 2007 and 31 December 2007, 646 cases of 612 patients admitted to a general postoperative patients admitted to general surgical-medical ICU were examined. The patients were classified into two groups, ICU treatment and ICU monitoring groups according to Knaus` suggestion which defines the kinds of treatment done exclusively in ICU. Patients` demographics, preoperative American Society of Anesthesiologists physical status classification (ASA) grade, prevalence of disease and emergent operation rate were analyzed. Results: 255 patients (39.5%) were included in the ICU treatment group and 391 cases (60.5%) in the ICU monitoring group. The prevalence of respiratory, gastrointestinal, and central nervous diseases was higher significantly in the ICU treatment group. In addition, the average of ASA grade and the duration of operation were higher significantly in the ICU treatment group. Conclusions: Admission rate only for monitoring was higher than one for intensive treatment. An alternative strategy should be considered to care for postoperative patients who need just close monitoring.

Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma: Penang General Hospital Experience

Phua, Chee Ee,Tan, Boon Seang,Tan, Ai Lian,Eng, Kae Yann,Ng, Bong Seng,Malik, Rozita Abdul,Ishak, Wan Zamaniah Wan Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.7

Purpose: To study the overall treatment time (OTT) and acute toxicity of intensity-modulated radiotherapy (IMRT) treatment for nasopharyngeal carcinoma (NPC). Methods: This retrospective study covered all NPC patients who underwent radical IMRT treatment at the Penang General Hospital from June 2011 to February 2012. Patients of any age and stage of disease with histologically proven diagnosis were included. Information was collected on patient demographics, clinical stage, treatment received, including any neoadjuvant and/or concurrent chemotherapy, acute toxity and completion of IMRT within the OTT. Results: A total of 26 NPC patients were treated with IMRT during the study period; 88.5% had stage III/IV disease. 45.2% received neo-adjuvant chemotherapy while 50.0% were given concurrent chemo-irradiation. All patients completed the treatment and 92.3% within the 7 weeks OTT. Xerostomia was present in all patients with 92.3% having grade 2. Severe grade III/IV acute toxicity occurred in 73.1% of patients, the commonest of which was oral mucositis (57.6%). This was followed by dysphagia which occurred in 53.8%, skin reactions in 42.3% and weight loss in 19.2%. However, haematological toxicity was mild with only one patient having leucopaenia. Conclusion: IMRT treatment for NPC is feasible in our center. More importantly, it can be delivered within the 7 weeks OTT in the majority of patients. Severe grade 3/4 toxicity is very common (73.1%) and thus maximal nutritional and analgesic support is required throughout the treatment.

원통형 처리 용기를 이용한 후추의 광펄스 살균 효과

박지현 ( Jihyun Park ),이광민 ( Gwangmin Lee ),김진원 ( Jin Won Kim ),이경미 ( Gyeong Mi Lee ),신정규 ( Jung-kue Shin ) 한국산업식품공학회 2018 산업 식품공학 Vol.22 No.3

비가열 살균 기술 중 하나인 광펄스 기술을 이용하여 후추에 존재하는 미생물의 사멸 효과를 원통형 처리 용기를 이용하여 검토하였다. 후추에 존재하는 미생물의 오염도는 일반세균은 약 2.0-4.0×10⁶ CFU/g, Bacillus cereus는 약 3.0-5.0×10³ CFU/g이었다. 펄스 수 5 pps, 광원과 처리용기 사이의 거리 4 cm의 동일한 조건에서 빛의 세기를 달리하여 처리하였을 경우 빛의 세기가 강할수록 사멸정도는 증가하였으며, 빛의 세기 1,000 V에서 흑후추의 경우 일반세균은 0.55 log, B. cereus는 0.6 log, 백후추의 경우 일반세균은 0.7 log, B. cereus는 0.6 log의 사멸효과를 보였다. 펄스 수를 달리하였을 경우에는 펄스수가 증가할수록 높은 사멸율을 보였으며, 광원과 처리 용기사이의 거리에 따른 사멸효과를 거리가 짧을수록 사멸율은 증가하였다. 입자의 크기에 따른 사멸 효과는 입자의 크기가 클수록 살균효과가 높은 것으로 나타났다. 후춧가루의 살균에 있어 광펄스 기술은 처리 조건에 따라 40-80%정도의 사멸율을 나타내어 후춧가루의 비가열 살균 기술로서의 적용 가능성을 볼 수 있었다. In this study, the effect of intense pulsed light (IPL) treatment in a tube-shaped treatment chamber on microbial inactivation in powdered pepper was investigated. Untreated samples showed a degree of contamination of 2.0-4.0×10⁶ CFU/g total aerobic bacteria, and 3.0-5.0×10⁵ CFU/g Bacillus cereus. The microorganisms found in powdered pepper decreased with exposure to increasing light intensity, pulse number and treatment time. At 1,000 V, the total aerobic bacteria in powdered black pepper was reduced by 0.55 log, and in and powdered white pepper by 0.6 log cycle, and B. cereus was reduced 0.7 log in black pepper and 0.6 log cycle in white pepper. The microbial inactivation rate increased with the increase in the distance between the light source and the treatment chamber during IPL treatment. The sterilization rate of powdered pepper using IPL was 40-80%, indicating that the IPL sterilization method may find potential applications for powder foods.