Utility Analysis for Pegfilgrastim in DLBCL Patients on R-CHOP Regimen

OBJECTIVE: This study was designed to compare pegfilgrastim and filgrastim in diffuse large B-cell lymphoma (DLBCL) patients treated with a rituximab with cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (R-CHOP) regimen in terms of clinical efficacy and cost-effectiveness. METHOD: Clinical efficacy was measured by trough level of absolute neutrophil count (ANC), days of ANC under 50% of baseline value, days of ANC under 90% of baseline value, duration of ANC recovery to baseline value, days of ANC less than 0.5 x 109 cells/L, and difference of peak and trough level of ANC during 1 cycle of R-CHOP regimen. To evaluate cost-effectiveness, total prices of used filgrastim and pegfilgrastim within 1 cycle of R-CHOP were analyzed. RESULTS: In terms of clinical efficacy, trough level of ANC and days to ANC recovery showed statistical significance. The median trough levels of ANC with administration of filgrastim and pegfilgrastim were 0.18 and 1.94 (p = 0.021), respectively, and the median durations of ANC recovery to baseline value were 5.5 days and 2 days (p = 0.023), respectively. For the median days of ANC under 50% of baseline value, days of ANC under 90% of baseline value, days of ANC less than 0.5 x 109 cells/L, and difference of peak and trough level of ANC during 1 cycle of R-CHOP, the pegfilgrastim group performed better than the filgrastim group. However the difference was not statistically significant. In terms of overall expense during 1 cycle of R-CHOP, pegfilgrastim is about 3.43 times more expensive than filgrastim. CONCLUSION: Pegfilgrastim is more efficient than filgrastim in terms of clinical efficacy. In terms of prices, pegfilgrastim is more expensive than filgrastim for patients, but it is more convenient in clinical use. Therefore, pegfilgrastim should be the preferred choice of G-CSF for neutropenic patients. Further comparative study of pegfilgrastim and filgrastim is needed.

Effects of a Responsive Parenting Education Program on Child's Behavioral Problems and Pivotal Developmental Behaviors in Children at Risk for Attention Deficit Hyperactivity Disorder

PURPOSE: This study was done to determine whether a parenting education program using responsive teaching strategies is effective for parenting stress, maternal interactional behavior and behavioral problems in children at risk for Attention Deficit Hyperactivity Disorder (ADHD). METHODS: Participants in this study were 17 elementary school children and their parents. The ADHD risk group was determined by scores on the Korean-ADHD Rating Scale. The parenting education program was developed based on Dr. Mahoney's responsive teaching curriculum. Mothers participated in the program once a week for 8 sessions. Treatment outcome was evaluated using the Korean version of the Child Behavior CheckList (K-CBCL), parenting stress, maternal interactional behavior, and child pivotal developmental behavior. Data were analyzed using Wilcoxon signed rank test, Mann-Whitney test, and regression analysis. RESULTS: After the parenting education program, no significant difference in parenting stress (Z=-1.00, p=.320) was found, but there was a significant decrease in the child's internal behavior problems (Z=-2.05, p=.040), and also a significant improvement in maternal interactional behavior and a significant difference in child pivotal developmental behavior (Z=-2.67, p=.008). CONCLUSION: The results indicate that parenting education programs based on responsive teaching strategies are effective and that application of a program is recommended to prevent behavioral problems and improve maternal child interaction for children at risk for ADHD.

Analysis of Relationships between Parenting Stress, Maternal Depression, and Behavioral Problems in Children at Risk for Attention Deficit Hyperactive Disorder

PURPOSE: In this study differences in behavioral problems between children at risk for Attention Deficit Hyperactive Disorder (ADHD) and normally developing children were identified. Further, relationships between parental stress, depression, and child behavioral problems according to ADHD symptoms were explored. METHODS: Participants were 222 elementary school children and their parents. The ADHD risk group was determined by the Korean-ADHD Rating Scale. Data were collected using the Korean-ADHD Rating Scale, Korean version of Child Behavior CheckList (K-CBCL), Parenting Stress Index, and Beck Depression Inventory. Data were analyzed using t-test, Pearson correlation coefficients, and regression analysis. RESULTS: 1) The ADHD risk group showed higher levels of behavioral problems, parenting stress, and maternal depression than the normal group. 2) There were significant relationships between ADHD scores and parenting stress (r=.66), maternal depression (r=.35), internal behavioral problems (r=.47), and external problems (r=.55), but, ADHD risk scores were negatively correlated with social competence (r=-.40). 3) The regression analysis revealed that ADHD levels affected the child's internal behavioral problems, mediated by maternal depression (beta=.29, p<.001). CONCLUSION: The study results show that higher risk scores for ADHD indicate a significant effect for behavioral problems. Also, parenting stress and depression influence child's behavioral problems. These results suggest that identification of children at risk for ADHD and development of parental education programs would contribute to the prevention of behavioral problems and aggravation of the ADHD symptoms.

Factors Related to Complications of Childhood Obesity / 대한소아내분비학회지

PURPOSE: Childhood obesity is associated with complications such as hyperinsulinemia/insulin resistance, dyslipidemia and fatty liver. The aims of this study were to evaluate the difference of measurements between obese and normal weight children and to investigate the factors related to complications of obesity. METHODS: The body mass index (BMI), trunk and total fat percent, lipid profiles, ALT, AST, leptin, LH, FSH, fasting insulin, glucose, IGF-1, IGFBP-3 were measured in 97 children (49 obese children and 48 non-obese controls). We calculated G/I ratio, loginsuin, HOMA-IR, logHOMA-IR, and QUICKI and evaluated the relationship between each anthropometric data and metabolic data. RESULTS: Hyperinsulinemia, dyslipidemia and abnormal ALT showed high prevalence in obese children. In obese, BMI was correlated with G/I ratio (r=-0.309, P<0.05), loginsuin (r=0.381, P<0.05), logHOMA-IR (r= 0.342, P<0.05), QUICKI (r=-0.343, P<0.05), ALT (r=0.451, P<0.01)) and AST (r=0.289, P<0.05). Serum insulin level had positive correlation with BMI (r=0.345, P<0.01), serum triglyceride (r=0.332, P<0.05) and all insulin resistance indices (P<0.01). Serum leptin levels were significantly correlated with BMI (r=0.555, P<0.01), trunk (r=0.463, P<0.01)) and total (r=0.506, P<0.01) fat percent, LDL (r=0.350, P<0.05), total cholesterol (r=0.297, P<0.05). CONCLUSION: BMI is valuable for predicting insulin resistance and prevalence of abnormal ALT or AST. Monitoring of insulin level is helpful to assess the morbidities of obesity. Also, serum leptin level might be an important predictor of obesity.

Study on the Prognosis According to Clinical Patterns and Laboratory Findings in Children with Acute Encephalopathy

PURPOSE:Acute encephalopathy is defined as diffuse interference of brain functions due to neuronal dysfunction by generalized or multifocal insults. In this study, we investigated the relationship between the prognosis and other factors such as clinical patterns, laboratory findings, electroencephalographic and radiologic findings in children with acute encephalopahty. METHODS:We carried out a retrospective review on the medical records of 43 patients who were initially diagnosed as encephalopathy from January 1995 to June 2004. We excluded the patients diagnosed as mumps meningitis, Reye syndome and neonatal hypoxic ischemic encephalopathy. RESULTS: 1) The morality rate was 50% in the patients below 1 year old at the admission, but all the patients above 10 years old were survived. 2) The morality rate was 40% in the patients with alert mental status at the admission and one patient with comatous mental status died. 3) The morality rate of the patients without seizures at the admission(35.7%) was higher than that of the patients with seizures(10.3%). But there was no statistical significance. 4) In the patients with abnormal liver function tests, the mortality rate(40%) was singnificantly higher than that of the patients with normal liver functions(7.1%, P value <0.05) 5) Only 5 patients(20%) among 25 patients who took both EEG's and imaging studies were taken showed abnormalities at the same locations in both studies. But there was no significant relationship between the mortality rate and EEG and the radiologic findings. CONCLUSION:In this study, we could not find out the statistically significant relationship between the prognosis and other factors such as age, consciousness levels, the presence of seizures at the admission, and electroencephalographic and radiologic abnormalities. But the patients with abnormal liver functions at the admission showed statistically significant higher mortality rates than patients with normal liver function.

The Effect of Hand Massage on the Anxiety of the Hysterectomy Patients in Immediately prior to Surgery / 간호학회지

The purpose of this study was to examine the effects of hand massage as a nursing intervention on the anxiety of the hysterectomy patients in immediately prior to surgery. The method of this study was Nonequivalent Control Group Non-Synchronized Design. The data were selected from at K university hospital in Pusan, and they consisted of Experimental group-25 patients, Control group -24 patients. The data were collected from Jan. 4 to Jan. 30 in 1999. The subjects' self-reports of anxiety (measured by the Spielberger Trait-State anxiety Inventory and Visual Analogue Scale developed by Cline et al.) were recorded before and immediately after the intervention. The objective physiologic measures of blood pressure and pulse rate. The collected data were analysed by means of frequency, percentage, standard deviation, chi- square test, t-test, ANCOVA with SPSS program. The results of this study were as following; 1. Hypothesis 1: The 1st hypothesis that "There will be significant difference of the state anxiety level just before surgery in the experimental group and control group" was supported(P= .000). 2. Hypothesis 2: The 2nd hypothesis that "There will be significant difference of the visual analogue scale score just before surgery in the experimental group and control group"was supported(P= .000). 3. Hypothesis 3: The 3rd hypothesis that "There will be significant difference of the systolic and diastolic blood pressure level just before surgery in the experimental group and control group"was supported (P= .003, P= .041). 4. Hypothesis 4: The 4th hypothesis that "There will be significant difference of the pulse rate just before surgery in the experimental group and control group"was supported(P= .004). In conclusion, hand massage is a benefical nursing intervention that alleviates the psychological, physiological anxiety of the hysterectomy patients in immediately prior to surgery. therefore it is recomended to use the hand massage as a nursing intervention for patients undergoing anxiety. The results of this study appear promising, additional research is recomended to further the appropriate uses of hand massage in nursing practice for this and other patient population.

A Case of Thymic Carcinoid Tumor / 결핵

Until 1972, many carcinoid tumors of the thymus were not recognized as distinct lesions and were mistakenly labeled as variants of thymomas. Thymic carcinoid tumors are unusual neoplasms that show different morphological, functional, and behavioral characteristics than those of thymomas. We report a case of a 65-year-old woman with thymic carcinoid tumor. The cinicopathological findings are discussed with a review of the literature.

Effect of bronchial artery embolization in the management of massive hemoptysis : factors influencing rebleeding / 결핵

BACKGROUND: Bronchial artery embolization has been established as an effective means to control hemoptysis, especially in patients with decreased pulmonary function and those with advanced chronic obstructive pulmonary disease. We evaluated the effect of arterial embolization in immediate control of massive hemoptysis and investigated the clinical and angiographic characteristics and the course of patients with reccurrent hemoptysis after initial succeseful embolization. Another purpose of this study was to find predictive that cause rebleeding after bronchial artery embolization. METHOD: We reviewed 47 cases that underwent bronchial artery embolization for the management of massive hemoptysis, retrospectively. We analyzed angiographic findings in all cases before bronchial artery embolization and also reviewed the angiographic findings of patients that underwent additional bronchial artery embolization for the control of reccurrent hemoptysis to find the causes of rebleeding. RESULTS: 1) Underlying causes of hemoptysis were pulmonary tuberculosis (n=35), bronchiectasis(n=5), aspergilloma(n=2), lung cancer(n=2), pulmonary A-V malformation(n=l), and unknown cases(n=2). 2) Overal immediate success rate was 94%(n=44), and recurrence rate was 40%(n=19). 3) The prognostic factors such as bilaterality, systemic-pulmonary artery shunt, multiple feeding arteries and degree of neovascularity were not statistically correlated with rebleeding tendency. (p value>0.05). 4) At additional bronchial artery embolization, Revealed recannalization of previous embolized arteries were 14/18cases(78%) and the presence of new feeding arteries was 8/18cases(44%). 5) The complications(31cases, 66%) such as fever, chest pain, cough, voiding difficulty, paralytic ileus, motor and sensory change of lower extremity, atelectasis and splenic infarction were occured. CONCLUSION: Recannalization of previous embolized arteries is the major cause of recurrence after bronchial artery embolization. Despite high recurrence rate of hemoptysis, bronchial artery embolization for management of massive hemoptysis is a effective and safe procedure in immediate bleeding control.