The Etiology of Acute Stroke with Experience of Repeated Upper Extremity Deep Vein Thrombosis

In stroke patients, upper extremity deep vein thrombosis (UEDVT) is uncommon compared with lower extremity. Unlike the blood stasis in lower extremity, UEDVT has been developed by secondary cause. We reported a case of stroke patient with repeated UEDVT, presenting superficial venous congestion, who was finally diagnosed with pulmonary adenocarcinoma. The cause of stroke was non-bacterial thromboembolism formed at the mitral valve. Our case shows that unexpected UEDVT should be closely evaluated for higher coagulable status such as a malignancy.

Efficacy of Cognitive Intervention Program for Persons with Mild Cognitive Impairment according to Cognitive Trainers

OBJECTIVE: The aim of this study is to investigate the effects of cognitive training and cognitive trainer on cognitive function in persons with mild cognitive impairment (MCI). METHODS: A randomized controlled single blind trial with 2 treatment groups was designed and 40 participants were included in this study. They received cognitive training intervention by cognitive professional and non-professional. The cognitive training focused on memory strategies. This cognitive intervention consisted of 8 sessions training and once a week. The effect of program was examined in performance-based measures of cognitive abilities; memory, language, constructional praxis, attention, and working memory. The comparison of effect of trainer was examined by repeated measure analysis of variance. RESULTS: Thirty-six MCI completed the cognitive intervention and was assessed neurocognitive test on pre- and post-intervention. Attention, language inhibition and semantic language were significantly improved compared with baseline in total group. The memory (p=0.003) was significantly improved in Professional Program Group and attention (p=0.007) was significantly improved in Non-Professional Program Group (NPG). Distinctively, Korean version of Short form of Geriatric Depression Scale mean score in NPG was statistically improved from 4.24 to 3.29 (p=0.018) after intervention, but the comparison between groups was not significant. CONCLUSION: This study shows that the cognitive intervention program may improve on memory, attention and language in cognitive functions of MCI. But there is difference in improvement of the domains of cognitive abilities depending on the trainer.

Working Memory Span in Normal Control, Mild Cognitive Impairment and Alzheimer's Disease

OBJECTIVE: The purposes of this study were to compare the working memory span between mild cognitive impairment (MCI) and Alzheimer's disease (AD) in the Korean elderly population and to evaluate the effectiveness of the working memory span tests. METHODS: 32 normal controls (NC), 26 patients with MCI and 28 AD patients at a mild stage were participated in this study. We used newly devised working memory span tests (Word span test and Dot matrix) according to the components of working memory ;central executive, phonological loop, and visuospatial sketchpad. And the results were compared with the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K). To evaluate the effectiveness of the working memory tests and CERAD-K to screen MCI and AD, receiver operating characteristic curves were plotted. RESULTS: All subsets of the two working memory span tests showed significant decline in verbal and visuospatial working memory in AD. But there was no significant difference between NC and MCI. Compared to CERAD-K, the two working memory tests showed good effectiveness to discriminate AD. CONCLUSION: This study showed that working memory span tests could be effective diagnosing tools for detecting AD. But for the MCI, the working memory impairment was not prominent than episodic memory impairment. This is supposed to result from the various kinds of working memory components, especially the episodic buffer.

Art therapy using famous painting appreciation maintains fatigue levels during radiotherapy in cancer patients

PURPOSE: The purpose of this study was to evaluate the efficacy of art therapy to control fatigue in cancer patients during course of radiotherapy and its impact on quality of life (QoL). MATERIALS AND METHODS: Fifty cancer patients receiving radiotherapy received weekly art therapy sessions using famous painting appreciation. Fatigue and QoL were assessed using the Brief Fatigue Inventory (BFI) Scale and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) at baseline before starting radiotherapy, every week for 4 weeks during radiotherapy, and at the end of radiotherapy. Mean changes of scores over time were analyzed using a generalized linear mixed model. RESULTS: Of the 50 patients, 34 (68%) participated in 4 sessions of art therapy. Generalized linear mixed models testing for the effect of time on mean score changes showed no significant changes in scores from baseline for the BFI and FACIT-F. The mean BFI score and FACIT-F total score changed from 3.1 to 2.7 and from 110.7 to 109.2, respectively. Art therapy based on the appreciation of famous paintings led to increases in self-esteem by increasing self-realization and forming social relationships. CONCLUSION: Fatigue and QoL in cancer patients with art therapy do not deteriorate during a period of radiotherapy. Despite the single-arm small number of participants and pilot design, this study provides a strong initial demonstration that art therapy of appreciation for famous painting is worthy of further study for fatigue and QoL improvement. Further, it can play an important role in routine practice in cancer patients during radiotherapy.

A Comprehensive Model of Factors Affecting Adoption of Clinical Practice Guidelines in Korea

This study aims to investigate the factors related to the adoption of clinical practice guidelines in clinical settings in Korea; it also aims to determine how these factors differ depending on the specific situation of health care system and professional climate. The research sample comprised physicians who are board members of academic societies with experiences in development of clinical practice guidelines using a convenient sampling. We analyzed 324 physicians with pooling two-year sample of 2007 and 2008. From all the respondents, 48.8% stated that they followed Clinical Practice Guidelines, and 93.4% agreed with the content in the Clinical Practice Guidelines. With regard to the item on the self-efficacy of practicing guidelines, 90.3% of the respondents selected 'low level'. In the regression analysis, the factors associated with implementation were level of recognition, agreement and self-efficacy and positive attitude towards practice guidelines. Although the health care system in Korea differs from those in Western countries, our results revealed that the factors related to the adoption of practice guidelines were similar to the research results of Western countries. These results suggest that professionals' attitudes towards clinical practice guidelines are universal, and implementation strategies should be developed globally.

Evaluation of Unexposed Images after Erasure of Image Plate from CR System / 의학물리

It is important to initialize Image Plate (IP) completely for removing residual latent image by sodium lamp for reliability and repeatability of computed radiography (CR) system. The purpose of this study was to evaluate latent images of computed radiography (CR) images respect to delay time after erasure of foregone latent image and its effect, and erasure level. Erasure thoroughness for CR acceptance test from American Association of Physicist in Medicine (AAPM) Report 93 (2006) was also evaluated. Measurements were made on a CR (Agfa CR 25; Agfa, BELGIUM) system. Chest postero-anterior (PA), Hand PA, L-spine lateral radiographs were chosen for evaluation. Chest phantom (3D-torso; CIRS, USA) was used for Chest PA and L-spine lateral radiography. For Hand PA radiography, projections was done without phantom. Except Hand PA radiographs, noise was increased with delay time, and ghost image was appeared on overexposed area. Effect of delay after erasure on latent image was not seen on naked eye, but standard deviation (SD) of pixel value on overexposed area was relatively higher than that of other areas. On Hand PA and Chest PA radiographs, noise were not occurred by adjustment of erasure level. On L-spine lateral images at lower erasure level than standard level, noise including ghost image were occurred because of high tube current. Erasure thoroughness of CR system in our department was to be proved by these evaluation. The results of this study could be used as a baseline for IP initialization and reliability of CR images.