Utility and Limitations of Fine-Needle Aspiration Cytology in the Diagnosis of Lymphadenopathy.

BACKGROUND: Fine needle aspiration cytology (FNAC) is a valuable tool for evaluating lymphadenopathy. The purpose of this study was to assess the reliability and effectiveness of FNAC in the diagnosis of lymphadenopathy. METHODS: Cytological characteristics were evaluated in 432 patients who underwent lymph node FNAC and follow-up biopsy at the Korea Cancer Center Hospital from January 2015 to December 2019. RESULTS: Fifteen (3.5%) of the four hundred and thirty-two patients were diagnosed as inadequate by FNAC, with five (33.3%) of these diagnosed as metastatic carcinoma on histological examination. Of the 432 patients, 155 (35.9%) were diagnosed as benign by FNAC, with seven (4.5%) of these diagnosed histologically as metastatic carcinoma. A review of the FNAC slides, however, showed no evidence of cancer cells, suggesting that the negative results may have been due to FNAC sampling errors. An additional five samples regarded as benign on FNAC were diagnosed as non-Hodgkin lymphoma (NHL) by histological examination. Of the 432 patients, 223 (51.6%) were cytologically diagnosed as malignant, with 20 (9.0%) of these diagnosed as tissue insufficient for diagnosis (TIFD) or benign on histological examination. A review of the FNAC slides of these 20 patients, however, showed that 17 (85.0%) were positive for malignant cells. The sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV), and accuracy of FNAC were 97.8%, 97.5%, 98.7%, 96.0%, and 97.7%, respectively. CONCLUSIONS: Preoperative FNAC was safe, practical, and effective in the early diagnosis of lymphadenopathy. This method, however, had limitations in some diagnoses, suggesting that additional attempts may be required according to the clinical situation.

Major Clues and Pitfalls in the Differential Diagnosis of Parathyroid and Thyroid Lesions Using Fine Needle Aspiration Cytology.

BACKGROUND: It is difficult to distinguish parathyroid lesions (PLs) from thyroid lesions using fine needle aspiration cytology (FNAC) because of their proximity and their similar cytomorphological features. METHODS: FNAC smears of 46 patients with pathologically proven PLs that were histologically diagnosed as parathyroid adenoma (PA, n = 35), parathyroid hyperplasia (PH, n = 3), atypical parathyroid adenoma (APA, n = 1), and parathyroid carcinoma (PC, n = 7) were retrospectively reviewed and analyzed. RESULTS: Our initial cytological diagnoses indicated correct diagnoses in 31 of 46 PL patients (67%). The 15 erroneous diagnoses were 5 patients with non-specific benign disease (11%), 4 with nodular hyperplasia of the thyroid (9%), 5 with atypical cells (11%), and 1 with a metastatic papillary thyroid carcinoma (2%). Follicular pattern, papillary structures, colloid-like material, and macrophages, which often suggest thyroid lesions, were also present in some PLs. We found that branching capillaries along the papillary structures, stippled nuclear chromatin, and frequent occurrence of naked nuclei were useful for determining a parathyroid origin. CONCLUSIONS: It is important to be aware that PLs are frequently mistaken for thyroid lesions based on FNAC. The specific and unique characteristics of PLs identified here may be helpful in diagnosis.

Importance of Individual Ghost Cells in Fine-Needle Aspiration Cytology Diagnosis of Pilomatricoma.

BACKGROUND: Although histological diagnosis of pilomatricoma is not difficult because of its unique histological features, cytological diagnosis through fine-needle aspiration cytology (FNAC) is often problematic due to misdiagnoses as malignancy. METHODS: We reviewed the cytological features of 14 cases of histologically-proven pilomatricoma from Korea Cancer Center Hospital, with a discussion on the diagnostic pitfalls of FNAC. RESULTS: Among 14 cases of pilomatricoma, 10 (71.4%) were correctly diagnosed through FNAC, and two (14.3%) were misdiagnosed as carcinoma. Cytologically, all cases had easily recognizable clusters of basaloid cells and foreign body-type multinucleated cells. Although ghost cells were also found in all cases, some were inconspicuous and hardly recognizable due to their small numbers. CONCLUSIONS: An accurate diagnosis of pilomatricoma in FNAC is feasible with consideration of clinical information and close examination of ghost cells.

Cytological Features That Differentiate Follicular Neoplasm from Mimicking Lesions.

BACKGROUND: It is difficult to correctly diagnose follicular neoplasms (FNs) on fine-needle aspiration cytology (FNAC) because it shares many cytological features with other mimicking lesions. The aim of this study was to identify the cytological features that differentiate FNs from mimicking lesions. METHODS: We included the cytological slides from 116 cases of thyroid FN diagnosed on FNAC, and included their subsequent histological diagnoses. We evaluated the cytological architectural pattern and nuclear features of the lesions according to their histological groups. RESULTS: The final histological diagnoses of the 116 cases varied, and included 51 FNs (44%), 47 papillary thyroid carcinomas (40%) including follicular variant, and seventeen cellular nodular hyperplasias (15%). Regardless of the final histological diagnosis, microfollicular pattern was observed in most cases. On the other hand, trabecular pattern was identified in 34% of FNs, but not in any other lesions. Additionally, elongated nuclei and ground glass chromatin were found in only some papillary thyroid carcinomas. CONCLUSIONS: This study shows that the trabecular pattern is a representative cytological feature of FNs that can be used to distinguish FNs from mimicking lesions. In addition, nuclear shape and chromatin pattern can be used to further confirm the diagnosis of FNs from mimicking lesions through FNAC.

[Development of a Korean Geriatric Suicidal Risk Scale (KGSRS)].

PURPOSE: Increase in suicide rate for senior citizens which has become widespread in our society today. It is not a normal social phenomenon and is beyond the danger level. The contents of this study include Korean senior citizens' suicide related risk factors and warning signs, and the development of a simple Geriatric Suicide Risk Scale. METHODS: This study is Methodological Research to verify reliability and validity of the Geriatric Suicide Risk Scale according to the tool development process suggested by Devellis (2012). RESULTS: For predictive validity assessment, high suicide screening accuracy was showed with an Area under the ROC curve (AUC) of .93. For the optimal cutoff point of 11, sensitivity was 93.9%, and specificity, 75.7% which are excellence levels. Cross validity for assessment of generalization possibility showed the Area under the ROC curve (AUC) as .82 and in case of a cutoff point of 11, sensitivity was 73.7%, and specificity, 65.9%. CONCLUSION: When it comes to practical nursing, it is significant that the Korean Geriatric Suicide Risk Scale has high reliability and validity through adequate tool development and the tool assessment step to select degree of suicide risk of senior citizens. Also, it can be easily applied and does not take a long time to administer. Further, it can be used by health care personnel or the general public.

The potential of deferasirox as a novel therapeutic modality in gastric cancer.

BACKGROUND: Iron is a crucial element for cell proliferation, growth, and metabolism. However, excess iron and altered iron metabolism are both associated with tumor initiation and tumor growth. Deferasirox is an oral iron chelator. Although some studies have indicated that deferasirox is a promising candidate for anti-cancer therapies, its effectiveness against gastric cancer has not yet been determined. This study was conducted to determine whether deferasirox exerts anti-tumor effects in gastric cancer cell lines and whether deferasirox and cisplatin act synergistically. METHODS: Four human gastric cancer cell lines (AGS, MKN-28, SNU-484, and SNU-638) were treated with various concentrations of deferasirox to determine the IC50 for each cell line. The effects of deferasirox on the cell cycle were evaluated by flow cytometry, and the effects of deferasirox on iron metabolism, the cell cycle, and apoptosis were assessed by Western blotting. To determine whether deferasirox enhances the effect of cisplatin, AGS cells were cultured in the presence and absence of cisplatin. RESULTS: Deferasirox inhibited the proliferation of all gastric cancer cell lines as assessed by MTT assays. Since the IC50 of deferasirox was the lowest (below 10 µM) in AGS cells, subsequent experiments were performed in this line. Deferasirox upregulated transferrin receptor 1 expression and decreased ferroportin expression. Moreover, deferasirox induced G1 arrest; upregulated p21, p27, and p53 expression; and downregulated cyclin D1, cyclin B, and CDK4 expression. Furthermore, deferasirox induced apoptosis, upregulated N-myc downstream regulated gene 1 (NDRG1), and downregulated p-mTOR and c-myc expression. It was also found to act synergistically with cisplatin. CONCLUSIONS: Our results suggest that deferasirox may exert anti-tumor effects in the context of gastric cancer. Deferasirox affects a number of different pathways and molecules; for instance, deferasirox upregulates NDRG1 expression, inhibits the cell cycle, downregulates mTOR and c-myc expression, and induces apoptosis. In addition, deferasirox appears to potentiate the anti-cancer effects of cisplatin. Although the efficacy of deferasirox remains to be tested in future studies, the results presented here indicate that deferasirox is a promising novel anti-cancer therapeutic agent.

Anti-tumoral effect of arsenic compound, sodium metaarsenite (KML001), in non-Hodgkin's lymphoma: an in vitro and in vivo study.

Arsenic compounds have been used in traditional medicine for several centuries. KML001 (sodium metaarsenite; NaAsO2) is an orally bio-available arsenic compound with potential anti-cancer activity. However, the effect of KML001 has not been studied in lymphoid neoplasms. The aim of this study is to evaluate the anti-proliferative effect of KML001 in non-Hodgkin's lymphoma and to compare its efficacy with As2O3. KML001 inhibited cellular proliferation in all tested lymphoma cell lines as well as JurkatR cells (adriamycin-resistant Jurkat cells) in a dose-dependent manner, while As2O3 was not effective. Cell cycle regulatory protein studies have suggested that KML001 induces G1 arrest via p27-induced inhibition of the kinase activities of CDK2, 4, and 6. Treatment of KML001 induced apoptosis in Jurkat and JurkatR cells. The apoptotic process was associated with down-regulation of Bcl-2 (antiapoptotic molecule), up-regulation of Bax (proapoptotic molecule), and inhibition of caspase-3, -8, and -9. In addition, cell signaling including the STAT, PI3K/Akt, MAPK, and NF-κB signal pathways were inhibited in KML001-treated Jurkat and JurkatR cells. Furthermore, targeting the telomere by KML001 was observed in the Jurkat and JurkatR cells. The In vivo anti-tumoral activity of KML001 was confirmed in a xenograft murine model. Interestingly, partial responses were seen in two lymphoma patients treated with 10 mg/day (follicular lymphoma for 16 weeks and mantle cell lymphoma for 24 weeks) without severe toxicities. These findings suggest that KML001 may be a candidate agent for the treatment of de novo, refractory, and relapsed non-Hodgkin's lymphoma patients.

Inhibition of checkpoint kinase 2 (CHK2) enhances sensitivity of pancreatic adenocarcinoma cells to gemcitabine.

Checkpoint kinase 2 (CHK2) plays pivotal function as an effector of cell cycle checkpoint arrest following DNA damage. Recently, we found that co-treatment of NSC109555 (a potent and selective CHK2 inhibitor) potentiated the cytotoxic effect of gemcitabine (GEM) in pancreatic cancer MIA PaCa-2 cells. Here, we further examined whether NSC109555 could enhance the antitumour effect of GEM in pancreatic adenocarcinoma cell lines. In this study, the combination treatment of NSC109555 plus GEM demonstrated strong synergistic antitumour effect in four pancreatic cancer cells (MIA PaCa-2, CFPAC-1, Panc-1 and BxPC-3). In addition, the GEM/NSC109555 combination significantly increased the level of intracellular reactive oxygen species (ROS), accompanied by induction of apoptotic cell death. Inhibition of ROS generation by N-acetyl cysteine (NAC) significantly reversed the effect of GEM/NSC109555 in apoptosis and cytotoxicity. Furthermore, genetic knockdown of CHK2 by siRNA enhanced GEM-induced apoptotic cell death. These findings suggest that inhibition of CHK2 would be a beneficial therapeutic approach for pancreatic cancer therapy in clinical treatment.

[Correlation between severe ALS patient-caregiver couples' characteristics and caregivers' health related quality of life].

PURPOSE: The purpose of this cross-sectional study was to examine the relationship between characteristics of severe ALS patient-caregiver couples and health related quality of life (HRQoL) in family caregivers. METHODS: The participants in this study were 89 pairs of ALS patients using ventilators and a family caregiver. The characteristics of the ALS patients and caregivers, Korean-Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised, Zarit Burden Interview and SF-36 were measured in this study. The data were collected from August 2008 to April 2009. Descriptive statistics, Pearson correlation coefficients, and canonical correlation were used for data analysis. RESULTS: The physical component summary and mental component summary of the HRQoL score for family caregivers were 147.49±31.63 and 129.09±35.83, respectively. HRQoL for caregivers was related to characteristics of the ALS patient-caregiver couples, such as patient's gender, caregiver's age, gender, marital status, daily time spent in caregiving and burden with one significant canonical variable. The significant variate showed that the lower the age, the time spent in caregiving and the burden of caregivers, the higher the HRQoL of caregivers. CONCLUSION: The support systems for caregivers considering caregiver characteristics such as demographics and burden should be implemented to improve the HRQoL of caregivers.

[Effectiveness of public health center smoking cessation counseling program using the transtheoretical model].

PURPOSE: The purpose of this study was to identify the effectiveness of public health center smoking cessation counseling program using the transtheoretical model on the process of change, smoking temptation, decisional balance and stage change transition. METHODS: A nonequivalent control group non-synchronized design was used for this study. The study population was 115 adult smokers. The counseling program was administered to the experimental group and a smoking cessation program from the Korean Ministry of Health & Welfare was administered to the control group. Descriptive analysis, chi(2)-test, t-test, and ANCOVA were used with the SPSS 12.0 program to analyze the data. RESULTS: After treatment with this program, the experimental group showed significantly higher scores for process of change (t=4.148, p<.001), smoking temptation (t=-2.988, p=.003), and stage change transition (chi(2)=5.871, p=.031) compared to the control group. Experimental group members also showed significantly lower score for Pros of smoking (t=-3.151, p=.002). CONCLUSION: The findings indicate that this program could have positive effect on process of change, smoking temptation, decisional balance and stage transition for adult smokers. Based on these findings, the authors suggest additional counseling program focusing on smokers in specific stages.

The centrosomal localization of KM-HN-1 (MGC33607) depends on the leucine zipper motif and the C-terminal coiled-coil domain.

KM-HN-1 is a C-terminal coiled-coil domain containing protein previously referred to as image clone MGC33607. This protein has been previously identified as a cancer/testis antigen and reported as nuclear and chromatin localizing protein. We raised polyclonal antisera with the GST fusion protein and identified them as a 105 kDa protein. Motif analysis showed that this protein harbors the leucine zipper motif in internal 1/3 region and the coiled-coil domain in the C-terminal region. Using the full length and various deletion mutants, we determined the motif that governs the subcellular localization of KM-HN-1. Immunofluorescence staining of the endogenous KM-HN-1 and various kinds of GFP-tagged KM-HN-1 revealed that KM-HN-1 localizes to the centrosomes as well as nucleus. The centrosomal localization-determining region of this protein is C-terminal coiled-coil domain in which the leucine zipper motif and the nuclear export signal (NES) harbor.

[Discriminating power of socio-demographic and psychological variables on addictive use of cellular phones among middle school students].

PURPOSE: The purpose of this study was to examine the degrees of cellular phone usage among middle school students and to identify discriminating factors of addictive use of cellular phones among sociodemographic and psychological variables. METHODS: From 123 middle schools in Busan, potential participants were identified through stratified random sampling and 747 middle school students participated in the study. The data was collected from December 1, 2004 to December 30, 2004. Descriptive and discriminant analyses were used. RESULTS: Fifty seven percent of the participants were male and 89.7% used cellular phones at school. The participants were grouped into three groups depending on the levels of the cellular phone usage: addicted (n=117), dependent (n=418), non-addicted (n=212). Within the three groups, two functions were produced and only one function was significant, discriminating the addiction group from non-addiction group. Additional discriminant analysis with only two groups produced one function that classified 81.2% of the participants correctly into the two groups. Impulsiveness, anxiety, and stress were significant discriminating factors. CONCLUSION: Based on the findings of this study, developing intervention programs focusing on impulsiveness, anxiety and stress to reduce the possible addictive use of cellular phones is suggested.

The effectiveness of the error reporting promoting program on the nursing error incidence rate in Korean operating rooms.

PURPOSE: The purpose of this study was to develop and evaluate an error reporting promoting program(ERPP) to systematically reduce the incidence rate of nursing errors in operating room. METHODS: A non-equivalent control group non-synchronized design was used. Twenty-six operating room nurses who were in one university hospital in Busan participated in this study. They were stratified into four groups according to their operating room experience and were allocated to the experimental and control groups using a matching method. Mann-Whitney U Test was used to analyze the differences pre and post incidence rates of nursing errors between the two groups. RESULTS: The incidence rate of nursing errors decreased significantly in the experimental group compared to the pre-test score from 28.4% to 15.7%. The incidence rate by domains, it decreased significantly in the 3 domains-"compliance of aseptic technique", "management of document", "environmental management" in the experimental group while it decreased in the control group which was applied ordinary error-reporting method. CONCLUSION: Error-reporting system can make possible to hold the errors in common and to learn from them. ERPP was effective to reduce the errors of recognition-related nursing activities. For the wake of more effective error-prevention, we will be better to apply effort of risk management along the whole health care system with this program.

[Predictors of coronary heart disease risk in healthy men and women].

OBJECTIVES: The purpose of this study was to identify predictors of coronary heart disease risk factors in healthy men and women. METHOD: The subjects of this study were 346 people (173 men and women aged 20 years and over) who received health screenings. Data was collected from December 1, 2005 to February 28, 2006. The FANTASTIC Lifestyle Assessment Inventory except smoking and the Framingham risk score of subjects were investigated. Data was analyzed by descriptive analysis, t-test, ANOVA, pearson correlation coefficients and stepwise multiple regression using the SPSS 10.0 program. RESULTS: The mean score of the lifestyle of the women (64.24) was higher than that of the men (59.12). The mean score of the risk of coronary heart disease of the men (5.28%) was higher than that of the women (0.28%). The framingham risk for men was significantly related to lifestyle such as dietary habit, use of caffeine and drugs, anxiety and depression, job satisfaction, and closeness with family. The main predictors of framingham risk for men and women were 'use of caffeine and drugs', and 'menopause' which explained 16.5%, and 30.7% respectively. CONCLUSION: Since lifestyles can be changed with effort, coronary heart disease can be prevented while people are healthy.

[The effects of a folk play program on cognition, ADL, and problematic behavior in the elderly with dementia].

PURPOSE: This study was to develop and evaluate a folk play program as a nursing intervention for the elderly with dementia. METHOD: First, a folk play program was developed through a careful study of literature review and field-work. Second, a nonequivalent control group pre-post test was designed. The subjects of the study were the elderly with dementia staying in nursing homes; 15 were in an experimental group adopting a folk play program developed through this study, 18 in the control group on a gymnastics and walking program which is generally used. The 40 min. intervention was conducted 5 times a week for 4 weeks. RESULT: The folk play program improved the cognition(t=6.12, p<.001) and ADL(t=2.92, p=.014) and diminished the frequency of problematic behaviors significantly(t=-6.39, p<.001). There was a significant difference of cognition, ADL, and problematic behaviors between the control and the experimental group before and after the experiment(t=3.38, p=.002; t=2.05, p=.046; t=-7.74, p<.001). CONCLUSION: Compared with the gymnastics and walking program, the folk play program proved to be much more effective in the elderly with dementia in improving their cognition and ADL, as well as in diminishing their problematic behaviors. Therefore, a folk play program should be applied as an effective and practical Korean nursing intervention for the elderly with dementia.

[Evaluating the validity of the Pediatric Index of Mortality II in the intensive care units].

PURPOSE: This study was to evaluate the validity of the Pediatric Index of Mortality II(PIM II). METHOD: The first values on PIM II variables following ICU admission were collected from the patient's charts of 548 admissions retrospectively in three ICUs(medical, surgical, and neurosurgical) at P University Hospital and a cardiac ICU at D University Hospital in Busan from January 1, 2002 to December 31, 2003. Data was analyzed with the SPSSWIN 10.0 program for the descriptive statistics, correlation coefficient, standardized mortality ratio(SMR), validity index(sensitivity, specificity, positive predictive value, negative predictive value), and AUC of ROC curve. RESULT: The mortality rate was 10.9%(60 cases) and the predicted death rate was 9.5%. The correlation coefficient(r) between observed and expected death rates was .929(p<.01) and SMR was 1.15. Se, Sp, pPv, nPv, and the correct classification rate were .80, .96, .70, .98, and 94.0% respectively. In addition, areas under the curve(AUC) of the receiver operating characteristic(ROC) was 0.954(95% CI=0.919-0.989). According to demographic characteristics, mortality was underestimated in the medical group and overestimated in the surgical group. In addition, the AUCs of ROC curve were generally high in all subgroups. CONCLUSION: The PIM II showed a good, so it can be utilized for the subject hospital.

[The effects of abdominal meridian massage on menstrual cramps and dysmenorrhea in full-time employed women].

PURPOSE: This study was designed to examine the effects of abdominal meridian(Kyongrak) massage on menstrual cramps and dysmenorrhea. METHOD: Eighty-five women (of 110 screened) enrolled in this study and were employed full-time with more than 6.0 points (in 0-10.0 VAS scale) in menstrual cramps or more than 20 points on the dysmenorrhea scale (range 13-52). The forty-two participants in the experimental group received abdominal meridian massage for 5 minutes per day during 6 days from the fifth day before menstruation to the first day of menstruation and the forty-three participants in the control group didn't receive any treatment. Data were collected from June 1st to August 30th, 2003 and analyzed using descriptive statistics, chi2-test, and t-test. RESULT: Menstrual cramps and dysmenorrhea of the experimental group were significantly lower after abdominal meridian massage than those of the control group (p<.001). CONCLUSION: Abdominal meridian(Kyongrak) massage was very effective for relief of menstrual cramps and dysmenorrhea. Therefore, we suggest that abdominal Kyongrak massage can be a useful nursing intervention for women with menstrual cramps or dysmenorrhea.

[Breast cancer screening and repeat screening].

PURPOSE: This study was to investigate the characteristics and related factors of breast cancer screening and repeat screening, and to propose nursing interventions to increase the rate of breast cancer screening and repeat screening. METHOD: Study subjects was 236 women residing in the community, teachers and nurses who were older than 45 were recruited. Data was collected with self administered questionnaires from July 1st to August 31st, 2003 and analysed using SPSS/WIN 10.0 with X(2)test, t-test, and stepwise multiple logistic regression at a significant level of =.05. RESULT: The breast cancer screening rate was 57.2%, and repeat screening rate was 15.3%. With the multiple logistic regression analysis, factors associated with mammography screening were age and perceived barriers of action, and factors related to the repeat mammography screening were education level and other cancer screening experience. CONCLUSION: Based on the results, we recommend the development of an intervention program to decrease the perceived barrier of action, to regard mammography as an essential test in regular check-up, and to give active advertisement and education to the public to improve the rates of breast cancer screening and repeat screening.

Factors associated with the stage of change of smoking cessation behavior in adolescents.

PURPOSE: The purpose of this study was to identify the stage of change of smoking cessation behavior and investigate factors associated with the stage of smoking cessation behavior according to the transtheoretical model. METHODS: The participants, 297 smokers & quitters were selected by a stratified random sampling from 127 high school sophomore students in B city. Data were collected from April 6th to 16th, in 2002 using the structured self-report questionnaire. RESULTS: The subjects were distributed in each stage of change of smoking cessation behavior: there were 46 subjects (15.5%) in precontemplation, 73 subjects (24.6%) in contemplation, 67 subjects(22.3%) in preparation, 56 subjects (18.5%) in action, 55 subjects (18.5%) in maintenance. Compared to the precontemplation and contemplation, people in preparation tended to smoke daily more and smoked for a shorter time, and as precontemplation progressed to the maintenance, past 1 year smoking cessation frequency increased and friends smoking decreased. Smoking onset age was the earliest in preparation, and the latest in maintenance. Helping relationships and self relationships are used a lot in precontemplation and also in contemplation. In preparation, self liberation and helping relationships are used a lot, in action, self liberation and helping relationships, and in maintenance, self liberation and environmental reevaluation. At each stage, the score of negative affect situation was the highest, but the one of negative affect situation, positive social situation, habitual strength, weight control decreased as precontemplation progressed to the maintenance. While the score of social pros and coping pros decreased with increasing stage, the one of cons tended to increase. Through stepwise discriminant analysis, it was found that social pros, smoking onset age, delf-libration were the most influencing powers among factors associated with the stages of smoking cessation behavior. CONCLUSIONS: This study suggested that, in developing an effective smoking cessation intervention for adolescents, all the stage of a client's cessation had to be assessed prior to applying intervention programs. In addition, the results of this study will become a pillar of smoking cessation program planning and application.