Educational interventions for improving nursing shift handovers: A systematic review.

AIM: This study analyzed the components of educational interventions for handovers among nursing students and nurses. BACKGROUND: A handover is a communication process that occurs when patient care responsibilities and rights are transferred from one nurse to another. This process is important in nursing to ensure the continuity of nursing care and patient safety. DESIGN: A systematic literature review of Korean and international studies was conducted to identify the components of handover educational programs for nursing students and nurses and analyze their effects, thereby providing a basis for the further development of these programs. METHODS: Studies published in English or Korean no later than June 30, 2022, were found via an electronic database search using the MEDLINE, Embase, and CINAHL databases. Three reviewers independently evaluated all the studies. These studies focused on educational interventions for nursing students and nurses regarding covering shift-to-shift nursing handovers. After reviewing 1971 extracted articles, 18 satisfied the inclusion criteria. RESULTS: Nine articles involved nursing students and nine involved nurses. Four articles covered bedside handovers as educational topics. Educational methods included lectures and active practice. Active practice comprised demonstrations, role-play, and feedback. The main content areas of the educational programs were an introduction to handovers; training regarding how to extract important information for handovers; and strategies using informatic and thematic structures, such as mnemonics, and concept mapping. The patient cases for role-play were provided in forms of written scenarios, virtual electronic charts, videos, scenario-based simulated situations, and actual patient cases assigned in clinical practice. The effects of the educational interventions were evaluated regarding knowledge, performance, and self-efficacy. Performance and self-efficacy were significantly higher in a study in which the intervention group was provided additional individual feedback compared to the control group and in a study in which the intervention group received multiple additional practice opportunities. CONCLUSIONS: Handover education for nursing students and nurses should include individual feedback, demonstrations, and opportunities to practice to improve their performance and self-efficacy. Feedback methods should be further developed to increase the effectiveness of educational programs. Sample cases involving patients should be devised to increase these opportunities, and methods for improving educator efficiency should be identified.

Factors Affecting Diet-Related Quality of Life Among Hemodialysis Patients According to Age-group.

This study identified factors influencing diet-related quality of life (QoL) among hemodialysis patients by age. In a cross-sectional correlational study in South Korea, 175 participants from two age groups-20-59 years and 60 years and above-completed self-report questionnaires assessing demographic and health-related characteristics, eating status, subjective health status, disease-related factors, dietary knowledge, and xerostomia severity. Findings indicated that the predictors of diet-related QoL included subjective health status and regular eating status (20-59 years) and self-efficacy, attitude toward hydration behaviors, and exercise (60 years and above). In order to improve the diet-related quality of life of dialysis patients, young adults need to focus on their physical health and regular meals, and the elderly need a differentiation strategy that considers psychological factors such as self-efficacy and attitude toward pollination.

Mobile-Application-Based Interventions for Patients With Hypertension and Ischemic Heart Disease: A Systematic Review.

BACKGROUND: Hypertension and ischemic heart disease are major causes of adult mortality. Related interventions to manage these conditions are important to implement during long, symptom-free periods. The recent proliferation of smartphones has spawned numerous health interventions that rely on mobile applications. PURPOSE: This systematic review was designed to summarize and analyze research on interventions using mobile applications for patients with hypertension and ischemic heart disease. METHODS: We searched for related studies published from January 2006 to August 2017 on MEDLINE, EMBASE, CINAHL, and three Korean databases. Seventeen studies were identified and evaluated against eligibility criteria that included a focus on patients with hypertension or ischemic heart disease and a discussion of the detailed effects of a mobile-app-based intervention. All of the identified studies were evaluated qualitatively using a methodology checklist. RESULTS: Twelve of the 17 studies were deemed as of acceptable quality according to the Scottish Intercollegiate Guideline Network quality assessment. According to the National Institutes of Health quality assessment tool, one article was of fair quality and four articles were of poor quality. Monitoring, education, and reminders were identified as application interventions. The effects of the app interventions were analyzed according to physiological factors, cognitive and behavioral factors, and psychological factors. Of the seven studies that measured blood pressure in patients with hypertension, five studies reported that the app-based interventions reduced blood pressure. Two of three studies showed a significant decrease of body mass index in patients with ischemic heart disease after the app-based interventions compared to the control group. Five of seven studies reported a significant change in medication adherence. Several studies showed different outcomes according to the disease, but the limited number of eligible studies was insufficient to demonstrate a conclusive effect. CONCLUSIONS: To ensure the long-term effects of mobile-application-based interventions, healthcare professionals should consider the functions of mobile applications. Moreover, because the focus of these interventions may differ based on the nature of the disease, it is recommended that the composition of interventions be tailored to the specific disease.

Ultrasmall SnS Quantum Dots Anchored onto Nitrogen-Enriched Carbon Nanospheres as an Advanced Anode Material for Sodium-Ion Batteries.

Structural pulverization of metal chalcogenides such as Sn-based compounds is a serious issue for development of high-performance anode materials and results in serious capacity fading during continuous charge and discharge cycles. In this work, we synthesize ultrasmall SnS quantum dots (QDs) anchored onto nitrogen-enriched carbon (NC) nanospheres through facile hydrothermal and carbonization processes to prepare a progressive anode material for sodium-ion batteries. The optimized SnS QDs@NC electrode delivered an initial discharge capacity of 281 mAh g-1 at 100 mA g-1 and exhibited excellent cycling stability with a capacity retention of 75% after 500 cycles at a high current density of 1000 mA g-1. Ex situ XRD, XPS, FE-SEM, TEM measurements, and kinetics study were performed to unveil the sodium storage mechanism of the SnS QDs@NC electrode. A sodium-ion full cell assembled with an SnS QDs@NC anode and a Na3V2(PO4)3 cathode exhibited high capacity and good cycling stability. Such a superior electrochemical performance of SnS QDs@NC can be attributed to the synergistic effects of NC and SnS QDs where NC serves as a conducting matrix to support SnS QDs and helps avoid structural degradation. This work provides a promising strategy to resolve the pulverization issue of alloying and conversion-type anode materials.

Factors Associated With Blood Pressure Classification in Korean University Students: A Descriptive Survey.

BACKGROUND: The prevalence of hypertension in young adults has increased. Hypertension is known to be a leading contributor to many diseases. PURPOSE: The study aimed to identify factors influencing blood pressure (BP) classification in university students and to establish a basis for the prevention and management of hypertension in young adults. METHODS: Four hundred three university students in South Korea were analyzed to determine the factors that influence BP classification. Data were analyzed using the chi-square test, analysis of variance, and multinomial logistic regression. RESULTS: The reference group for the logistic regression analysis included students with normal BP. The odds of being male and of having an overweight or obese body mass index were significantly higher in the prehypertension group than in the normal BP group. The odds of regular (≥ 6 months) exercise habits, having subcutaneous and borderline visceral fat types, and social support were significantly lower in the prehypertension group than in the normal BP group. The odds of being male, being overweight or obese, and having more exercise barriers were significantly higher in the hypertension group than in the normal BP group. The odds of having a high or low economic status were higher and lower in the hypertension group, respectively. Finally, the odds of having subcutaneous or borderline visceral fat types and a vigorous physical activity level were significantly lower in the hypertension group than in the normal BP group. CONCLUSIONS: Interventions that address the factors related to BP in young adults are necessary to prevent the occurrence and progression of hypertension in young adults.

Factors influencing blood pressure classification for adults: Gender differences.

AIM: Hypertension is a common condition contributing to many diseases. Factors influencing blood pressure (BP) classification for adults have changed over time. This study aimed to identify factors influencing BP classification according to gender. METHODS: Data from the Sixth Korean National Health and Nutrition Examination Survey (2014) were used in this descriptive, cross-sectional study. Participants were 1555 adults (589 men, 966 women). Measures included demographic, health-related, and lifestyle factors. RESULTS: Compared with the male normal BP group, in the male prehypertension group, body mass index, problem drinking, and reduced sleep duration were higher; and in the male hypertension group, age, poor subjective health status, body mass index, diabetes, problem drinking, smoking, and sodium intake were higher. Compared with the female normal BP group, age, and body mass index were higher in the female prehypertension group; and age, poor subjective health status, body mass index, menopause, and diabetes were higher in the female hypertension group. CONCLUSION: Hypertension and prehypertension prevention interventions for adults should be distinguished according to gender.

Systematic Review of Behavioral Therapy to Improve Swallowing Functions of Patients With Parkinson's Disease.

Decreased swallowing function is a common and main cause of malnutrition and aspiration pneumonia in patients with Parkinson's disease. The aims of this systematic review were to summarize and qualitatively analyze the studies that have been published on behavioral therapies for improving swallowing functions in patients with Parkinson's disease. Studies published from January 2000 to December 2015 were identified via electronic database searches using Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and 8 Korean databases. Two reviewers independently evaluated the studies using inclusion criteria. Nine studies were included, of which 6 evaluated rehabilitation technique studies and 3 evaluated compensatory strategies. The 9 studies were evaluated qualitatively using a methodology checklist of the Scottish Intercollegiate Guideline Network, according to which all of the studies had acceptable quality. The available data on the effects of rehabilitation techniques and compensatory strategies remain insufficient. Further randomized controlled studies should be done to investigate the effect of behavioral therapy on improving swallowing functions in patients with Parkinson's disease.

Effects of a Physical Activity and Sedentary Behavior Program on Activity Levels, Stress, Body Size, and Sleep in Sedentary Korean College Students.

This study examined the effects of a physical activity and sedentary behavior program on physical activity, sedentary behavior, stress, body size, and sleep in 63 Korean college students. This study used a quasiexperimental approach with a nonequivalent control group pretest-posttest design. The results showed that the program increased physical activity and step counts and reduced sedentary behavior, waist circumference, and stress levels.

Sex differences in social cognitive factors and physical activity in Korean college students.

[Purpose] This study examined sex differences in physical activity and social cognitive theory factors in Korean college students. [Subjects and Methods] A cross-sectional survey of 688 college students (285 men and 403 women) in Korea was conducted using a self-reported questionnaire. [Results] There was a significant difference in the level of physical activity between male and female students. The significant predictors of physical activity for male students were physical activity goals, physical activity self-efficacy, and sitting time. Meanwhile, those for female students were perceived weight, physical activity goal, physical activity outcome expectations, and sitting time. [Conclusion] Sex differences should be considered when developing interventions to increase physical activity.

Factors influencing BMI classifications of Korean adults.

[Purpose] This study aimed to identify factors influencing the BMI classifications of 3,583 Korean adults using data from the fifth Korean National Health and Nutrition Examination Survey. [Subjects and Methods] Measures included lifestyle factors, physiologic factors, perceived health state, stress, subjective body recognition, health-related quality of life, and weight control behavior. [Results] Body perception scores were lower with underweight and higher with overweight and obesity than with a healthy weight. There was a lower proportion of underweight men and a higher proportion of overweight or obese men than women. Instances of Alcohol Use Identification Scores (AUDIT) ≥ 9 were proportionately lower with underweight and more with overweight or obesity relative to an AUDIT score < 9 with healthy weight. Hemoglobin A1c and systolic blood pressure were higher with obesity than with healthy weight. The total cholesterol level was greater with overweight and obesity than with healthy weight. [Conclusion] These results suggest that obesity intervention for adults should be based on age and sex and should include drinking habits and physical activity.

Factors influencing the adaptation to skilled nursing facilities among older Korean adults.

This study was conducted to identify the factors that influence the level of adaptation of older Korean adults to skilled nursing facilities. The subjects were 500 adults aged 65 or older who were living in six different skilled nursing facilities in Seoul and Gyeong-gi-do, South Korea. The measures were a demographic form, Health Self-Rating Scale, Activities of Daily Living Scale, Self-Efficacy Instrument, Korean Simple Depression Scale, Quality of the Facility Scale and Facility Adaptation Scale. The analyses showed that the prediction model was significant (F = 128.624, P < 0.001). The value of the adjusted R(2) was 0.435, which corresponds to the explanatory power of 43.5%. The factor that was found to have the greatest influence on the adaptation of older Korean adults to skilled nursing facilities was activities of daily living (ß = -0.564), followed by self-efficacy (ß = 0.321), quality of the facility (ß = 0.164), depression (ß = 0.133), decision to enter a skilled nursing facility (ß = 0.122), perceived health status (ß = 0.064) and age (ß = -0.010). This cross-sectional study provides preliminary evidence that the level of adaptation of older Korean adults to skilled nursing facilities is related to their activities of daily living, self-efficacy, depression, decision to enter a skilled nursing facility, perceived health status and age, and to the quality of the facility.

NSAID is inversely associated with asymptomatic gastric ulcer: local health examination data from the Korean National Health Insurance Corporation.

BACKGROUND. Silent peptic ulcer has been considered to be associated with nonsteroidal anti-inflammatory drug (NSAID). The recent studies have reported no relationship between them. AIM. We attempted to investigate an association between asymptomatic peptic ulcer and NSAID in Korean adults. METHODS. The subjects were enrolled from participants visiting Myongji Hospital for health examination program of the Korean National Health Insurance Corporation. The questionnaires were designed to investigate individual medical information and gastroduodenal symptoms. RESULTS. From May 2005 to March 2009, 5459 participants were enrolled and 299 participants were excluded. Of 5160 participants, 3144 (60.9%) participants were asymptomatic and 424 (8.2%) participants had peptic ulcer. Among 3144 asymptomatic participants, NSAID-taking participants had the odds ratio of 1.4 [95% confidence interval (CI): 0.7-2.6, p = 0.339] for the risk of peptic ulcer. Among 424 peptic ulcer patients, 247 (58.3%) were asymptomatic. They had lower prevalence of NSAID use (4.9% vs. 14.7%). The asymptomatic gastric ulcer patients had smaller size and more frequent healing stage than the symptomatic gastric ulcer patients. In multivariable analysis of 424 peptic ulcer patients, NSAID patients had the odds ratio of 0.249 (95%CI: 0.115-0.536, p < 0.05) for asymptomatic peptic ulcer. In subgroup analysis of 284 gastric ulcer patients, NSAID-taking patients had the odds ratio of 0.263 (95% CI: 0.105-0.657, p = 0.004) for asymptomatic peptic ulcer. CONCLUSION. NSAID has an inverse association with asymptomatic patients with gastric peptic ulcer, but has no association with gastroduodenal symptoms in duodenal ulcer patients. These suggest that NSAID may be associated with gastroduodenal symptoms rather than masking symptoms, at least in gastric ulcer patients.

Is esophagogastroduodenoscopy necessary in patients with positive fecal occult blood tests and negative colonoscopy?

BACKGROUND: False positives of fecal occult blood tests (FOBT) regarding colorectal cancer detection are common. The aim was to investigate the upper gastrointestinal (GI) condition confirmed by endoscopy in positive FOBT patients without advanced colorectal neoplasia, hemorrhoid, or colitis. METHODS: The authors reviewed the collective data of 340 positive FOBT patients who underwent both esophagogastroduodenoscopy (EGD) and colonoscopy from January 2005 to October 2011. Demographic data, effects of medications, including antiplatelet agents, nonsteroidal anti-inflammatory drugs, or warfarin on the results of FOBT, presence or absence of GI mucosal lesions confirmed by EGD and colonoscopy, and FOBT titer in 552 positive FOBT patients were analyzed. RESULTS: On colonoscopy, colorectal cancer was detected in 35 patients (10.3%), advanced adenoma in 22 patients (6.4%). "Negative colonoscopy" included no significant lesions and non-advanced adenomas. In 243 patients with "negative colonoscopy", EGD findings included 3 (1.2%) gastric cancers and 39 (16%) peptic ulcer diseases. Gastric cancers were all found in patients who had no experience of EGD within 2 years; however, the incidence of peptic ulcer disease was not different in patients with or without previous EGD within 2 years. Two or more antiplatelet agents increased false positive rates of FOBT. CONCLUSIONS: Upper GI evaluation is mandatory in patients with positive FOBTs and negative colonoscopy especially in patients without experience of EGD within 2 years.

Which should go first during same-day upper and lower gastrointestinal endoscopy? A randomized prospective study focusing on colonoscopy performance.

BACKGROUND: Same-day bidirectional endoscopy is commonly performed in clinical practice. However, the optimal sequence of procedures for same-day bidirectional endoscopy has not been established. The purpose of this study was to compare colonoscopy performance and quality between patients who underwent colonoscopy before or after esophagogastroduodenoscopy (EGD). METHODS: A total of 1,103 patients were prospectively randomized into either the EGD-colonoscopy or colonoscopy-EGD sequence groups. Three patients who had incomplete cecal intubation due to structural obstruction were excluded from the analysis. During colonoscopy, colonoscopic parameters including difficult cecal intubation (cecal intubation failure and prolonged insertion), insertion time, and adenoma detection rate were measured. Out of 1,100 patients, 524 patients without sedation completed a questionnaire designed to assess subjective discomfort experienced. RESULTS: The colonoscopy completion rate was 99.5 %, and the rate of difficult cecal intubation was 14.5 %. The time from insertion to reaching the cecum (minutes:seconds, 06:32 ± 04:26 vs. 06:40 ± 04:09, p = 0.649), difficult cecal intubation ratio (76 of 550 vs. 83 of 550, p = 0.593), and colonoscopic adenoma detection rate (29.8 vs. 25.5 %, p = 0.106) did not differ between the groups. On multivariate analysis, difficulty with cecal intubation increased specifically in women, in patients aged 55 years and over, in patients with poor bowel preparation, and in patients who had undergone previous abdominal surgery. Subjective discomfort after EGD was higher in the colonoscopy-EGD sequence group. CONCLUSIONS: The procedural sequence did not affect colonoscopy performance and quality in same-day bidirectional endoscopy, and factors such as old age, female gender, poor bowel preparation, and previous abdominal surgery were confirmed to adversely affect colonoscopy. In addition, the EGD-colonoscopy sequence induced less subjective discomfort during EGD.

[Effects of a home-based exercise program for patients with stomach cancer receiving oral chemotherapy after surgery].

PURPOSE: The purpose of this study was to identify the effects of a home based exercise program for patients with stomach cancer who were undergoing oral chemotherapy. METHODS: The home-based exercise program was developed from the study findings of Winningham (1990) and data from the Korea Athletic Promotion Association (2007). The home-based exercise program consisted of 8 weeks of individual exercise education and exercise adherence strategy. Participants were 24 patients with stomach cancer who were undergoing oral chemotherapy following surgery in 2007 or 2008 at a university hospital in Seoul. Patients were randomly assigned to either the experimental group (11) or control group (13). The effects of the home-based exercise program were measured by level of cancer related fatigue, NK cell ratio, anxiety, and quality of life. Data were analyzed using SPSS/WIN 13.0 version. RESULTS: The degree of cancer related fatigue and anxiety in the experimental group decreased compared to the control group. The NK cell ratio and the degree of quality of life of experimental group increased while that of the control group decreased. CONCLUSION: This study result indicate the importance of exercise and provide empirical evidence for continuation of safe exercise for patients with cancer during their chemotherapy.

Factors associated with the overuse or underuse of health care services among medical aid beneficiaries in Korea.

PURPOSE: To compare and contrast demographic characteristics and health care service utilization between overusers and underusers of health care services and to identify factors associated with the overuse or underuse of health care services among the medical aid beneficiaries in Korea. METHODS: Secondary data analysis was performed using health care costs and medical aid case management progress data. Data on demographic characteristics, health-related quality of life (HRQoL), and inappropriate health care service user category (overuse or underuse) were provided by the Medical-Aid Case Management Center of Korea, and heath care service reimbursement data were provided by the Korea National Health Insurance Corporation (NHIC). Data on 22,697 beneficiaries were used for analysis, and logistic regression analysis was conducted to examine factors that are associated with overuse and underuse of health care services. RESULTS: The study results revealed that older individuals, women, unemployed individuals, type 1 medical aid beneficiaries, and those with higher education and disabilities were more likely to belong to the overuse group, but urban residents, compared to metropolitan residents, and those with higher HRQoL were more likely to belong to the underuse group (p < .05). CONCLUSIONS: Understanding factors associated with the overuse or underuse of health care services may help to provide tailored case management services to improve the HRQoL of the beneficiaries and optimize their use of health care services. CLINICAL RELEVANCE: Promoting appropriate use of health care services may enhance clients' quality of life and preserve resources for other essential services for medical aid beneficiaries.

[Factors influencing sleep of elderly women].

PURPOSE: The study was done to identify factors influencing the sleep of elderly women. METHODS: Data were collected by questionnaires from 203 elderly women in Seoul and Gyeong-gi province. Measures were physical health state, family support, life satisfaction, sleep, depression, and quality of life. Data were analyzed using Pearson correlation coefficients, t-test, ANOVA, and stepwise multiple regression with SPSS/WIN 13.0 version. RESULTS: The mean score for sleep for elderly women was 39.04. Sleep for elderly women according to religion, education level, spouses, and monthly income showed significant differences. Sleep for elderly women showed significantly positive correlations to physical health state, family support, life satisfaction, and quality of life. The significant factors influencing sleep of elderly women were physical health state, family support, depression, and quality of life, which explained about 70.4% of the variance. The strongest factors influencing the sleep was physical health state. CONCLUSION: The results suggest that in developing nursing interventions and practice for sleep pattern of elderly women spouses and family support should be considered.

[Influencing factors for fatigue in cancer patients].

PURPOSE: The purpose of this study was to identify degrees of fatigue and influencing factors for fatigue in cancer patients. METHOD: Data was collected by questionnaires from 115 cancer patients at 3 hospitals in Seoul. The research instruments utilized in this study were fatigue, physical symptoms, depression, family support, and health promoting behaviors. Data was analyzed using the pearson correlation, t-test, ANOVA, and stepwise multiple regression with SPSS/WIN 12.0. RESULT: The mean score of fatigue for cancer patients was 12.90(range: 6-36). Fatigue for cancer patients according to age group and weight change showed a significant difference. Fatigue for cancer patients showed a significantly positive correlation to physical symptoms and depression. There was a negative correlation between family support and health promoting behaviors. The significant factors influencing fatigue for cancer patients were physical symptoms, health promoting behaviors, depression, and age group, which explained about 45.9%. CONCLUSION: The results suggest that symptoms and depression management, nursing interventions and practices for providing health promoting behaviors according to age are needed to manage the fatigue in cancer patients.

Assessment of lymph node metastases using 18F-FDG PET in patients with advanced gastric cancer.

PURPOSE: The aim of this study was to assess the diagnostic accuracy of (18)F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) with respect to lymph node (LN) metastasis in patients with advanced gastric cancer, and to ascertain the factors that affect this accuracy. METHODS: Seventy-three patients with advanced gastric cancer, verified in all cases by endoscopic biopsy, were enrolled in this prospective study. We conducted FDG PET and other routine preoperative studies, including abdominal computed tomography (CT). Patients underwent either curative-intent gastrectomy and lymphadenectomy (n = 67) or exploratory laparotomy. The Japanese system for the classification of gastric cancer was used for LN assessment. RESULTS: FDG PET was able to detect primary lesions in 70 of the 73 cases. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value of FDG PET for LN metastasis were 40%, 95%, 91% and 56%, respectively. Signet-ring cell carcinoma was associated with the lowest sensitivity (15%), whereas other cell types could be detected with moderate sensitivity (30-71%) and high specificity (93-100%). According to multiple logistic regression, the standardised uptake value for primary tumours was the only independent variable to be significantly related to sensitivity for LN metastasis (p = 0.02, odds ratio = 1.14). CT was superior to PET in terms of sensitivity (p < 0.0001), and PET was superior to CT in terms of specificity (p < 0.0001) and PPV (p = 0.05). CONCLUSION: FDG PET exhibits good specificity for LN staging of gastric cancer, and FDG uptake in the primary tumour is significantly related to the accuracy of FDG PET. Despite some clear limitations, FDG PET proved useful in the LN staging of FDG-avid gastric cancer.

Weekly docetaxel in combination with capecitabine in patients with metastatic gastric cancer.

Docetaxel (T) and capecitabine (X) are active agents against gastric cancer with synergistic antitumor effects. We conducted the current phase II study to assess the response rate and toxicity of combination TX regimen in patients with metastatic gastric cancer. Eligible patients were treated with docetaxel (36 mg/m2 intravenously) on days 1 and 8 and capecitabine (1000 mg/m2 orally twice a day) on days 1-14 of a 3-week schedule until progression occurred. From December 2001 to May 2003, 55 patients with median age of 54 years (range, 22-73 years) were enrolled; 47 patients had measurable lesions. A total of 358 courses of treatment were given, with a median of 5 (range, 1-22+) per patient. Objective responses were documented in 19 of 47 patients with measurable lesions (response rate, 40.4%; 95% confidence interval [CI], 25.9-54.9), with the median response duration of 5.6 months (range, 2.1-13.6+). At a median follow up of 15.9 months for all of 55 study patients, the median time to progression and survival were 4.5 months (95% CI, 3.4-5.6) and 12.0 months (95% CI, 7.5-16.6), respectively. Hematologic toxicities were mild to moderate, and the observed grade 3 nonhematologic toxicities, the most frequent of which was stomatitis, were generally manageable. Four patients experienced pneumonitis, but all of them responded to steroid treatment. The TX regimen was relatively well tolerated and effective against metastatic gastric cancer, with the added advantage of being an outpatient regimen.