OBJECTIVES: This study aimed at assessing the quality of dental services, as perceived by the disabled, and analyzing the factors identified to be of both high importance and low performance, as identified by IPA. METHODS: The data were collected from June 8 to November 2, 2016, after approval by the institutional review board. Questionnaires were distributed to 1466 disabled dental service consumers, of which 349 cases were included. The data were analyzed by frequency analysis, multi-regression analysis for implicit importance, and IPA matrix for marketing strategy. RESULTS: The performance results revealed that cost level, reduction of the fee, and waiting time for treatments were the sources of greatest dissatisfaction. The IPA matrix results categorized the next appointment, explanation of the fee, waiting time for treatment, professionalism of the staff, and convenient facilities as high-importance, low-performance factors. Meanwhile, the results of the IPA matrix for consumer segmentation, according to recently used dental institutions were different. The dental clinic users evaluated professionalism of the staff, convenience of the facility, explanation of the fee, and cost level as high-importance, low-performance attributes. The dental hospital users indicated that waiting time for treatment and next appointment were high-importance, low-performance attributes. Finally, the public health center users indicated that convenience of booking, waiting time for treatment, convenience of facilities, reduction of the fee, and next appointment as high-importance, low-performance attributes. CONCLUSIONS: To improve the quality of dental service, we need to understand the needs of the dental patients with disability. All attributes that were categorized as high-importance, low-performance must be improved first and should accordingly be used as strategic factors to increase satisfaction with oral medical institutions.
Dental Clinics ; Ethics Committees, Research ; Fees and Charges ; Humans ; Marketing ; Professionalism ; Public Health

Most terminally ill cancer patients experience various physical and psychological symptoms during their illness. In addition to pain, they commonly suffer from fatigue, anorexia-cachexia syndrome, nausea, vomiting and dyspnea. In this paper, I reviewed some of the common non-pain symptoms in terminally ill cancer patients, based on the National Comprehensive Cancer Network (NCCN) guidelines to better understand and treat cancer patients. Cancer-related fatigue (CRF) is a common symptom in terminally ill cancer patients. There are reversible causes of fatigue, which include anemia, sleep disturbance, malnutrition, pain, depression and anxiety, medical comorbidities, hyperthyroidism and hypogonadism. Energy conservation and education are recommended as central management for CRF. Corticosteroid and psychostimulants can be used as well. The anorexia and cachexia syndrome has reversible causes and should be managed. It includes stomatitis, constipation and uncontrolled severe symptoms such as pain or dyspnea, delirium, nausea/vomiting, depression and gastroparesis. To manage the syndrome, it is important to provide emotional support and inform the patient and family of the natural history of the disease. Megesteol acetate, dronabinol and corticosteroid can be helpful. Nausea and vomiting will occur by potentially reversible causes including drug consumption, uremia, infection, anxiety, constipation, gastric irritation and proximal gastrointestinal obstruction. Metoclopramide, haloperidol, olanzapine and ondansetron can be used to manage nausea and vomiting. Dyspnea is common even in terminally ill cancer patients without lung disease. Opioids are effective for symptomatic management of dyspnea. To improve the quality of life for terminally ill cancer patients, we should try to ameliorate these symptoms by paying more attention to patients and understanding of management principles.
Analgesics, Opioid ; Anemia ; Anorexia ; Anxiety ; Benzodiazepines ; Cachexia ; Comorbidity ; Constipation ; Delirium ; Depression ; Dyspnea ; Education ; Fatigue ; Gastroparesis ; Haloperidol ; Humans ; Hyperthyroidism ; Hypogonadism ; Lung Diseases ; Malnutrition ; Metoclopramide ; Natural History ; Nausea ; Ondansetron ; Palliative Care ; Quality of Life ; Stomatitis ; Terminal Care ; Terminally Ill* ; Tetrahydrocannabinol ; Uremia ; Vomiting

Sclerosing hemangioma of the lung is uncommon benign neoplasm of uncertain histogenesis, although their radiological appearance is relatively distinct and well-defined. Recently, we experienced 2 cases of sclerosing hemangiomas of the lungs in 61 and 39 years old women. The light microscopic findings of the tissues are similar to the features reported by Liebow and Hubbell(1956). The basic cellular response is thought to be type II pneumonocytes because of findings of multilamellar-like bodies within stromal cells with electron microscopy in case I in addition to other characteristics generally found in epithelial cells.
Female ; Humans ; Hemangioma

Chromosome 4q deletion syndrome is a rare disease caused by partial deletion of the long arm of chromosome 4. Phenotypic severity and expressivity vary among patients with chromosome 4q deletions, depending on the size and region of the deletion of the affected chromosome. Although there have been many reports of proximal 4q deletion cases, very few have been confirmed by high-resolution array comparative genomic hybridization (aCGH). In the current study, we presented a new case of 4q proximal deletion, with detailed genetic and clinical characteristics, and compared these characteristics to those of six previous cases with available aCGH data. According to our review, several genes known to be associated with specific phenotypes of 4q12q21.1 deletion cannot sufficiently explain the variable phenotypes observed among the cases. These phenotypes include mental retardation, microcephaly, ocular anomalies, dental anomaly, and piebaldism. Consequently, we recommend further detailed investigations into the genes associated with 4q12q21.1 deletion to assist in identifying genotype-phenotype associations more clearly.

OBJECTIVES: The aims of this study are 1) to determine if GAST is a better indicator in predicting ovarian response to COH compared with patient's age or basal FSH level and 2) to evaluate its role in detecting abnormal ovarian response. DESIGN : Prospective study in 118 patients undergoing IVF-ET using GnRH-a short protocol during May-September 1995. MATERIALS AND METHODS: After blood sampling for basal FSH and estradiol (E2) on cycle day two, 0.5 ml (0.525 mg) GnRH agonist (Suprefact, Hoechst) was injected subcutaneously. Serum E2 was measured 24 hours later. Initial E2 difference (deltaE2) was defined as the change in E2 on day 3 over the baseline day 2 value. Sixteen patients with ovarian cyst or single ovary or incorrect blood collection time were excluded from the analysis. The patients were divided into three groups by deltaE2; group A (n=30):deltaE2<40 pg/ml, group B (n=52): 40 pg/ml< or =deltaE2<100 pg/ml, group C (n=20): deltaE2< or =100 pg/ml. COH was done by GnRH agonist/HMG/hCG and IVF-EF was followed. Ratio of E2 on day of hCG injection over the number of ampules of gonadotropins used (E2hCGday/Amp) was regarded as ovarian responsiveness. Poor ovarian response and overstimulation were defined as E2 hCGday less than 600 pg/ml and greater than 5000 pg/ml, respectively. RESULTS: Mean age (+/-SEM) in group A, B and C were 33.7+/-0.8*, 31.5 +/-0.6 and 30.6+/-0.5*, respectively (*: p<0.05). Mean basal FSH level of group A (11.1+/-1.1 mIU/ml) was significantly higher than those of B (7.4+/- 0.2 mIU/ml) and C (6.8+/-0.4 mIU/ml) 0<0.001). Mean E2hCGday of group A was significantly lower than those of group B or C, i.e., 1402.1+/-187.7 pg/ml, 3153.2+/- 240.0 pg/ml, 4078.8+/-306.4 pg/ml respectively (p<0.0001). The number of ampules of gonadotropins used in group A was significantly greater than those in group B or C: 38.6+/-2.3, 24.2+/-1.1 and 18.5+/-1.0 (p<0.0001). The number of oocytes retrieved in group A was significantly smaller than those in group B or C: 6.4+/-1.1, 15.5+/-1.1 and 18.6+/-1.6, respectively (p<0.0001). By stepwise multiple regression, only deltaE2 showed a significant correlation (r=0.68, p<0.0001) with E2HCGday/Amp, while age or basal FSH level were not significant. Likewise, only deltaE2 correlated significantly with the number of oocytes retrieved (r=0.57, p<0.001). All four patients whose COH was canceled due to poor ovarian response belonged to group A only (Fisher's exact test, p<0.01). Whereas none of 30 patients in group A (0%) had overstimulation, 14 patients among 72 patients (19.4%) in group B and C had overstimulation (Fisher's exact test, p<0.01). CONCLUSIONS: These data suggest that initial E2 difference after GAST may be a better prognostic indicator of ovarian response to COH than age or basal FSH level. Since initial E2 difference demonstrates significant association with abnormal ovarian response such as poor ovarian response necessitating cycle cancellation or overstimulation, GAST may be helpful in monitoring and consultation of patients during COH in IVF-ET cycle.
Estradiol ; Female ; Gonadotropin-Releasing Hormone* ; Gonadotropins ; Humans ; Oocytes ; Ovarian Cysts ; Ovary ; Ovulation Induction* ; Prospective Studies

PURPOSE: Delivering bad news (DBN) to a patient or patient's family is one of the most difficult tasks for physicians. As a complicated task, DBN requires better than average communication skills. This study investigated trainee's attitude and awareness of DBN based on a self-assessment of their experiences and performance in practice. Survey subjects were also asked to assess their perception and the need for education in conducting DBN. METHODS: A survey was carried out on their experiences with DBN, how they currently deal such situations, how they perceive such situations and the need for education and training programs. A SPIKES protocol was used to assess how they currently deal with DBN. RESULTS: One hundred one residents and fellows being trained in a teaching hospital participated in the survey. Around 30% had bad experiences due to improperly delivered bad news to a patient. In terms of self-assessment of how to do DBN, over 80% of trainees assessed that they were doing DBN properly to patients, using a SPIKE protocol. As for how they perceived DBN, 90% of trainees felt more than the average level of stress when they do DBN. About 80% of trainees believed that education and training is much needed during their residency program for adequate skill development regarding DBN. CONCLUSION: We suggest that education and training on DBN may be needed for trainees during the residency program, so that they could avoid unnecessary conflict with patients and reduce stress from DBN.
Disclosure ; Education ; Hospitals, Teaching ; Humans ; Internship and Residency ; Self-Assessment

It is well accepted that kidney transplantation cannot be done if the recipient has antibodies showing a positive HLA cross-match to the donor. Recently, Schweitzer and his associates used a combination therapy with plasmapheresis, IV gamma globulin, and potent immunosuppression to induce HLA cross-match negative conversion in patients with a positive HLA cross-match to living donors and they reported good results after the trials. Therefore, we treated a patient with combination therapy who had persistent-positive HLA cross-match to multiple living donors. The patient was a 38-year-old female suffering from chronic renal failure and she showed persistent positive HLA cross-match to multiple living donors. Using a combination therapy with plasmapheresis, IV gamma globulin and immunosuppression, we have successfully achieved a HLA cross-match negative conversion in a patient and we did kidney transplantation without any sign of hyperacute or acute rejection. Although we present possibility of a HLA cross-match negative conversion by combination therapy, especially in a recipient with a low titer cross-match positive to a family donor, further long-term study with more patients is needed for evaluation of the efficacy of this trial.
Adult ; Antibodies ; Female ; gamma-Globulins ; Humans ; Immunosuppression ; Kidney Failure, Chronic ; Kidney Transplantation ; Living Donors ; Plasmapheresis* ; Tissue Donors

BACKGROUND: Many invasive and life-threatening infections are diagnosed by the culture of normally sterile body fluids. Because microorganisms are present in very low concentrations, and these infections are often caused by fastidious or slow-growing microorganisms, they may not be detected by conventional culture methods. The present study was designed to assess the performance of the BacT/Alert blood culture system in order to recover microorganism with standard aerobic and anaerobic bottles and FAN aerobic and anaerobic bottles versus conventional culture methods for culturing normally sterile body fluids other than blood. METHODS: Between February and April 2003, sterile body fluids, such as cerebrospinal fluids (CSF), pleural fluids, peritoneal fluids, continuous ambulatory peritoneal dialysate (CAPD), and other fluids submitted to the microbiology laboratory for culture were entered into the study. Only specimens with a minimum volume of 3.0 mL were included, and the specimens were divided equally among three arms of the study. All BacT/Alert bottles were monitored for up to 5 days. Conventional blood agar plate and thioglycollate broth were incubated for up to 3 days before being discarded as negative, while anaerobic cultures were maintained for a minimum of 5 days. Bacterial identification and antimicrobial susceptibility tests were performed using standard laboratory protocols. RESULTS: A total of 247 specimens (CSF 85, pleural fluids 68, peritoneal fluids 71, CAPD 17, others 6) were included in this study, with 45 isolates recovered from 43 specimens. The recovery rates for each method were standard bottles 65.1% (28/43), FAN bottles 79.1% (34/43), and conventional culture 48.9% (21/43). For CSF and peritoneal fluids, more isolates were recovered from the FAN bottles compared to the conventional culture or standard bottles. The FAN bottles recovered more coagulase negative staphylococci than those from the conventional culture or standard bottles. CONCLUSIONS: Even though the BacT/Alert system using FAN bottles improved the recovery rate for CSF and peritoneal fluids compared to either the standard bottles or conventional culture, coagulase negative staphylococci were also frequently recovered. Therefore, further evaluations are required to assess the clinical usefulness of culturing sterile body fluids using the Bact/Alert blood culture system.
Agar ; Arm ; Ascitic Fluid ; Body Fluids* ; Cerebrospinal Fluid ; Coagulase ; Peritoneal Dialysis, Continuous Ambulatory

Refractory anemia with excess blasts (RAEB), the most commom type of myelodysplastic syndrome (MDS), accounts for 40-60% of all patients newly diagnosed with MDS. Various clonal cyto-genetic abnormalities are found in 30 to 50% of the cases. But, trisomy 9 as a sole chromosomal aberration is not common, which was observed in our patient. We report a 65-year-old female with trisomy 9. She was diagnosed with RAEB-II four years ago, and she had no evidence of progression to acute leukemia without therapy.
Aged ; Anemia, Refractory* ; Chromosome Aberrations* ; Female ; Humans ; Leukemia ; Myelodysplastic Syndromes ; Trisomy*

BACKGROUND: Rheumatoid arthritis (RA) is the most common autoimmune rheumatic disease, but sensitive and specific test for its diagnosis is lack. This study evaluated the analytical performance and diagnostic role of a new automated ELISA anti-cyclic citrullinated peptide (anti-CCP) antibody test. METHODS: Anti-CCP antibody test was done with the enzyme-linked immunosorbent assay (ELISA) in serum samples from 49 RA patients and 104 non-RA patients, and 51 healthy subjects. Serum pools were used to determine its precision and linearity. The optimal cut-off values were determined by the receiver-operator characteristics (ROC) curve. The rheumatoid factor (RF) by turbidimetry was also assayed in every samle and the results were compared to anti-CCP for sensitivity and specificity. RESULTS: The total imprecision (CV%) was 4.8%, 7.6% for serum pools with low (mean concentration: 2.7 U/mL) and high (mean concentration :82.2 U/mL) concentration, respectively. Linearity data were acceptable (R2=0.9907). At each optimal cut-off value, the sensitivity of anti-CCP was higher than that of RF (81.6 % vs 69.4%), but statistical significance was not defined. Specificity of anti-CCP was higher than that of RF (95.5% vs 75.5%, p<0.001). A combination of anti-CCP and RF increased sensitivity and specificity to 87.7%, 98.0%, respectively. Nine of 15 (60.0%) sera from RF negative RA patients were positive for anti-CCP. CONCLUSIONS: Anti-CCP ELISA antibody test, we examined on a fully automated enzyme immunoassay, is easy to assay in routine laboratory, and showed good analytical performance. And anti-CCP antibody test also showed higher diagnostic specificity than RF. So, anti-CCP antibody may be useful serologic marker for diagnosis and monitoring of RA, if performed concomitantly with RF assay.
Antibodies* ; Arthritis, Rheumatoid ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoenzyme Techniques* ; Nephelometry and Turbidimetry ; Rheumatic Diseases ; Rheumatoid Factor ; Sensitivity and Specificity