BACKGROUND: Untreated malignant gastrointestinal obstruction is rapidly fatal and causes various symptoms and malnutrition, and so decreases the quality of life and shortens the survival. We reviewed clinical characteristics and analyzed prognostic factors in terminal cancer patients with malignant gastrointestinal obstruction. METHODS: We retrospectively reviewed the medical records of 63 patients with malignant gastrointestinal obstruction who had been confirmed by endoscopy or colonoscopy, upper gastrointestinal series or barium study and proper radiologic study at Sam Anyang hospital from May in 2002 to December in 2004. We excluded patients with palliative tumor resection. We analyzed prognostic factors for overall survival and symptom-free survival. RESULTS: There were 30 males (48%) and 33 females (52%), and median age of 63 patients was 64 years. The cause of malignant gastrointestinal obstruction was colorectal (26 patients, 41%), stomach (19, 30%), pancreas (4, 6%) and others (14, 23%). Twenty one patients (33%) had Eastern Cooperative Oncology Group (ECOG) performance status of 2 score and 42 patients (67%) 3 or 4 score. Forty two patients (67%) have been performed palliative procedures and 21 patients (33%) have not. Median survival of patients with palliative procedure was significantly higher than that of patients who have not been performed palliative procedures (144 days v 45 days, p=0.0001). By mutivariate analysis, palliative procedures and performance status were independent prognostic factors. However, age, gender, primary cancer, site of obstruction, and previous chemotherapy were not independent prognostic factors. Performance status was only independent prognostic factor that improves symptom free survival in patients with palliative procedures (p=0.014) and median symptom free survival was 90 days. There was no mortality on palliative procedures. CONCLUSIONS: We confirmed that palliative procedures and performance status are significant independent prognostic factors in terminal cancer patients with malignant gastrointestinal obstruction.
Barium ; Colonoscopy ; Drug Therapy ; Endoscopy ; Female ; Gyeonggi-do ; Humans ; Male ; Malnutrition ; Medical Records ; Mortality ; Pancreas ; Prognosis ; Quality of Life ; Retrospective Studies ; Stomach

OBJECTIVES: Remote medical services have been expanding globally, and this is expansion is steadily increasing. It has had many positive effects, including medical access convenience, timeliness of service, and cost reduction. The speed of research and development in remote medical technology has been gradually accelerating. Therefore, it is expected to expand to enable various high-tech information and communications technology (ICT)-based remote medical services. However, the current state lacks an appropriate security framework that can resolve security issues centered on the Internet of things (IoT) environment that will be utilized significantly in telemedicine. METHODS: This study developed a medical service-oriented frame work for secure remote medical services, possessing flexibility regarding new service and security elements through its service-oriented structure. First, the common architecture of remote medical services is defined. Next medical-oriented secu rity threats and requirements within the IoT environment are identified. Finally, we propose a "service-oriented security frame work for remote medical services" based on previous work and requirements for secure remote medical services in the IoT. RESULTS: The proposed framework is a secure framework based on service-oriented cases in the medical environment. A com parative analysis focusing on the security elements (confidentiality, integrity, availability, privacy) was conducted, and the analysis results demonstrate the security of the proposed framework for remote medical services with IoT. CONCLUSIONS: The proposed framework is service-oriented structure. It can support dynamic security elements in accordance with demands related to new remote medical services which will be diversely generated in the IoT environment. We anticipate that it will enable secure services to be provided that can guarantee confidentiality, integrity, and availability for all, including patients, non-patients, and medical staff.
Computer Security ; Confidentiality ; Humans ; Internet* ; Medical Staff ; Pliability ; Telemedicine

OBJECTIVES: New methods for obtaining appropriate information for users have been attempted with the development of information technology and the Internet. Among such methods, the demand for systems and services that can improve patient satisfaction has increased in hospital care environments. METHODS: In this paper, we proposed the Hospital Exam Reservation System (HERS), which uses the data mining method. First, we focused on carrying clinical exam data and finding the optimal schedule for generating rules using the multi-examination pattern-mining algorithm. Then, HERS was applied by a rule master and recommending system with an exam log. Finally, HERS was designed as a user-friendly interface. RESULTS: HERS has been applied at the National Cancer Center in Korea since June 2014. As the number of scheduled exams increased, the time required to schedule more than a single condition decreased (from 398.67% to 168.67% and from 448.49% to 188.49%; p < 0.0001). As the number of tests increased, the difference between HERS and non-HERS increased (from 0.18 days to 0.81 days). CONCLUSIONS: It was possible to expand the efficiency of HERS studies using mining technology in not only exam reservations, but also the medical environment. The proposed system based on doctor prescription removes exams that were not executed in order to improve recommendation accuracy. In addition, we expect HERS to become an effective system in various medical environments.
Appointments and Schedules ; Data Mining* ; Diagnosis ; Electronic Health Records ; Hospital Information Systems ; Internet ; Korea ; Mining ; Patient Satisfaction ; Prescriptions ; Systems Integration

BACKGROUND: Documentation is very important; a considerable number of documents exist for use in accreditation inspection. However, most laboratories do not effectively manage the processes of documentation, organization, and storage. The purpose of this study was to facilitate the establishment of a strategically effective and sustainably standardized document management system. METHODS: A document code formatting system was modified by comparing the document list data received from 3 major university hospitals. In addition, a questionnaire regarding document code standardization was created and sent to 268 institutes to establish document classifications and generate a standard coding scheme. A computerized document management system was developed. RESULTS: Only 32% (8 out of 25 institutes) answered that they were able to identify all of the document types and their numbers. In total, 76% of institutes (19 out of 25) answered that a systematic document management system was necessary. Disorganized document files were systemized by classifying them into 8 major groups according to their characteristics: patient test records (T), test quality control (Q), manuals (M), equipment and environment management (E), statistics (S), division administration (A), department administration (R), and others (X). CONCLUSIONS: Our documentation system may serve as a basis for the standardization of documents and the creation of a document management system for all hospital laboratories.
Documentation/*standards ; Hospitals, University ; Laboratories, Hospital/*standards ; Questionnaires ; Tertiary Healthcare ; User-Computer Interface

We sequenced 1,841 BAC clones by terminal sequencing, and 1,830 of these clones were characterized with regard to their human chromosomal location and gene content using Korean BAC library constructed at the Korean Science (KCGS). Sequence analyses of the 1,830 BAC clones was performed for chromosomal assignment: 1,144 clones were assigned to a single chromosome, 190 clones apparently assigned to more than one chromosome, and 496 clones to no chromosome. Evaluating gene content of the 1,144 BAC clones, we found that 706 clones represented 1,069 genes of which 415 genes existed in the BAC clones covering the full sequence of the gene, 180 genes covering a 50%~99%, and 474 genes covering less than 50% of the gene coverage. The estimated covering size of the KBAC clones was 73,379 kilobases (kb), in total corresponding to 2.3% of haploid human genome sequence. The identified BAC clones will be a public genomic resource for mapped clones for diagnostic and functional studies by Korean scientists and investigators worldwide.
Clone Cells* ; Genome ; Genome, Human ; Haploidy ; Humans ; Research Personnel ; Sequence Analysis

BACKGROUND/AIMS: The predictive role of contrast-enhanced ultrasonography (CEUS) before performing transarterial chemoembolization (TACE) has not been determined. We assessed the possible predictive factors of CEUS for the response to TACE. METHODS: Seventeen patients with 18 hepatocellular carcinoma (HCC) underwent TACE. All of the tumors were studied with CEUS before TACE using a second-generation ultrasound contrast agent (SonoVue(R), Bracco, Milan, Italy). The tumor response to TACE was classified with a score between 1 and 4 according to the remaining enhancing-tumor percentage based on modified response evaluation criteria in solid tumors (mRECIST): 1, enhancing tumor <25%; 2, 25%< or =enhancing tumor<50%; 3, 50%< or =enhancing tumor<75%; and 4, enhancing tumor> or =75%). A score of 1 was defined as a "good response" to TACE. The predictive factors for the response to TACE were evaluated during CEUS based on the maximum tumor diameter, initial arterial enhancing time, arterial enhancing duration, intensity of arterial enhancement, presence of a hypoenhanced pattern, and the feeding artery to the tumor. RESULTS: The median tumor size was 3.1 cm. The distribution of tumor response scores after TACE in all tumors was as follows: 1, n=11; 2, n=4; 3, n=2; and 4, n=1. Fifteen tumors showed feeding arteries. The presence of a feeding artery and the tumor size (< or =5 cm) were the predictive factors for a good response (P=0.043 and P=0.047, respectively). CONCLUSIONS: The presence of a feeding artery and a tumor size of less than 5 cm were the predictive factors for a good response of HCC to TACE on CEUS.
Adult ; Aged ; Aged, 80 and over ; Antibiotics, Antineoplastic/administration & dosage ; Carcinoma, Hepatocellular/pathology/therapy/*ultrasonography ; Chemoembolization, Therapeutic ; Contrast Media/*chemistry ; Doxorubicin/administration & dosage ; Female ; Humans ; Liver Neoplasms/pathology/therapy/*ultrasonography ; Male ; Microspheres ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome