Background/Aims: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL). Methods: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up. Results: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis. Conclusions Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.

BACKGROUND: This study aimed to analyze correlations between depression, cognitive function, oral health state, ability to perform activities of daily living, oral dryness symptoms, and oral health-related quality of life, and determine factors influencing the latter.METHODS: This was a cross-sectional study based on questionnaires completed by 260 participants with suspected dementia, residing in South Korea. Psychiatrists, psychiatric nurses, and dental hygienists visited clinics in the participating regions for examination and questionnaire administration. General characteristics, the geriatric depression scale, ability to perform activities of daily living, cognitive function, oral health state, and oral health-related quality of life were analyzed. Independent t-tests, one-way analysis of variance (ANOVA), correlation analysis and multiple regression analysis were conducted, identifying factors affecting oral health-related quality of life. Data analysis was performed using SPSS ver. 20.0 (IBM Corp., USA), and the significance was set at p<0.05.RESULTS: Approximately 65.0% of participants were female, 63.5% were in their 70s, and 90.0% had health insurance. About 21.5%, 42.0%, and 36.5% were normal, slightly impaired, and had dementia, respectively. High cognitive impairment was associated with poor oral health. Sex, education levels, marital status, and living arrangements influenced oral health-related quality of life. According to the regression analysis, geriatric depression and oral dryness affected the Geriatric Oral Health Assessment Index scores.CONCLUSION: In conclusion, oral dryness and depression levels among elders influenced oral health-related quality of life. The results showed that to enhance elders' oral health-related quality of life, it is essential to not only improve their oral health state, but also relieve oral health problems, especially oral dryness, and take into consideration their psychological aspects.
Activities of Daily Living ; Aged ; Cognition ; Cognition Disorders ; Cross-Sectional Studies ; Dementia ; Dental Hygienists ; Depression ; Education ; Female ; Humans ; Insurance, Health ; Korea ; Marital Status ; Oral Health ; Psychiatry ; Quality of Life ; Residence Characteristics ; Statistics as Topic

PURPOSE: The treatment strategy for elderly patients older than 80 years with diffuse large B-cell lymphoma (DLBCL) has not been established because of poor treatment tolerability and lack of data. MATERIALS AND METHODS: This multicenter retrospective study was conducted to investigate clinical characteristics, treatment patterns and outcomes of patients older than 80 years who were diagnosed with DLBCL at 19 institutions in Korea between 2005 and 2016. RESULTS: A total of 194 patients were identified (median age, 83.3 years). Of these, 114 patients had an age-adjusted International Prognostic Index (aaIPI) score of 2-3 and 48 had a Charlson index score of 4 or more. R-CHOP was given in 124 cases, R-CVP in 13 cases, other chemotherapy in 17 cases, radiation alone in nine cases, and surgery alone in two cases. Twenty-nine patients did not undergo any treatment. The median number of chemotherapy cycles was three. Only 37 patients completed the planned treatment cycles. The overall response rate from 105 evaluable patients was 90.5% (complete response, 41.9%). Twentynine patients died due to treatment-related toxicities (TRT). Thirteen patients died due to TRT after the first cycle. Median overall survival was 14.0 months. The main causes of death were disease progression (30.8%) and TRT (27.1%). In multivariate analysis, overall survival was affected by aaIPI, hypoalbuminemia, elevated creatinine, and treatment. CONCLUSION: Age itself should not be a contraindication to treatment. However, since elderly patients show higher rates of TRT due to infection, careful monitoring and dose modification of chemotherapeutic agents is needed.
Aged* ; B-Lymphocytes* ; Cause of Death ; Creatinine ; Disease Progression ; Drug Therapy ; Humans ; Hypoalbuminemia ; Korea ; Lymphoma, B-Cell* ; Multivariate Analysis ; Retrospective Studies*

BACKGROUND: Volume overload results in higher mortality rates in patients on continuous ambulatory peritoneal dialysis (CAPD). The ratio of bioimpedance (RBI) might be a helpful parameter in adjusting dry body weight in CAPD patients. This study examined whether it is possible to distinguish between non-hypervolemic status and hypervolemic status in CAPD patients by using only RBI. METHODS: RBI was calculated as follows: RBI = impedance at 50 kHz/impedance at 500 kHz. Based on the experts’ judgements, a total of 64 CAPD patients were divided into two groups, a non-hypervolemic group and a hypervolemic group. The RBI was measured from right wrist to right ankle (rw-raRBI) by bioimpedance spectroscopy (BCM®, Fresenius Medical Care) before and after the peritosol was emptied. Other RBIs were measured from the right side of the anterior superior iliac spine to the ipsilateral ankle (rasis-raRBI) to control for the electro-physiological effects of peritoneal dialysate. RESULTS: The mean rw-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients in the presence (1.141 ± 0.022 vs. 1.121 ± 0.021, P < 0.001) of a peritosol. Likewise, the mean rasis-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients (presence of peritosol: 1.136 ± 0.026 vs. 1.109 ± 0.022, P < 0.001; absence of peritosol: 1.131 ± 0.022 vs. 1.107 ± 0.022, P < 0.001). CONCLUSION: The volume status of CAPD patients was able to be simply expressed by RBI. Therefore, this study suggests that when patients cannot be analyzed using BCM, RBI could be an alternative.
Ankle ; Body Weight ; Electric Impedance ; Humans ; Mortality ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Pilot Projects* ; Spectrum Analysis ; Spine ; Wrist

This study was conducted to derive core and detailed competencies of dental hygienists to be utilized as educational targets to be reached by graduation as well as basic data that can be reflected in the development and improvement of dental hygiene curricula. This study analyzed publication reports from the Korean Dental Hygienists Association, the International Federation of Dental Hygienists, the Commission on Dental Accreditation, and the American Dental Education Association. Based on the academic classification system for dental hygiene studies, the components of core and detailed competencies of dental hygiene school at the time of graduation were extracted and developed through expert panel discussions. This study defined competencies at the graduation level of dental hygiene school and derived eight core competencies and their 52 detailed competencies to serve as educational objectives from four areas: professionalism, communication, clinical practice, and community and health promotion. In the future, it will be necessary to conduct self-assessments of competencies based on those developed in this study, at time of the graduation from dental hygiene school, as well as to continuously develop competency-based curricula according to entry level, knowledge level, and graduation level. Thus, it is urgently necessary to develop a system that can evaluate the competencies of dental hygienists after graduation and put this system into practical use.
Accreditation ; Classification ; Competency-Based Education ; Curriculum ; Dental Hygienists ; Education, Dental ; Health Promotion ; Humans ; Oral Hygiene* ; Professionalism ; Publications ; Self-Assessment

PURPOSE: This study was a descriptive research to assess the level of and the relationship of related factors in the performance of end-of-life care by intensive care unit (ICU) nurses. METHODS: Participants were 238 ICU nurses from university and general hospitals. Data were collected, using structured questionnaires, and collected data were analyzed using t-test, ANOVA, Scheffé test, Pearson correlation coefficients, and multiple regression analysis with SPSS/WIN 22.0. RESULTS: There were significantly positive effects between performance of end-of-life care and end-of-life care attitudes. Performance end-of-life care was negatively associated with end-of-life care stress and obstacles. Factors that significantly influenced ICU nurses' performance of end-of-life were end-of-life care stress, medical team in obstacles related to end-of-life care, and end-of-life care attitudes, which explained about 53% of the variance in the performance of end-of-life care. CONCLUSION: Findings indicate that hospital organizations should carry out stress management and counseling programs in order to lower ICU nurses' end-of-life care stress, and to enhance end-of-life care attitudes. In addition, concern needs to be given to the medical team which was one of the obstacles to end-of-life care. It is also necessary to decrease the heavy workload and increase the communication with medical workers.
Counseling ; Hospitals, General ; Intensive Care Units ; Terminal Care

BACKGROUND/AIMS: Cigarette smoking is the most common risk factor for chronic obstructive pulmonary disease (COPD). However, few studies of the attitudes toward COPD of smokers, the group at risk of developing this condition, have been conducted. The purpose of this study was to explore the awareness of and attitudes toward COPD of current smokers. METHODS: The sample consisted of 502 individuals aged 45 and older from throughout Korea who smoked at least 10 packs of cigarettes per year. Telephone interviews using a structured questionnaire were conducted with respondents. RESULTS: First, we evaluated the health status of subjects, finding that 45.4% considered themselves to be in good health. We also asked about COPD-related symptoms, and 60.6% of subjects reported such symptoms. However, only 1.2% of subjects had been diagnosed with or treated for COPD, only 0.4% spontaneously mentioned COPD as a respiratory disease, and only 26.5% recognized COPD as a respiratory disease after seeing a list of such diseases. Television ranked as the top source of information about COPD. The willingness of 45.0% of subjects to stop smoking increased after being informed about COPD. CONCLUSIONS: Despite having COPD-related symptoms, most smokers did not know that COPD is a respiratory disease. The attitudes of smokers toward COPD and smoking cessation varied according to socioeconomic status. In summary, a continuous effort to increase the awareness of COPD among smokers is needed. Additionally, strategies tailored according to different socioeconomic groups will also be necessary.
Aged ; Asian Continental Ancestry Group/*psychology ; *Awareness ; Consumer Health Information ; Cross-Sectional Studies ; Female ; Health Knowledge, Attitudes, Practice/*ethnology ; Health Promotion ; Health Status ; Health Surveys ; Humans ; Male ; Mass Media ; Middle Aged ; Patient Compliance/ethnology ; Pulmonary Disease, Chronic Obstructive/diagnosis/*ethnology/psychology/therapy ; Republic of Korea/epidemiology ; Risk Factors ; Risk Reduction Behavior ; Smoking/*adverse effects/*ethnology/prevention & control/psychology ; Smoking Cessation/ethnology ; Socioeconomic Factors ; Surveys and Questionnaires ; Time Factors

PURPOSE: Increased awareness and understanding of chronic obstructive pulmonary disease (COPD) is an important aspect of disease management. The aim of this study was to explore COPD awareness among smokers participating in a smoking cessation program. MATERIALS AND METHODS: Face-to-face interviews were conducted with 289 subjects in three smoking cessation clinics, using a structured questionnaire. RESULTS: A total of 68.2% of subjects had COPD-related symptoms, and 19.7% were in poor health. Only 1.0% of the subjects knew that COPD was a respiratory disease. A total of 2.4% of subjects had been diagnosed with COPD and received treatment. Television was the most common source of information about COPD, with 57.1% of the subjects receiving information in this way. After being informed about COPD, smoking-cessation willingness increased in 84.1% of the study group. It increased in 86.3% of the subjects without awareness of COPD and in 81.2% of subjects with COPD-related symptoms. CONCLUSION: We found that awareness of COPD is very poor among current smokers in Korea. Many smokers perceived their health status as good, despite the presence of COPD-related symptoms. As the level of smoking-cessation willingness was different between those with and without awareness of COPD or COPD-related symptoms, a personalized education program with various educational tools may be needed to enhance awareness of the disease and to motivate smokers to quit.
Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group/psychology ; *Awareness ; Female ; *Health Knowledge, Attitudes, Practice ; Health Status ; Health Surveys ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Motivation ; *Pulmonary Disease, Chronic Obstructive/diagnosis/etiology/prevention & control ; Questionnaires ; Republic of Korea ; Risk Factors ; Smoking/*adverse effects/epidemiology ; Smoking Cessation

PURPOSE: Various scoring systems have been introduced in grading severity and predicting mortality of trauma patients. The objective of this study is to apply novel trauma scoring systems; BIG score (Base deficit (B), International normalized ratio (I), Glasgow Coma Scale (G)), Emergency Trauma Score (EMTRAS), Probability of Survival score version 12 (PS12), and MGAP (Mechanism, GCS, Age, Arterial pressure) to adults with major trauma, and to compare their performance with traditional systems; Injury Severity System (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS). METHODS: Retrospective data collected between January 2011 and June 2012 from a regional trauma center registry on adult major trauma patients (Age> or =18, ISS> or =16) were used to identify factors associated with death. Univariate associations were calculated, and a multiple logistic regression analysis was used to determine variables associated with hospital mortality. RESULTS: A total of 298 adult major trauma patients were retrieved in order to validate new trauma scoring systems. The median ISS was 22 [interquartile range (IQR) 17~25], and the hospital mortality rate was 30.9%. Traditional trauma scoring systems were each calculated to have an area under the curve of ISS 0.72 [95% confidence interval (CI): 0.67-0.77], TRISS 0.91 (95% CI: 0.88-0.94), and RTS 0.90 (95% CI: 0.86-0.93). New trauma scoring systems were calculated to have an area under the curve of EMTRAS 0.91 (95% CI: 0.87-0.94), BIG score 0.90 (95% CI: 0.86-0.93), PS12 0.91 (95% CI: 0.87-0.94), and MGAP 0.89 (95% CI: 0.85-0.93). CONCLUSION: The new trauma scoring systems (EMTRAS, BIG, MGAP) were good predictors of mortality in adult major trauma patients on admission. They performed well compared to traditional trauma scoring systems (ISS, RTS, TRISS).
Adult* ; Emergencies ; Fatal Outcome ; Glasgow Coma Scale ; Hospital Mortality ; Humans ; Injury Severity Score ; International Normalized Ratio ; Logistic Models ; Mortality* ; Retrospective Studies ; Trauma Centers ; Trauma Severity Indices ; Triage

OBJECTIVE: The aim of this study was to examine clinical characteristics of Korean rheumatoid arthritis (RA) patients with clinically indications for TNF-alpha blocker, and to compare their clinical parameters with the Korean National Health Insurance reimbursement criteria. METHODS: Data were obtained from a registry of RA patients who visited rheumatology clinics of Hallym University affiliated hospitals. Among patients who were previously prescribed DMARDs for more than three months, rheumatologists selected patients clinically indicated for TNF-alpha blocker. The clinical characteristics at the time TNF-alpha blocker use was deemed indicated were examined. Radiographic damage was quantified by Modified Sharp van der Heijde score in hand and foot simple AP radiograph. RESULTS: From August 2010 to January 2013, five rheumatologists in four hospitals selected 109 patients clinically indicated for TNF-alpha blocker. When TNF-alpha blocker was considered, mean DAS28 was 5.2 (range 2.1~8.05), mean swollen joint count was 6 (range 0~22), mean tender joint count was 10.6 (range 0~28), mean ESR was 43.2 mm/hr (range 1~140) and mean CRP was 2.5 mg/dL (range 0.1~18.3). The mean total modified Sharp van der Heijde score was 32.72 (range 0~240). Eighty one percent of subjects did not have enough active joints to satisfy the Korean National Health Insurance reimbursement standard. CONCLUSION: Our results show that patients with clinically indications for TNF-alpha blocker had a broad range of disease activity and clinical parameters, and the majority did not meet the Korean National Health Insurance reimbursement criteria.
Antirheumatic Agents ; Arthritis, Rheumatoid* ; Foot ; Hand ; Humans ; Joints ; National Health Programs ; Rheumatology ; Tumor Necrosis Factor-alpha*