Prevalence and prognostic implications of psychological distress in patients with gastric cancer

BACKGROUND: The aim of this study was to investigate the prevalence and prognostic significance of psychological distress in gastric cancer patients. METHODS: The study population included 229 gastric cancer patients visiting Yonsei Cancer Center between November 2009 and March 2011. The distress was measured by available tools including the Modified Distress Thermometer (MDT), Hospital Anxiety and Depression Scale (HADS), and Center for Epidemiologic Studies-Depression Scale (CES-D). Patients with psychological distress were defined as those who scored above the cut-off values in both the MDT and either one of the HADS or CES-D. RESULTS: The median age of patients was 56 (range, 20 to 86) and 97 (42.4%) patients were with stage IV disease status at enrollment. The overall prevalence of psychological distress was 33.6% (95% CI: 27.5-39.8%) in 229 gastric cancer patients. In multiple logistic regression analysis, lower education level (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.11-5.17, P = 0.026) and higher disease stage (OR 2.72; 95% CI 1.47-5.03, P = 0.001) were associated with psychological distress. In stage I-III disease, patients with psychological distress had worse disease-free survival (DFS) (5-year DFS rate: 60% vs 76%, P = 0.49) compared with those without psychological distress. In stage IV disease (n = 97), patients with psychological distress showed poorer overall survival than those without psychological distress (median OS (Overall Survival): 12.2 vs. 13.8 months, P = 0.019). CONCLUSION: Psychological distress is common in patients with all stages of gastric cancer and is associated with worse outcomes.ope

Design and Construction Techniques of Traffic Database supporting Archived Data

현재 한국도로공사에서 운영하는 고속도로 교통관리시스템(FTMS : Freeway Traffic Management System)과 우회도로 교통정보시스템(ARTIS : Alternative Route Traffic Information System)은 차량검지장치(VDS), 차량번호인식장치(AVI), 그리고 CCTV를 통해 실시간 교통자료를 수집하고, 도로전광표지(VMS), 방송, 인터넷 등 다양한 매체로 교통정보를 제공하는 시스템이다. 이러한 운영계 시스템은 매일 도로에서 수집되는 엄청난 양의 교통자료를 가공하여 실시간으로 교통정보를 제공하는데 목적을 두고 있어, 교통정보를 제공하는데 필요한 최소한의 교통자료만을 저장하고 있다. 그러므로 연구자가 교통자료를 가공하여 분석을 수행하는 연구 환경으로 운영계 시스템을 사용하기에는 분석할 수 있는 교통자료의 양이 제한적이며, 교통자료가 여러 운영계 시스템으로 분산되어 있어 여러 교통자료를 가지고 비교 분석을 하는데 어려움이 있다. 본 논문에서는 여러 운영계 시스템으로부터 대용량의 교통자료를 가져와 하나의 통합 교통 데이터베이스를 구축하고, 이를 통해 교통정보 이력자료를 연구할 수 있는 환경을 제안한다. 제안된 통합 교통 데이터베이스는 연구자에게 차량검지장치(VDS) 자료, 차량번호인식장치(AVI) 자료, 고속도로 통행료수납(TCS) 자료, 고속도로 전자통행료수납(HI-PASS) 자료, 돌발상황 자료, 도로전광표지(VMS) 자료, 기상 자료와 같은 7개 자료에 대한 검색 기능과, 처리 기능을 제공한다.;The current Freeway Traffic Management System (FTMS) and Alternative Route Traffic Information System (ARTIS) operated by Korea Expressway Corporation are the systems which gather the traffic data in real-time through Vehicle Detecting System (VDS), Auto Vehicle Identification (AVI) and CCTV, and provide information on traffic through various media such as Variable Message System (VMS), broadcasting, and the Internet. Such operational systems aim to provide real-time information on traffic by processing an enormous amount of traffic data gathered from highways every day, therefore, it only saves the minimum required traffic data to provide traffic information. Hence, the amount of traffic data available for a researcher to analyze is very limited if he/she uses such operational systems as a research environment, and also it is difficult to compare and analyze the various traffic data since they are dispersed into a number of operational systems. In this study, it is recommended to build up an integrated traffic database by fetching a large amount of traffic data from diverse operational systems and an environment where such traffic data records can be studied. The suggested integrated traffic database will provide a search function and a management function in the 7 types of data - data on Vehicle Detecting System (VDS), Auto Vehicle Identification (AVI), Toll Collection System (TCS), Highway Auto Toll Payment System (HI-PASS), Events, Variable Message System (VMS), and weather forecast.1. 서론 = 1 1.1 연구 배경 및 목적 = 1 1.2 논문 구성 = 3 Ⅱ. 관련 연구 = 4 2.1 교통정보 이력자료 관리 시스템 소개 = 4 2.2 한국도로공사 운영계 시스템 분석 = 6 2.2.1 고속도로 교통 관리 시스템 = 6 2.3.2 우회도로 교통 정보 시스템 = 9 2.3.3 도로공사 전사데이터웨어하우스 = 13 Ⅲ. 통합 교통 데이터베이스 = 16 3.1 데이터베이스 구조 = 16 3.2 이용자 요구사항 분석 = 17 Ⅳ. 통합 교통 데이터베이스 설계 = 20 4.1 통합 데이터 모델링 = 20 4.2 논리적 설계 = 23 4.2.1. 시간 정보 모델링 = 23 4.2.2. 공간 정보 모델링 = 25 4.2.3. 차량검지기 자료 모델링 = 28 4.3 물리적 설계 = 30 4.3.1 객체 명명 규칙 = 30 4.3.2 집계 계획 = 31 4.3.3 데이터 분할 계획 = 32 4.3.4 인덱싱 전략 = 33 Ⅴ. 통합 교통 데이터베이스 구축 = 35 5.1 데이터 추출, 변환, 적재 = 35 5.1.1 데이터 추출 = 37 5.1.2 데이터 변환 = 41 5.1.3 데이터 적재 = 41 5.2 통합 교통정보 이력자료 이용자 서비스 기능 - 자료 검색 = 44 Ⅵ. 통합 교통 데이터베이스 성능 평가 = 48 6.1 성능 평가 환경 = 48 6.2 성능 평가 결과 = 49 Ⅶ. 결론 및 향후 연구 = 52 참고문헌 = 53 ABSTRACT = 5

Etude sur les personnages des Fables de la Fontaine

17세기의 寓話作家 La Fontaine (1621-1695)는 Les Fables의 素材를 고대 그리스, 로마의 우화들 뿐 아니라, 인도의 우화, 프랑스 중세의 우화들로부터 채용하고 있음에도 불구하고, 가장 위대한 우화작가 중의 한 사람으로 評價되고 있다. 우리는 그 소재를 登場人物로 한정시켜 살펴봄으로써, La Fontaine의 독창성과, 그가 우화작가로서 위대한 평가를 받는 까닭을 알아보고자 한다. 우리는 본 논문의 제Ⅱ장을 통해 Les Fabies의 등장인물들을 그 특유의 性格에 의해 類型分類하고, 제Ⅲ장에서는 등장인물의 描寫, 心理分析, La Fontaine의 人生觀이 투영된 인물의 성격, La Fontaine가 창작한 우화들의 등장인물들을 살펴봄으로써, La Fontaine의 독창성과 위대성은 傳統寓話에서 채용한 등장인물을 個性化시키고, 다루는 그의 방법들 속에 있음을 확인한다. 본 硏究를 통해, 우리는 La Fontaine가 등장인물들을 통해, 그와 同時代人들의 모습을 그리려 했음을 확인하고, 그의 독창성은 자신의 우화가 새로운 것이어야 한다는 La Fontaine의 작가로서의 意識에서 비롯된 것임을 알았다.;Le but de cette e´tude est de constater l'originalite´ de La Forttaine comme fabuliste. On ne peut pas nier que La Fontaine doit beaucoup de ses personnages aux anciens auteurs de la Gre｀ce, de l'Empire Romain, et aux fables de la tradition orale en France. Donc, nous re-cherchons l'origirnalite´ de La Fontaine dans les manie｀res qu'il a prtses et dans le tour qu'il donne aux personnages. Cette etude se fait en deux chapitres a｀ l'exception de l'introduction (le chapitre Ⅰ) et de la conclusion (le chapitre Ⅳ). Dans le chapitre Ⅱ, nous classons les types des person-nages par leurs caracte｀res: le type du renald (ou de la ruse), le type du l'a＾ne (ou de la sottise) et le type de lion (ou du tyran). Nous y constatons que La Fontaine fait le tableau de la socie´te´ de son temps et qu'il est pessimtste avec sa conception des hommes. Dans le chapitre Ⅲ, nous e´tudions la description des personnases, la psychologie et la vision du monde, etc. Et nous constatons que La Fortaine, par son ge´nie, trans-forme la fable, genre monotone, didactique et ennuyeux, en un re´cit vivant. Par consequent nous arrivons a｀ la conclusion que l'origi-nalite´de La Fortaine Comme fabuliste se fonde sur la connais-sance nouvelle a｀ la fable.論文槪要 = ⅳ Ⅰ. 序論 = 1 Ⅱ. 類型分類와 그 性格分析 = 5 Ⅱ-A. 여우類 = 5 Ⅱ-B. 당나귀類 = 10 Ⅱ-C. 사자類 = 15 Ⅲ. Les Fables에 나타만 登場人物의 Nouveaute′ = 19 Ⅲ-A. 인물묘사 = 20 Ⅲ-B. 心理分析 = 28 Ⅲ-C. 自然法剔에 대한 順應 = 32 Ⅲ-D. La Fontaine 독창의 테마에 의한 寓話의 登場人沕 = 38 Ⅳ. 結論 = 40 參考文獻 = 43 Resume = 4

Controlling chemotherapy-induced nausea requires further improvement: symptom experience and risk factors among Korean patients

PURPOSE: The purpose of the present study is to describe the incidence and intensity of chemotherapy-induced nausea and vomiting (CINV) and patterns of symptom change after chemotherapy among Korean cancer patients for whom antiemetic guidelines were widely utilized and guideline-consistent antiemetics were available. The study also aimed to determine the contribution of known risk factors for CINV to the incidence and intensity of CINV, as well as patterns of symptom change. METHODS: A prospective observational descriptive study was conducted. A total of 332 adult cancer patients starting their first adjuvant chemotherapy participated in this study. Items of the Multinational Association of Supportive Care in Cancer Antiemesis Tool were utilized to generate a symptom diary. Descriptive statistics, logistic regression analyses, repeated measures ANOVA, and hierarchical generalized linear models were applied to analyze the data. RESULTS: Vomiting occurred, on average, less than once in the acute and delayed phases, and its frequency remained similar throughout 5 days after chemotherapy infusion in the first and second cycles. A quadratic pattern of nausea change was found. Nausea intensity increased to a peak on the third day after chemotherapy infusion (first-cycle incidence rate ratio (IRR) = 1.40 and second-cycle IRR = 1.27, both p < .001) and then changed gradually (first-cycle IRR = 0.69 and second-cycle and IRR = 0.76, both p < .001). Nausea experience in the previous cycle contributed to the subsequent nausea intensity (IRR = 2.78, p < .001). Younger age, consuming less alcohol, and expecting nausea were identified as risk factors for chemotherapy-induced nausea that needed to be considered from the start of the chemotherapy. CONCLUSIONS: Nausea control, especially in the delayed phase, has room for improvement. As the first chemotherapy-induced nausea experience contributes to subsequent symptom experience, intense control from the start of chemotherapy is necessary while considering patient-related risk factors. Future studies should evaluate the contribution of risk factors when antiemetic prophylaxis is fully provided in multiple settings.restrictio

Gaps exist between patients' experience and clinicians' awareness of symptoms after chemotherapy: CINV and accompanying symptoms

INTRODUCTION: Correlating patients' chemotherapy-induced nausea and vomiting (CINV) experience with clinicians' understanding of the symptom severity and the patients' and clinicians' symptom management goals would aid in advancing symptom management. Identifying rankings of symptom severity after chemotherapy would help prioritizing symptom management. OBJECTIVE: The purpose of this study was to investigate and compare patients' CINV experience and clinicians' awareness of symptoms and symptom management goals. The study also aimed to identify and compare rankings of the severity of symptoms after chemotherapy by patients and clinicians. METHODS: A prospective observational study was conducted. Cancer patients starting the first adjuvant highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC) (n = 313), and oncology clinicians at two university hospitals (n = 73) in Korea participated in the study. The Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) items and 20-symptom list were used to generate a symptom diary and survey questions. Descriptive statistics with a 95 % confidence interval and the Mann-Whitney U test were used to analyze the data. RESULTS: In general, clinicians overestimated the patients' CINV experience. Patients' symptom experiences and clinicians' estimates only corresponded for delayed nausea after the second cycle MEC. For symptom management goals, patients aimed for absolute vomiting control and avoiding significant nausea. Patients' symptom management goals exceeded the clinicians' goals for CINV control except for the goal for delayed nausea control. Clinicians rated chemotherapy-induced nausea as the most problematic symptom followed by vomiting; however, fatigue and loss of appetite were the top rated symptoms by patients. CONCLUSIONS: Gaps exist between patients' symptom experience and clinicians' symptom awareness. Clinicians overestimated the patients' CINV experience and set less stringent symptom control goals. Enhancing clinicians' understanding of patients' symptom experience and retargeting the CINV management goals are the next steps for advancing symptom management. Symptoms other than CINV require more attention to set symptom management priorities reflecting patient experience and clinical significance.restrictio

Assessment of Adrenal Function and Health-Related Quality of Life in Advanced Gastric Cancer Patients Who Received First-Line Chemotherapy.

OBJECTIVE: We performed this prospective study to identify both the incidence of adrenal insufficiency (AI) and health-related quality of life (HRQOL) in advanced gastric cancer (AGC) patients who were treated with the S-1 plus cisplatin (SP) regimen as a first-line palliative chemotherapy. METHODS: We assessed adverse events (AEs) observed in 52 patients who received the SP regimen for AGC between January 2009 and June 2010 using the Common Toxicity Criteria Adverse Events (CTCAE) version 3.0. Adrenal function was assessed at baseline and 12 weeks after chemotherapy using the low-dose adrenocorticotropic hormone stimulation test. HRQOL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 (EORTC-QLQ C30). RESULTS: The incidence of AI was 30.8% (n = 16) and of AE observed 55% (n = 29) among 52 patients after 12 weeks of chemotherapy. Of 29 patients with AE, 34.4% (n = 10) were diagnosed with AI, and of 23 patients without AE, 26.1% (n = 6) were diagnosed with AI. CONCLUSION: The incidence of secondary AI in AGC patients was not rare and was not correlated with the presence of nonspecific AEs. Although patients diagnosed with AI did not show any related symptoms, they are at risk of potentially life-threatening consequences. Thus, the evaluation of AI could be suggested for patients who received chemotherapy.restrictio