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PubMed2000

[Assessment of the comprehension of new rephrasing drug package inserts].

BACKGROUND: The information included in drug package inserts is often difficult for users to understand. The impact of rephrasing inserts on comprehension was assessed. SUBJECTS AND METHOD: A community double-blind clinical trial was undertaken with random allocation of subjects to unmodified or modified inserts, in which presentation and structure had been improved and technical content expressed in plain language. A questionnaire on comprehension of the use of four common drugs was administered to all participants. The following aspects were analyzed: indications, interval of administration, administration in relation to meals, contraindications, storage and what to do in cases of missing a dose or improvement in symptoms. RESULTS: 1,560 participants were included, among whom 770 randomly received the unmodified inserts. The mean proportion of correct answers was 45.7% in the unmodified insert group and 75.5% among those who received the modified version. In all groups of age, study level and employment status, participants with modified texts achieved a higher correct response rate than the unmodified group. An improvement > 73% in the correct response rate was observed in interval of administration, administration in relation to meals and what to do in cases of missing a dose. With the modified leaflet the odds ratio of successfully answering more than 70% of questions was 13.5 (95% confidence interval, 10.5-17.5) compared with the unmodified leaflet. CONCLUSIONS: The comprehension of drug package inserts may be considerably improved by making simple changes in their content. These changes may contribute to accident prevention or inappropriate use of commonly prescribed drugs.

Adolescent↗

PubMed2001

Relationship between duration of therapy services in a comprehensive rehabilitation program and mobility at discharge in patients with orthopedic problems.

BACKGROUND AND PURPOSE: The purpose of this study was to examine the relationship between duration of physical therapy and occupational therapy and mobility at the time of discharge from a comprehensive rehabilitation program in a group of patients with orthopedic diagnoses. SUBJECTS: Subjects were 116 consecutive patients with orthopedic diagnoses (mean age=72.6 years, SD=12.0, range=21-99) who were admitted to a comprehensive inpatient rehabilitation program. METHODS: This retrospective cohort study utilized the Uniform Data Set, social service records, and quality assurance records to provide demographic and medical information. The Functional Independence Measure (FIM) provided information regarding mobility at admission and discharge. The duration of physical therapy and occupational therapy was measured in hours. RESULTS: Subjects received an average of 40.8 hours of therapy and showed an average change in FIM mobility subscale scores of 24.5. Multiple linear regression was used to demonstrate that duration of therapy was a predictor of FIM score at the time of discharge (partial correlation=.069) after controlling for length of stay, number of diagnoses, FIM cognitive subscale score at admission, and FIM mobility subscale score at admission. Duration of therapy accounted for 6.9% of the variance in the model. CONCLUSION AND DISCUSSION: This study indicates that the amount of physical therapy and occupational therapy that patients with orthopedic diagnoses receive during enrollment in an inpatient comprehensive rehabilitation program is related to the FIM mobility subscale score at the time of discharge. The authors suggest that increasing the hours of therapeutic intervention that a patient receives in inpatient rehabilitation could improve functional outcomes at discharge.

Activities of Daily Living↗

PubMed2001

Handling expressiveness and comprehensibility requirements in GLIF3.

Clinical guidelines are aimed at standardizing patient care and improving its quality and cost effectiveness. Guidelines represented in a computer-interpretable (CI) format can be used to provide automatic decision support applied to individual patients during the clinical encounter. The process of creating computer-interpretable guidelines (CIG) re-moves ambiguities contained in paper-based guidelines, thus making the guideline more comprehensible. For these reasons, CIGs may have a larger impact on clinician behavior than paper-based guidelines. Since much effort goes into creating guidelines in a CI format, it is desirable that different institutions and software systems share them. In a guideline representation workshop hosted by the InterMed Collaboratory in March 2000, the need for a standard representation format for sharable CIGs was recognized. As a first step towards achieving this goal, we proposed a set of functional requirements for sharable CIGs. The requirements encompass the entire life cycle of a CIG: development, implementation, use and maintenance. In this paper we discuss requirements that are important during the development stage of a CIG. We have abstracted the requirements into two groups: expressiveness--the ability to ex-press the knowledge content of different types of guidelines--and comprehensibility--the ability to manage complexity, facilitate coherence, and visualize a guideline model to aid in human comprehension. The Guideline Interchange For-mat version 3 (GLIF3) is a language for structured representation of CIGs. It is under development to facilitate sharing CIGs among different institutions and systems. We illustrate how GLIF3 meets the specified development requirements.

Decision Making, Computer-Assisted↗

PubMed2001

[Evaluation on comprehensive benefits of different regulation models of agroforestry ecosystem in snail river beach].

The economic, ecological, social and comprehensive benefits of different regulation models of agroforestry ecosystem in Nangeng river beach were evaluated by AHP. The results showed that agroforestry ecosystem was significantly superior to reed(Phragmites communis) system. Different regulation models of agroforestry ecosystem had different benefits. The sheet-thinning model had the highest economic, social, and comprehensive benefits, and it was the optimal regulation model. For all thinning models, the key approach to further raise benefits was to choose some intercrop variations, which had a high economic value, especially a high ratio of output to input. For no-thinning model, keeping on intercropping was the effective measure to raise the social and comprehensive benefits.

Ecosystem↗

PubMed2000

[Evaluation on the effects of community-based comprehensive prevention and control of hypertension in the rural areas in China].

OBJECTIVE: To explore the strategies and measures of community-based comprehensive prevention and control of hypertension in the rural areas. METHODS: Community-based comprehensive prevention and control of hypertension was put in practice in 120,000 people in Fangshan District of Beijing during the period of "The Ninth Five-Year Plan (1996 - 2000)". RESULTS: After intervention, blood pressure of the whole subjects were under control and kept the level of baseline data; the rate of increase of prevalence in the intervention areas was below the rate of that from 1979 to 1991 in China (the former was 14.7%, while the latter was 53.7%); the incidence rate of the subjects was 1.4%, close to the average rate of age 15 and above in China; the rates of awareness, treatment and control were above the levels of baseline data; SBP and DBP of the patients decreased by 2.9% and 5.6%, respectively; while the rate of having high risk factors reduced by 13.4% on average. CONCLUSION: The community-based comprehensive strategies and measures played an important and effective role in prevention and control of hypertension in rural areas.

Adult↗

PubMed2000

[A comprehensive evaluation on psychological quality among automobile drivers].

OBJECTIVE: To study the comprehensive evaluation on the indexes of psychological quality on automobile drivers. METHODS: A index system, consisted of seven psychological indexes (including relevant physiological indexes), was developed through Delphi method and mathematical statistics. Basic data of the seven psychological and physiological indexes including mean, standard deviation and percentile, were taken from more than 8,000 occupational licensed automobile drivers and more than 6,000 trainees who were randomly sampled from 5 cities across China. The weight coefficients of indexes were determined by analytical hierarchy process (AHP). RESULTS: Comprehensive evaluation equations of the occupational automobile drivers and the trainees were established respectively. The critical values of evaluation were divided into grades by the percentiles of evaluated values. Verified results showed that there was significant difference of the values under evaluation between drivers who had accidents and who did not (t = 14.68, P < 0.01; H = 73.61, P < 0.001). The test of consistence showed that the consistence was quite good (rate of consistence = 92.99%; kappa = 0.85). CONCLUSION: Results showed that the comprehensive equations for evaluation were reasonable and feasible for detecting the potential accident-proneness drivers.

Accident Proneness↗

PubMed2002

Speed of comprehension of visualized ordered sets.

The authors investigated the effects of visual properties of hierarchical graphs on speed of comprehension: planarity (crossing of lines), slopes (orientation of lines), and levels (adjustment of dots). In each of 4 experiments, 30 participants responded to interpretive questions that required comparisons among the elements of the graph. Knowledge provided to participants differed across Experiments 1a, 1b, and 1c; question demands varied in Experiment 2. Analysis of response latencies showed that crossing of lines is the most influential variable independent of orientation, dot adjustment, and question demands. Speed of comprehension decreased with increasing question demands. When question demands were high, orientation of lines also had an effect on speed of comprehension. Preliminary conclusions for the presentation of hierarchical graphs are drawn.

Adolescent↗

PubMed2002

A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders.

AIMS: To test the usefulness of tailoring cognitive-behavioral therapy (CBT) for patients with temporomandibular disorders (TMD) who demonstrated poor psychosocial adaptation to their TMD condition, independent of physical diagnosis. METHODS: A randomized clinical trial compared a 6-session CBT intervention delivered in conjunction with the usual TMD treatment to the usual conservative treatment by TMD specialist dentists. For study inclusion, Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), Axis II criteria, were used to target patients with elevated levels of TMD pain-related interference with daily activities, independent of physical diagnosis (i.e., Axis I). RESULTS: At the post-treatment assessment, about 4 months after the baseline evaluations, the comprehensive care group, when compared to the usual treatment group, showed significantly lower levels of characteristic pain intensity, significantly higher self-reported ability to control their TMD pain, and a strong trend (P = .07) toward lower pain-related interference in daily activities. From post-intervention to 1-year follow-up, all subjects showed improvement. At the 1-year follow-up, the comprehensive care group, while not losing any of its early gains, was not significantly different from the usual care group with regard to reported levels of pain, ability to control pain, and levels of interference in activities. For many of these psychosocially disabled TMD patients, pain and interference 1 year after treatment remained at the same or higher levels than those observed at baseline among a group of patients selected for a separate randomized clinical trial on the basis of better psychosocial adaptation. CONCLUSION: The 6-session CBT intervention for patients with heightened psychologic and psychosocial disability was effective in improving pain-related variables over the course of the CBT in conjunction with usual treatment, but was too brief an intervention to result in further improvement after the sessions ended. Patient ratings of treatment satisfaction and helfulness were high for both groups, but they were significantly higher for the comprehensive care group.

Activities of Daily Living↗

PubMed2001

[CEA comprehensive evaluation for Western and traditional Chinese hypotensive drugs].

OBJECTIVE: To make a cost-effectiveness analysis (CEA) comprehensive evaluation for 4 hypotensive drugs, by observing the effects of drugs on blood pressure lowering, symptom improving, and adverse effect and quality of life (QOL) influencing. METHODS: Two hundred and ninety-two patients with mild to moderate hypertension were divided into 4 groups at random and treated with compound Lingjiao Jiangya Pill, benazepril, amlodipine and indapamide respectively with a therapeutic course of 6 weeks. QOL was measured with FS-36 questionnaire and efficacy policy model was applied for comprehensive evaluation of CEA. RESULTS: Through CEA a comprehensive evaluation was made in order as follows: indapamide 3.65 which was the best, and then Lingjiao Jiangya Pill 3.55, amlodipine 2.90 and benazepril 2.35. CONCLUSION: The 4 drugs can not only lower blood pressure but also improve clinical symptoms with less adverse effect. It is of great practical significance to evaluate hypotensive drugs by combining QOL appraisal. The position of Lingjiao Jiangya Pill in CEA order suggests that more attention should be paid to herbal hypotensive drugs.

Adult↗

PubMed2004

[Environmental hygiene and comprehensive processing of copper sulphate ore].

The modern comprehensive processing of copper-sulphate ores is based on using the fire, chemical and combined fire-and-hydrometallurgy processes. The existing schemes of comprehensive ore processing do not provide for a total utilization of the metallurgical cycles wastes due to the inherent technological and design shortcomings; besides, they are a source of environmental pollution. Contamination of the atmospheric air with discharge elements has unfavorable effects on the health condition of population; it worsens the natural body resistance and contributes (through the induction of chromosome aberrations) to a higher general morbidity and mortality due to malignant neoplasms. Health-improve measures are supported by modern achievements in the sphere of copper-sulphate ore processing technologies--they ensure the hygienic and ecological rational management and usage at all stages of the processing of raw materials and secondary products. Institutions of the territorial medical-and-ecological monitoring are the corner stones for ecological safety of persons residing in areas of comprehensive copper-and-sulphate ore processing.

Copper Sulfate↗

PubMed2004

[Effects of a comprehensive intervention program on simple obesity of children in kindergarten].

OBJECTIVE: The purpose of the study was to explore a comprehensive management program for the obese children in kindergarten. The program should be scientific, rational, suitable for kindergarten, and easy to apply. Child care workers, parents, and child health care doctors participated in the program to help obese children establish a scientific life style through their daily life, to control their weight and to maintain their physical and mental health. METHODS: The theories of behavior science, nutriology and kinematics were applied to make the weight control of obese children in kindergarten quantified and relatively standardized. Children were divided into three groups, intervened obese children, non-intervened obese children and normal children. Data such as weight, height, and body mass index (BMI) were observed to assess the effect of weight control and define whether it affects the linear gain of children's height. RESULTS: The recovery rate of intervened obese group, non-intervened group was 62.5% and 5.3%, respectively. The general effective rate was 91.7% and 15.8%, respectively. The weight gain of intervened group was 4.15 kg lower than that of non-intervened group. The BMI of intervened group significantly decreased by 2.9 as compared to the non-intervened group. The height gain of intervened group was similar to that of normal group. Parents and health care workers' realization of children obesity and their corresponding actions, the behaviors of obese children at home and in kindergarten were changed toward the direction beneficial to weight control. CONCLUSION: The implementation of the comprehensive intervention program for obesity in children, which involved obese children, child care worker, parents, and child care doctors alleviated the obesity level of those obese children without affecting their normal height gain. The program was safe and effective. Through the comprehensive intervention, the obese children could establish good habits during the sensitive period.

Body Height↗

PubMed2005

[Effects of comprehensive interventions in community on smoking, chronic bronchitis, and asthma in rural areas of Beijing].

OBJECTIVE: To study the effects of comprehensive interventions in community on smoking, chronic bronchitis, and asthma in rural areas of Beijing. METHODS: Twenty-three villages in rural areas of Beijing were randomly divided into interventional (13 villages) and control villages (10 villages) in 1992. Comprehensive interventions including education of former-smokers and improvement of living environment were carried out in the interventional villages, and none was done in the control villages. In April 2000, surveys on smoking, chronic bronchitis, and asthma were carried out among 34,436 participants aged 15 or more in the interventional and control villages. During the same period, knowledge on prevention from chronic obstructive pulmonary diseases (COPD), living environments, and smoking were assessed among 1658 high-risk individuals of COPD at baseline and following-up period. RESULTS: The scores of knowledge and improvement on living environments in the interventional villages were significantly higher than those in control villages (P < 0.001). The decrease rate of smoking and current smoking rate in the interventional villages were significantly higher than in the control villages (0.4% vs -0.8%, P < 0.001; 2.4% vs 1.3%, P < 0.001) in men, while not different in women (P > 0.05). Among never smokers at baseline, the accumulated incidence of smoking among people aged 15 to 24 from 1993 to 2000 was significantly lower in the interventional villages than in the control villages in men (18.9% vs 23.7%, P = 0.005) and in women (0% vs 0.7%, P = 0.005). Daily cigarettes smoked by smokers in the interventional villages were less than in control villages in both men (14.8 +/- 7.0 vs 17.2 +/- 8.2 cigs daily, P < 0.001) and women (12.8 +/- 6.9 vs 13.4 +/- 7.2 cigs daily, P = 0.088). The increase of prevalence of chronic bronchitis in the interventional villages was less than in the control villages (men: 0.9% vs 1.3%, P = 0.012; women: 0.1% vs 0.3%, P = 0.003). After the age factor is adjusted, odds ratio (OR) for accumulated incidence of chronic bronchitis from 1993 to 2000 in the interventional villages were 0.80 (95%CI: 0.60-1.07) for men, 0.76 (95%CI: 0.45-1.28) in women. The OR for asthma was not significant in both men and women. CONCLUSIONS: Comprehensive interventions in community may improve knowledge of COPD prevention and living environments, decrease the smoking rate, cigarettes smoked per day, and incidence of chronic bronchitis, but have no significant effects on asthma.

Adolescent↗

PubMed2005

[Multicenter randomized controlled study on acupuncture-massage comprehensive program for treatment of cervical spondylosis of arterial type].

OBJECTIVE: To probe into clinical value of the acupuncture-massage comprehensive program for treatment of cervical spondylosis of arterial type (CSA). METHODS: By using three-center, single-blind, randomized, controlled method, the eligible subjects were randomly divided into an acupuncture-massage group, an acupuncture group, a massage group, 60 cases in each group. They were treated with acupuncture-massage comprehensive program, simple acupuncture and simple massage, respectively. And multiple-dimensional indexes were established to evaluate the therapeutic effect and safety. RESULTS: The baselines of the general data were no different among the 3 groups. The cured-markedly effective and the effective rate were 68.3% and 88.3% in the acupuncture-massage group, 51.7% and 75.0% in the acupuncture group, and 50.0% and 76.7% in the massage group, respectively, the acupuncture-massage group being better than the other 2 groups (P<0.05); after treatment, the total cumulative scores for symptoms in the 3 groups decreased significantly (all P<0.01), the acupuncture-massage group being superior to the other 2 groups (P<0.05); and the physical signs in the 3 groups improved significantly (P<0.01), with no significant differences among the 3 groups (P>0.05); the time inducing the effect in the acupuncture-massage group was shorter than that in the other 2 groups (P<0.05 or P<0.01); and no adverse effects were found in the 3 groups. CONCLUSION: This acupuncture-massage comprehensive therapy has a definite therapeutic effect on CSA with safety, and it is of superiority as compared with the simple acupuncture or the simple massage.

Acupuncture Points↗

PubMed2006

[Individualized and comprehensive therapy for severe acute pancreatitis in early stage: analysis of 110 cases].

OBJECTIVE: To investigate the risk factors of exacerbation of severe acute pancreatitis (SAP) in early stage, in order to formulate therapeutic strategies including minimally invasive intervention and organ support, and to finalize an individualized and comprehensive therapy for the SAP in early stage to decrease the mortality. METHODS: Fifty-three patients with SAP admitted from 1995 to 1999 was categorized as group 1, and 57 patients admitted from 2000 to 2005 as group 2, were analyzed retrospectively. Ranson's score, acute physiological and chronic health evaluation II (APACHE II) score, Balthazar CT grade, presence or absence of biliary tract obstruction, hypoxia, lung infection, shock, abdomen compartment syndrome (ACS), hyperlipemia, pleural effusion were analysed logistically. Mortality following different treatments and incidence rate of complications were also evaluated. RESULTS: In the two groups, 13 patients of the group 1 and 14 of group 2 were complicated with multiple organ dysfunction syndrome (MODS) in the early stage. There was difference in Ranson's score, APACHE II, Balthazar CT grade, between the groups with and without MODS (all P<0.05). Higher incidences of shock, biliary tract obstruction, ACS, hyperlipemia, pleural effusion were seen in group with MODS (P<0.01). Mortality of group 2 patients was lowered after receiving a comprehensive therapy including bedside hemodialysis (CBP) and artificial liver support (P<0.01). CONCLUSION: Development of MODS in SAP and its mortality are related to strategies of treatment, and adoption of an individualized and comprehensive therapy for the SAP in early stage can decrease the complications and the mortality.

Acute Disease↗

PubMed2006

Comprehensive treatment of generalized parodontitis.

The complexity of pathogenesis of periodontitis makes the use of comprehensive treatment necessary. We observed 60 patients, 20 women and 40 men among them aged from 20 to 50. In the course of parodontitis, we determined the intensity of inflammatory-destructive changes (Pi) in the course of periodontitis, the degree of fang denudation, the depth of gum and parodontal recesses, degree of the teeth becoming loose; we conducted the microbiological study of the oral cavity microflora and drew up an antibiotic graph. We included laser therapy in the comprehensive treatment course of generalized parodontitis. We divided the patients into two groups. The patients of the first group were treated in two stages. We used peridex, composed of chlorhexidine for antiseptic treatment of oral cavity. We used a combined solution of sage, eucalyptus, camomile and calendula to irrigate the oral cavity. At the second stage we used ointment applications with the composition of 3% indometacin, heparin, vitamins, sea-buckthorn oil and antibiotics. In the course of comprehensive treatment of the patients of the II group we included laser therapy. Our interest in the laser beam, as in the means of parodontitis treatment was stimulated by a number of properties of the laser beam and namely, its anti-inflammatory, desensitizing and antibacterial action promotes intensifying the reparation processes and does not entail any complications. The mentioned method has produced the best therapeutic results and has resulted in the reduced treatment period.

Adult↗

PubMed2006

[Comprehensive prevention and pathogenesis of ventilator-associated pneumonia in elderly patients: a prospective, randomized, case-control clinical trial].

OBJECTIVE: To assess the value of comprehensive prevention measures to ventilator-associated pneumonia (VAP) of patients more than 60 years old and to investigate the pathogenesis of VAP. METHODS: With a prospective, randomized, case-control design, patients more than 60 year of age with expected mechanical ventilation > 48 h were randomly assigned to a control group receiving a standard endotracheal tube or a comprehensive intervention group including semi-recumbent, mosapride citrate, and endotracheal tube for continuous subglottic secretions drainage. The duration of mechanical ventilation, length of ICU/hospital stay, the incidence, mortality, contributable mortality, relative risk as well as the bacterial concordance in gastric juice or lower respiratory tract between two groups were compared. The rates of methylene blue found in lower respiratory tract were also observed. RESULTS: Eighty-six cases were enrolled in this trial, including 41 in the intervention group and 45 in the control group. The duration of mechanical ventilation, length of ICU/hospital stay in the intervention group were all less than the control group. However, no significant difference existed in mortality and attributable mortality. Same types of bacterial pathogens were found between gastric juice and lower respiratory tract of the VAP patient. The RR of the incidence of VAP in two groups was 0.259 (95% CI 0.106 - 0.634). The rate of the same bacterial type or methylene blue detected in lower respiratory tract/oropharynx under microscope in the intervention group were lower than the control group (P < 0.05). CONCLUSIONS: The comprehensive prevention measures can reduce the incidences of VAP. The astro-pulmonary route is one of the pathogenesis of VAP.

Aged↗

PubMed2006

Physiological improvements and health benefits during an exercise-based comprehensive rehabilitation program in medically complex patients.

OBJECTIVES: To determine the effects of an exercise-based comprehensive rehabilitation program on the physiological, health, and cost benefit in medically complex patients. DESIGN: Case series SETTING: Comprehensive rehabilitation centers. PARTICIPANTS: Elderly chronically ill men (n = 39, age = 75.3 +/- 1.4) and women (n = 74, age = 76.5 +/- 0.9 years). INTERVENTION: Patients participated in individualized physical therapy with therapeutic exercises (stretching, strengthening, endurance, balance, sitting and standing dynamic exercises) three times/week for three months under the supervision of a physician. MEASUREMENTS: Upper (back) and lower (leg flexors) extremity strength, aerobic power as measured by metabolic equivalents (METS) at 80% of age predicted maximal heart rate (APMHR), physical functioning and mental health as assessed by the Short Form-36 (SF-36) questionnaire, and medical events (falls, physician visits, and hospitalizations) questionnaire was collected at baseline and after three months of the program. RESULTS: Strength measures improved by approximately 30% (P < 0.05) as well as aerobic power improved by approximately 25% (P < 0.05) over the three-month period. There were significant improvements in two of the SF-36 Physical Component Scales: Physical Functioning (P < 0.05) and Role Physical (P < 0.05); plus, there were significant improvements in all four of the Mental Component Scales: Vitality (P < 0.05), Social Functioning (P < 0.05), Role Emotional (P < 0.05), and Mental Health (P < 0.05). There were significant reductions in fall rate (P < 0.05), physician visits (P < 0.05), and hospitalizations (P < 0.05). CONCLUSION: Patients improve physical capacity, which result in improvements in health status with concurrent reductions in healthcare utilization during a comprehensive rehabilitation program.

Aged↗

PubMed2006

[Comprehensive protocol for diagnosis and treatment of childhood neuroblastoma--results of 45 cases].

OBJECTIVE: The aim of the paper was to improve the prognosis of neuroblastoma (NB) stage III and IV in children through the comprehensive therapy including chemotherapy, delayed tumor resection, autologous stem cell transplantation (ASCT) and inducing differentiation and to analyze the factors affecting the prognosis. METHODS: Newly diagnosed neuroblastoma patients seen from Oct.1998 to Dec.2003 were divided into high, medium and low risk groups depending on clinical stage and age. Comprehensive protocol included accurate staging, delayed and/or second tumor resection for stage III and IV patients, chemotherapy of different intensity mainly composed of cell cycle nonspecific drugs and 13-cis-retinoid for inducing cell differentiation. ASCT was given at the end of therapy for high risk group. RESULT: Forty-five patients, 6 months to 11 years of age, 32 males and 13 females, were analyzed. Of them, 15 were found to have the tumor in adrenal gland, 12 had the tumor extended to the retro-peritoneal space, while in 15 cases the tumor was beside the spinal column in chest and in 3 the tumor was located in other places. Nine cases had stage I, 1 case had stage II, 8 cases had III, 26 cases had stage IV and 1 case had stage IVs of the tumor. Depending on the age and stage of the tumor, 26 cases were aligned into high risk protocol, 10 into medium risk and 9 into low risk groups. Thirty nine cases were treated as planned. Eleven of them received ASCT including 2 cases who received second ASCT. Of the thirty-nine patients, 31 achieved complete remission (CR) and 8 partial remission (PR) after surgery and/or chemotherapy. During up to 21 months median following up period (range 14 to 64 months), 24 cases (62%) kept CR (median 22 months) and 4 survived with stable disease. The survival rate (SR) was 72%. Eleven cases died of relapse and disease progression. No death occurred from treatment complication. Statistical analysis showed that the age older than 18 months, and stage III and IV of the tumor were the factors predicting poor prognosis (P = 0.04 and 0.003, respectively). Patients who had the tumor originated from the retroperitoneal space, who had incomplete tumor resection, and those who did not receive ASCT had poorer prognosis, but the differences were not significant (P = 0.092, 0.55 and 0.60, respectively). CONCLUSION: The comprehensive protocol seemed to be reasonable. Age older than 18 months, and stage III and IV were the factors suggesting poor prognosis. The origin of the tumor, completeness of tumor resection, and use of ASCT had no significant impact on the prognosis.

Age Factors↗