• Journal of Chest Surgery
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• v.49 no.3
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• pp.157-164
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• 2016

Background: Heart-lung transplantation (HLT) has provided hope to patients with end-stage lung disease and irreversible heart dysfunction. We reviewed the clinical outcomes of 10 patients who underwent heart-lung transplantation at Asan Medical Center. Methods: Between July 2010 and August 2014, a total of 11 patients underwent HLT at Asan Medical Center. After excluding one patient who underwent concomitant liver transplantation, 10 patients were enrolled in our study. We reviewed the demographics of the donors and the recipients' baseline information, survival rate, cause of death, and postoperative complications. All patients underwent follow-up, with a mean duration of $26.1{\pm}16.7months$. Results: Early death occurred in two patients (20%) due to septic shock. Late death occurred in three patients (38%) due to bronchiolitis obliterans (n=2) and septic shock (n=1), although these patients survived for 22, 28, and 42 months, respectively. The actuarial survival rates at one year, two years, and three years after HLT were 80%, 67%, and 53%, respectively. Conclusion: HLT is a procedure that is rarely performed in Korea, even in medical centers with large heart and lung transplant programs. In order to achieve acceptable clinical outcomes, it is critical to carefully choose the donor and the recipient and to be certain that all aspects of the transplant procedure are planned in advance with the greatest care.

• Journal of Korean Academy of Nursing
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• v.41 no.2
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• pp.225-235
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• 2011

Purpose: To describe psychosocial adjustment of low-income Koreans who have cancer. Methods: Data were collected during 2008 using individual in-depth interviews with 18 Korean people with cancer. The income status of the participants was low, 11 were recipients of the National Basic Livelihood Protection program. Mean age was 58.3 yr and 11 were female. Five participants had stomach cancer, five, colorectal cancer, and four, breast cancer. Data were analyzed using grounded theory methodology. Results: The core category emerged as 'bearing up alone with double suffering'. 'Poverty and cancer: A double suffering' emerged as a causal condition. The adjustment process consisted of three stages: 'forming a treatment will to live', 'practicing for the cure', and 'restructuring self and repaying favors'. Each stage indicated action-interaction strategies which were employed to bear up alone with double suffering during the illness process. Self-reflection, parental responsibility, and support from the public sector played important roles in overcoming the double suffering. Two types of consequences were identified: Transcended life and strained life suppressed by poverty and cancer. Conclusion: The results provide insights into the psychosocial adjustment process for low income Korean with cancer and can be used in developing and implementing efficient home-care services for these people.

• The Korean Journal of Food And Nutrition
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• v.28 no.4
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• pp.717-727
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• 2015

Although the NutriPlus program has shown considerable evidence of enhancing users' nutritional status, the budget does not cover all eligible mothers and children. This study aimed to conduct a cost-benefit analysis of the NutriPlus program to assess its economic efficiency. 53 families with 79 users in the NutriPlus program at Daejeon Dong-gu Health Center participated in this study with informed consent. The costs and benefits were estimated from both the administrator's and users' perspectives. We converted the time cost into Korean currency based on the minimum wage in 2014. The value of nutrition education and service (B2), estimated by contingency valuation method (CVM), was counted as an economic benefit. 6 families (11.3%) were recipients of national medical care and 22 families (41.5%) paid 10% of the food package cost by themselves. The total cost was \7,450,167 and the total benefit was \12,402,239. The budget for the health center (C1+C2+C3+C4) was \5,984,381 a month. Time and transportation cost for receiving nutrition education (C6) differed significantly according to the economic status of families. Household food consumption increase (C4-B4) was 40,379 in the poverty group, which was four times more than in the other groups. The net benefit (B-C) was \4,852,172 and the B/C ratio was 1.66. Therefore, the NutriPlus program is beneficial in the economic aspect as well as in the nutritional aspect. If the enhancement of nutritional status was also considered, the total benefit would be even higher. These results confirm the legitimacy of a secure budget for the NutriPlus program. And we suggest expanding its budget to cover more eligible individuals to improve people's health and welfare.

• Korean Journal of Clinical Pharmacy
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• v.29 no.1
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• pp.18-24
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• 2019

Background: Although a growing number of guidelines and clinical researches are available for immunosuppressive treatment of post-transplantation, there is no clinical practice guideline for the care of kidney transplant recipients in Korea. Selection of a researchable question is the most important step in conducting qualified guideline development. Thus, we aimed to formulate key questions for Korean guideline to aid clinical decision-making for immunosuppressive treatment. Methods: Based on previous published guidelines review, a first survey was constructed with 29 questions in the range of immunosuppressive treatments. The experts were asked to rate the clinical importance of the question using a 5-point Likert scale. The questions reached 60% or more from the first survey and additional new questions were included in the second survey. In analyzing the responses to items rated on the 9-point scale, consensus agreement on each question was defined as 75% or more of experts rating 7 to 9. Results: In the first survey, 50 experts were included. Among the 29 questions, 27 were derived to get 60% or more importance and 3 new questions were additionally identified. Through the second survey, 9 questions were selected that experts reached consensus on 75% and over of the options. Finally, we developed key questions using PICO (patient, intervention, comparison, and outcome) methodology. Conclusion: The experts reached a high level of consensus on many of key questions in the survey. Final key questions provide direction for developing clinical practice guideline in the immunosuppressive treatment of transplantation.

• Journal of Chest Surgery
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• v.56 no.1
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• pp.6-13
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• 2023

Background: Coronavirus disease 2019 (COVID-19) has been found to cause life-threatening respiratory failure, which can progress to irreversible lung damage. Lung transplantation can be a life-saving treatment in patients with terminal lung disease (e.g., acute respiratory distress syndrome caused by infection). This study aimed to present the clinical course and results after initial lung transplantation in patients with severe COVID-19 who did not recover even with optimal medical care. Methods: From August 2019 to February 2022, this study enrolled 10 patients with COVID-19 (5 men; median age, 55.7 years) who underwent lung transplantation at a single center in Korea. All patients' characteristics, clinical pathway, overall survival, complications, and operative data were collected and analyzed. Results: Veno-venous extracorporeal membrane oxygenation or an oxygenator in a right ventricular assist device circuit was applied to 90% of the patients, and the median length of extracorporeal life support before operation was 48.5 days. There were no cases of mortality after a median follow-up of 372.8 days (interquartile range, 262.25-489 days). The major complications included the requirement for postoperative extracorporeal membrane oxygenation support in 2 cases (20%), re-transplantation in 1 case (10%), and re-exploration due to bleeding in 2 cases (20%). During the follow-up period, 3 out of 10 patients died. Conclusion: Excellent early outcomes were observed for patients who underwent lung transplantation. Thus, lung transplantation can be an effective and feasible treatment for patients with end-stage lung disease caused by COVID-19.

• Health Policy and Management
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• v.33 no.1
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• pp.40-54
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• 2023

Background: Based on the increase in the needs for convalescent rehabilitation medical services in Korea, this study aims to calculate the needs for rehabilitation services and examine its determinants for 229 regions. Methods: Claim data from the Health Insurance Review and Assessment Service were used to estimate patients who need to receive rehabilitation services, and data from various sources were also used for analysis. The number of cases and incidence rates of hospitalization related to convalescent rehabilitation were calculated to estimate the needs for services by region, and the results were visualized via a map. Multivariate regression and fixed effects regression using panel data were performed to identify the determinants of regional variation of the incidence rate. Results: First, the incidence rate of rural areas such as Jeolla-do, Gyeongsang-do, and Chungcheong-do was higher than urban areas (metropolitan cities). Second, the population, proportion of the elder, medical aid recipients, financial independence, traffic deaths, smoking, diabetes rate, and medical infrastructure correlated significantly with the incidence rate. Third, 'rho' values which mean the fraction of variance due to individual terms in panel data regression models were 0.965 and 0.976, respectively. Conclusion: The incidence rate of hospitalizations was correlated with most independent variables in this study and there is a gap between urban and rural areas. These regional disparities are fixed in our society. An improved regional convalescent rehabilitation system is suggested to cover the entire area including rural areas with a high rate of aging.

• Korean Journal of Occupational Health Nursing
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• v.33 no.1
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• pp.12-25
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• 2024

Purpose: This quasi-experimental study used a non-equivalent control group pretest-posttest design with clinical nurses to develop a compassion improvement program and verify its effects on compassion competence and empathic communication. Methods: The Triandis Interpersonal Behavior model (Triandis, 1980) was used as a theoretical framework, and a compassion improvement program was developed based on the ADDIE model. The experimental treatment in the program was conducted for 120 minutes per session, once a week, for a total of six sessions. The data collection and research period ranged from September 7 to November 16. It involved a pre-survey of measured variables, six sessions of experimental treatment, a post-survey, and a follow-up survey in sequence. The collected data were analyzed using the statistical program SPSS/WIN 25.0 and then based on a t-test and repeated measures ANOVA to verify the effectiveness of the program. Results: Clinical nurses participating in the compassion improvement program showed improved compassion competence (F=8.00, p=.001) due to the cultivation of insight, sensitivity, and communication skills. In addition, the improvement in attentive listening (F=3.32, p=.024) indicated that the program was partially effective in empathic communication. Conclusion: The compassion improvement program for clinical nurses, which was developed in this study, is expected to be useful in nursing practice. In other words, the compassion improvement program may contribute to creating a positive atmosphere in the workplace for nurses and an empathic relationship between nurses and healthcare recipients through improvement in the compassion competence of nurses. If the compassion improvement program is continuously implemented as a facilitating condition, it will greatly help prevent the turnover of clinical nurses, assist them in adapting to hospital life, and enhance the quality of nursing care.

• 한국노년학
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• v.29 no.2
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• pp.683-699
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• 2009

Family caregiving to the elderly is one of the most important social issues in recent Korea. Among various kinds of family caregivers, spouse caregivers particularly constitute a special group, generally characterized by continuous intimate association with the care recipients at many levels and by special commitments and responsibilities associated with the marriage bond. And the number of spouse caregiver is expected to increase in the future. Moreover, since a conjugal relation is consisted of husband and wife, their caregiving experiences and caregiving burden may vary by gender. Thus, the present study was to examine the effect of caregiving experience, especially caregiving motivation and social support focusing on the gender differences. We analysed 「2001 Survey of Care-giving Status and welfare Needs of Older Persons in Korea」 data by performing descriptive statistics, t-test and logistic regression. As a result, we found that the husband was likely to feel more burden when he started caregiving because of few alternatives. For wife caregivers, the less awareness of social support they had, the more possibility of economic burden they felt. With these results, we suggest the necessity of having gender-sensitive perspective in research and policy making for caregivers.

• 한국노년학
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• v.29 no.4
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• pp.1591-1609
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• 2009

Adult child caregivers and spousal caregivers might deal with differential challenges. Studies about caregivers' psychological outcomes, however, tended to investigate associations between caregiving and its outcomes by pooling adult child caregivers and spousal caregivers together. By using a U. S. sample of family caregivers who assisted a relative with dementia, this study examined whether the relationship of caregivers to care receivers (daughter caregivers or spousal caregivers) made a difference in levels of depressive symptoms. The result showed that wife caregivers were more likely to be depressed than daughter caregivers. For daughter caregivers, role overload, role captivity, and behavior problems significantly influenced on depression. Besides these variables, the level of education was a significant predictor for wife caregivers. Role captivity and behavior problems significantly impacted on depression for husband caregivers. Thus, role captivity and behavioral problems were common predictors for all the caregivers. Specifically, higher levels of role captivity and behavioral problems were likely to make caregivers more depressed. The implication of these results were discussed.

• Journal of agricultural medicine and community health
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• v.48 no.4
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• pp.262-274
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• 2023

Objectives: This study examined the evaluation and potential improvements of 'Integrated Healthcare and Social Welfare service model' based on the experiences of practitioners from institutions participating in the 'Dalgubeol Health Doctor Services' and the service recipients. Methods: Qualitative research was conducted from September to November 2022 in this study, focusing on 4 providers from the dedicated Dalgubeol Health Doctor Services Team, 5 contact partners from affiliated organizations, and 6 service beneficiaries. The data gathered underwent thematic analysis. Results: The evaluation indicated that Dalgubeol Health Doctor Services has proven to be effective in addressing the complex needs of vulnerable populations. By providing integrated services through quick and simple beneficiary selection and resource linkage, it has contributed to the resolution of complex demands, recovery of positive attitudes towards life, and improvement in quality of life for users who have fear the use of medical and welfare services. Dalgubeol Health Doctor Services has established an integrated health care system involving not only public but also private organizations, from the referral agency to the service provider. Centered around Daegu Medical Center and involving five tertiary hospitals, it has established a model that supports treatment appropriate to the severity of the patient, from mild to severe. Conclusions: These findings indicate an enhancement in health equity, achieved through the active identification and subsequent health and welfare issue resolution of individuals marginalized from medical benefits.