• Title/Summary/Keyword: Integrated Health Care

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Impact of Anti-Tuberculosis Drug Use on Treatment Outcomes in Patients with Pulmonary Fluoroquinolone-Resistant Multidrug-Resistant Tuberculosis: A Nationwide Retrospective Cohort Study with Propensity Score Matching

  • Hongjo Choi;Dawoon Jeong;Young Ae Kang;Doosoo Jeon;Hee-Yeon Kang;Hee Jin Kim;Hee-Sun Kim;Jeongha Mok
    • Tuberculosis and Respiratory Diseases
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    • v.86 no.3
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    • pp.234-244
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    • 2023
  • Background: Effective treatment of fluoroquinolone-resistant multidrug-resistant tuberculosis (FQr-MDR-TB) is difficult because of the limited number of available core anti-TB drugs and high rates of resistance to anti-TB drugs other than FQs. However, few studies have examined anti-TB drugs that are effective in treating patients with FQr-MDR-TB in a real-world setting. Methods: The impact of anti-TB drug use on treatment outcomes in patients with pulmonary FQr-MDR-TB was retrospectively evaluated using a nationwide integrated TB database (Korean Tuberculosis and Post-Tuberculosis). Data from 2011 to 2017 were included. Results: The study population consisted of 1,082 patients with FQr-MDR-TB. The overall treatment outcomes were as follows: treatment success (69.7%), death (13.7%), lost to follow-up or not evaluated (12.8%), and treatment failure (3.9%). On a propensity-score-matched multivariate logistic regression analysis, the use of bedaquiline (BDQ), linezolid (LZD), levofloxacin (LFX), cycloserine (CS), ethambutol (EMB), pyrazinamide, kanamycin (KM), prothionamide (PTO), and para-aminosalicylic acid against susceptible strains increased the treatment success rate (vs. unfavorable outcomes). The use of LFX, CS, EMB, and PTO against susceptible strains decreased the mortality (vs. treatment success). Conclusion: A therapeutic regimen guided by drug-susceptibility testing can improve the treatment of patients with pulmonary FQr-MDR-TB. In addition to core anti-TB drugs, such as BDQ and LZD, treatment of susceptible strains with later-generation FQs and KM may be beneficial for FQr-MDR-TB patients with limited treatment options.

Factors Influencing Sexual Experiences in Adolescents Using a Random Forest Model: Secondary Data Analysis of the 2019~2021 Korea Youth Risk Behavior Web-based Survey Data (랜덤 포레스트 모델을 활용한 국내 청소년 성경험 영향요인 분석 연구: 2019~2021년 청소년건강행태조사 데이터)

  • Yang, Yoonseok;Kwon, Ju Won;Yang, Youngran
    • Journal of Korean Academy of Nursing
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    • v.54 no.2
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    • pp.193-210
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    • 2024
  • Purpose: The objective of this study was to develop a predictive model for the sexual experiences of adolescents using the random forest method and to identify the "variable importance." Methods: The study utilized data from the 2019 to 2021 Korea Youth Risk Behavior Web-based Survey, which included 86,595 man and 80,504 woman participants. The number of independent variables stood at 44. SPSS was used to conduct Rao-Scott χ2 tests and complex sample t-tests. Modeling was performed using the random forest algorithm in Python. Performance evaluation of each model included assessments of precision, recall, F1-score, receiver operating characteristics curve, and area under the curve calculations derived from the confusion matrix. Results: The prevalence of sexual experiences initially decreased during the COVID-19 pandemic, but later increased. "Variable importance" for predicting sexual experiences, ranked in the top six, included week and weekday sedentary time and internet usage time, followed by ease of cigarette purchase, age at first alcohol consumption, smoking initiation, breakfast consumption, and difficulty purchasing alcohol. Conclusion: Education and support programs for promoting adolescent sexual health, based on the top-ranking important variables, should be integrated with health behavior intervention programs addressing internet usage, smoking, and alcohol consumption. We recommend active utilization of the random forest analysis method to develop high-performance predictive models for effective disease prevention, treatment, and nursing care.

Trends and Future Direction of the Clinical Decision Support System in Traditional Korean Medicine

  • Sung, Hyung-Kyung;Jung, Boyung;Kim, Kyeong Han;Sung, Soo-Hyun;Sung, Angela-Dong-Min;Park, Jang-Kyung
    • Journal of Pharmacopuncture
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    • v.22 no.4
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    • pp.260-268
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    • 2019
  • Objectives: The Clinical Decision Support System (CDSS), which analyzes and uses electronic health records (EHR) for medical care, pursues patient-centered medical care. It is necessary to establish the CDSS in Korean medical services for objectification and standardization. For this purpose, analyses were performed on the points to be followed for CDSS implementation with a focus on herbal medicine prescription. Methods: To establish the CDSS in the prescription of Traditional Korean Medicine, the current prescription practices of Traditional Korean Medicine doctors were analyzed. We also analyzed whether the prescription support function of the electronic chart was implemented. A questionnaire survey was conducted querying Traditional Korean Medicine doctors working at Traditional Korean Medicine clinics and hospitals, to investigate their desired CDSS functions, and their perceived effects on herbal medicine prescription. The implementation of the CDSS among the audit software developers used by the Korean medical doctors was examined. Results: On average, 41.2% of Traditional Korean Medicine doctors working in Traditional Korean Medicine clinics manipulated 1 to 4 herbs, and 31.2% adjusted 4 to 7 herbs. On average, 52.5% of Traditional Korean Medicine doctors working in Traditional Korean Medicine hospitals adjusted 1 to 4 herbs, and 35.5% adjusted 4 to 7 herbs. Questioning the desired prescription support function in the electronic medical record system, the Traditional Korean Medicine doctors working at Korean medicine clinics desired information on 'medicine name, meridian entry, flavor of medicinals, nature of medicinals, efficacy,' 'herb combination information' and 'search engine by efficacy of prescription.' The doctors also desired compounding contraindications (eighteen antagonisms, nineteen incompatibilities) and other contraindicatory prescriptions, 'medicine information' and 'prescription analysis information through basic constitution analyses.' The implementation of prescription support function varied by clinics and hospitals. Conclusion: In order to implement and utilize the CDSS in a medical service, clinical information must be generated and managed in a standardized form. For this purpose, standardization of terminology, coding of prescriptions using a combination of herbal medicines, and unification such as the preparation method and the weights and measures should be integrated.

Development of the Critical Pathway for Cesarean Section Patient (제왕절개술 환자를 위한 Critical Pathway 개발)

  • Chung Kyung-Hee;Jang Keum-Seung
    • The Journal of Korean Academic Society of Nursing Education
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    • v.4 no.1
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    • pp.66-80
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    • 1998
  • With the opening of healthcare market, the health care environment in Korea is anticipating a drastic change. In this Internationally open market environment, it is necessary to introduce a systematic health care plan and DRG system which offer qualitative medical services as well as reduced cost. Purpose of this study is to develop and test the critical pathway for Cesarean section patient in the way to be possible the integrated inpatient management. It was adopted the process of six phases to develop the critical pathway as the theoretical framework implemented by Johns Hopkins Hospital, Maryland, U.S.A. In the first phase, make a selection of diagnosis/procedures to develop. In the second phase, organize a development team consisted of eight expertises working in maternity nursing area. In the third phase, analyze the overall medical service offered to patient through review medical records and decided the service content and the implementation period for the Cesarean section patient. In the forth phase, make out a preliminary critical pathway after verification of expert group on content validity. In the fifth phase, validity operate to ten Cesarean section patients to test implementation in practice by using the preliminary critical pathway, In the sixth phase, defined the final critical pathway. The result of this study was as follows. 1. There were classified 8 categories as monitoring/assesment, treatment, medication, activity, diet, test, consult, education/discharge plan for vertical axis and showed hospital stayed from admission to discharge for horizontal axis of critical pathway through analysis 68 Cesarean section patients medical records. 2. After critical review 68 medical records to make out a preliminary critical pathway, hospital stays for horizontal axis were showed 6 days, mean hospital stays were 7.5 days, 2.1 days were to be taken operation after admission and 4.2 days were stayed until discharge after operation. 3. After making out a questionare in 90 items of a medical service content of eight categories and verifying the content validity of expertises, the 85 items of the preliminary critical pathway were selected by expertises agreement over 88% and modified or deleted 5 items showing agreement below 75%. 4. After verifying a validity to 10 patients for 4 weeks, hospital stays were 5.9 days. There were deleted 1 item and modified or supplemented the 9 items of the 10 items.

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Case Study on the Application and Evaluation of an Integrated Medical Service Model to Improve the Quality of Life for Breast Cancer Patients and Caregivers (유방암 환자와 보호자의 삶의 질 증진을 위한 통합의료서비스모델 적용평가 사례 연구)

  • Moon Joo Cheong;Do-Eun Lee;Un Jong Choi;Han Baek Cho;Hyung Won Kang
    • Journal of The Korean Society of Integrative Medicine
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    • v.12 no.3
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    • pp.163-178
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    • 2024
  • Purpose : This study aimed to evaluate the effectiveness of an integrative medical service model applied to breast cancer patients and their caregivers, exploring its feasibility and challenges within the context of South Korean healthcare system. Methods : A case study approach was chosen to assess the integrative medical service model's efficacy, involving one breast cancer patient and her primary caregiver from W University Hospital. The patient had completed reconstructive surgery and chemotherapy and was undergoing radiotherapy. The model included standard treatments alongside psychological counseling, aromatherapy, axillary rehabilitation exercise, make-up program, art therapy, laughter therapy, horticultural therapy, and yoga programs, and meditation programs delivered over eight weeks. Quantitative and qualitative data were collected through surveys, psychological tests, and feedback assessments. Results : The integrative medical service model demonstrated notable improvements in the quality of life for both breast cancer patients and their caregivers. Participants reported enhanced emotional well-being, reduced stress levels, and improved coping mechanisms throughout the treatment journey. Qualitative feedback highlighted the positive impact of holistic interventions in alleviating psychological distress and fostering resilience. Quantitative data corroborated these findings, showing statistically significant improvements in various psychosocial parameters assessed. Conclusions : Our findings underscore the benefits of integrative medical service model with standard medical treatments in the care of breast cancer patients and their caregivers. The holistic approach not only addresses physical symptoms but also enhances overall well-being and quality of life. However, the implementation of such models faces challenges within the South Korean healthcare system, including fragmented service networks and financial constraints. Addressing these structural barriers is crucial for the widespread adoption and sustainability of integrative care models in oncology practice. Future research should focus on larger-scale studies to further validate these findings and inform policy decisions aimed at optimizing cancer care delivery.

Factors Influencing the Safety Consciousness and Health status of the Young-old and Old-old elderly on Injury Occurrence Analysis (전기-후기노인의 안전의식 및 건강요인이 손상 및 손상기전에 미치는 영향)

  • Kim, Chang-Hwan
    • Journal of the Health Care and Life Science
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    • v.8 no.2
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    • pp.155-163
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    • 2020
  • The purpose of this study is to examine the current status of the Injury based on the 7th National Data on the National Health and Nutrition Survey, identify the relationship between general characteristics, safety awareness, health status, injury, and identify the factors that affect the occurrence of injury. The subjects were selected for the final analysis of 1,608data. For the analysis, frequency analysis, cross analysis, and multiple logistic regression analysis were performed. the results of the study show that in the young-old elderly, gender(woman), marital status(separated of divorced), lower the awareness of safety, body discomfort, sickness, and in-outpatient, Annual unmet medical service experienced are higher the occurrence of injury. Therefore, as a prevention education that lowers the incidence of injury. selective education is required for the Young-old and Old-old elderly, and legal penalties for drunk driving on various means of transportation and an integrated approach to strengthening and education is required.

A Diagnostic Study on High School Students' Health and Quality of Life - Based on the PRECEDE model - (고등학생의 건강 및 삶의 질에 대한 진단적 연구 - PRECEDE 모형을 근간으로 -)

  • Yoo Jae-Soon;Hong Yeo-Shin
    • The Journal of Korean Academic Society of Nursing Education
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    • v.3
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    • pp.78-98
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    • 1997
  • Health education, as the most fundamental concept for national health promotion, alms for developing the self-care ability of the general public. High school days are regarded as the period when most important physical, mental and social developments occur, and most health-related behaviors are formed. School health education is one of the major learning resources influencing health potential in the home and community as well as for the individual student. High school health education in Korea has a fundamental systemic flaw in that health-related subjects are divided and taught under various subjects areas at school. In order to achieve the goal of school health education, it is essential to make a systematic assessment of the learner's concerns connected with his health and life, and the factors affecting them. So far, most of the research projects that had been carried out for improving high school health education were limited in their concerns to a particular aspect of health. Even though some had been done in view of comprehensive school health education, they failed to Include a health assessment of the learner. Therefore, in this study the high school students' concerns related to health and life were investigated in the first place on the basis of the PRECEDE model, developed by Green and others for the purpose of a comprehensive diagnostic research on high school health education. This study was done in two steps : one was the basic study for developing research instrument and the other was the main one. The former was conducted at five high schools in Seoul and Cheongju for 2 months-beginning in March, 1996. The students were asked to respond to questions related to their health and lives in unstructured open-ended question forms. On the basis of analysis of the basic study, the diagnostic instruments for the quality of life, health problems, health behavior and educational factors were constructed to be used for the collection of data for main study. An expert panel and the pilot study were used to improve content validity and reliability of the instruments. The reliability of the instruments was measured at between .7697 and .9611 by the Cronbach $\alpha$. The data for this study were collected from the sample consisted of the junior and senior classes of twenty general and vocational high schools in Seoul and Cheongju for two months period beginning in July, 1996. In analyzing the data, both t-test and $X^2$-test were done by using SAS-$PC^+$ Program to compare data between the sexes of the high school students and the types of high school. A canonical correlation analysis was carried out to determine the relationships among the diagnostic variables, and a multivariate multiple regression analysis was conducted by using LISREL 8.03 to ascertain the influences of variables on the high school students' health and quality of life. The results were as follows : 1) The findings of the hypothesis tests (1) The canonical correlation between the educational diagnosis variables and behavioral, epidemiological, social diagnosis variables was .7221, which was significant at the level of p<.001. (2) The canonical correlation between the educational diagnosis variables and the behavior variables was .6851, which also was significant (p<.001). (3) The canonical correlation between the behavioral diagnosis variables and the epidemiological variables was 4295, which was significant (p<.001). (4) The canonical correlation between the epidemiological diagnosis variables and the social variables was .6005, which was also significant (p<.001). Therefore, the relationship between each diagnosis variable suggested by the PRECEDE model had been experimentally proven to be valid, supporting the conceptual framework of the study as appropriate for assessing the multi-dimensional factors affecting high school students' health and quality of life. Health behavior self-efficacy, the level of parents' interest and knowledge of health, and the level of the perception of school health education, all of which are the educational diagnostic variables, are the most influential variables in students' health and quality of life. In particular, health behavior self-efficacy, a causative factor, was one of the main influential variables in their health and quality of life. Other diagnostic variables suggested in the steps of the PRECEDE model were found to have reciprocal relations rather than a unidirectional causative relationship. The significance of this research is that it has diagnosed the needs of high school health education by the learner-centered assessment of variety of factors related to the health and the life of the students. This research findings suggest an integrated system of school health education to be contrived to enhance the effectiveness of the education by strengthening the influential factors such as self-efficacy to improve the health and quality of the lives of high school students.

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The Effect of the Integrated Therapy of Neurofeedback, Brain Gymnastics, and Oriental Herbal Tea on the Improvement of Brain Functions and the Quality of Life of Elders living alone (뉴로피드백·뇌체조·한방차를 병행한 통합요법이 독거노인의 뇌기능 향상 및 삶의 질에 미치는 영향)

  • Jeong, Eun-sil;Lee, Jung-eun;Jung, Hyun-mo;Kim, Soo-Kyung;Youn, Mee-Kyung;Lee, Eun-han
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.17 no.12
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    • pp.569-581
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    • 2016
  • This experimental study employs a pretest -posttest method concerning the integrated therapy of neurofeedback training, brain gymnastics, and oriental herbal tea effects on seniors living alone. The purpose of the study is to identify effects on brain functions and quality of life. The study participants included 23 seniors living alone (male 10, female 13), ranging in age from 65~90. The experiment lasted 8 weeks, from December 22, 2014, to February 28, 2015. The neurofeedback training utilized the 2 Channel neurofeedback system by Braintech Corporation and was conducted a total of 16 times over 8 weeks, having two sessions per week lasting for 30 minutes focusing on relaxation, concentration and memory. Brain gymnastics, developed by the Korean Science Institute of Psychiatry, ran for 30 minutes, twice a week for a total of 16 sessions administered over 8 weeks. Participants were required to drink 3 cups of oriental herbal tea developed according to Donguibogam for 8 weeks. The results of applying integrated therapy found positive effects on brain function resulting from changes in level of tension and anti-stress quotient. Quality of life, daily life basic measurements, and depression symptoms were significantly influenced by decreases in blood pressure and blood sugar. Results of this study find the integrated therapy of neurofeedback training, brain gymnastics, and oriental herbal tea can significantly enhance brain functions and quality of life within seniors living alone. Therefore integrated therapy involving neurofeedback, brain gymnastics, and oriental herbal tea is a necessary intervention to improve the quality of life of seniors living alone, and will improve the quality of life through healing both mind and body in a more practical and systematical manner.

A Study on the Effect of User Value on Smartwatch Digital HealthcareAcceptance Intention to Promote Digital Healthcare Venture Start Up (Digital Healthcare 벤처창업 촉진을 위한, 사용자 가치가 Smartwatch Digital Healthcare 수용의도에 미치는 영향 연구)

  • Eekseong Jin;soyoung Lee
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.18 no.2
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    • pp.35-52
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    • 2023
  • Recently, as the non-face-to-face environment has developed due to COVID-19 and environmental pollution, the importance of online digital healthcare is increasing, and venture start-ups and activities such as health care, telemedicine, and digital treatments are also actively underway. This study conducted the impact on the acceptability of digital healthcare smartwatches with an integrated approach of the expanded integrated technology acceptance model (UTAUT2) and the behavioral inference model (BRT). The most advanced integrated technology acceptance model for innovative technology acceptance research was used to identify major factors such as utility expectations, social effects, convenience, price barriers, lack of alternatives, and behavioral intentions. For the study, about 410 responses from ordinary people in their teens to 60s across the country were collected, and based on this, the hypothesis was verified using structural equations after testing reliability and validity of the data. SPSS 23 and AMOS 23 were used for research analysis. Studies have shown that personal innovation has a significant impact on the reasons for acceptance (use value, social impact, convenience of use), attitude, and non-use (price barriers, lack of alternatives, and barriers to use). These results are the same as the results of previous studies that confirmed the influence of the main value of innovative ICT on user acceptance intention. In addition, the reason for acceptance had a significant effect on attitude, but the effect of the reason for non-acceptance was not significant. It can be analyzed that consumers are interested in new ICT products and new services, but purchase them more carefully and selectively. This study has evolved from the acceptance analysis of general-purpose consumer innovation technology to the acceptance analysis of consumer value in smartwatch digital healthcare, which is a new and important area in the future. Industrially, it can contribute to the product's purchase and marketing. It is hoped that this study will contribute to increasing research in the digital healthcare sector, which will play an important role in our lives in the future, and that it will develop into in-depth factors that are more suitable for consumer value through integrated approach models and integrated analysis of consumer acceptance and non-acceptance.

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Factors influencing health and quality of life among allergy and asthma patients: With specific focus on self-efficacy, social support and health management (건강과 삶의 질에 영향을 주는 요인에 대한 분석: 자기효능감, 사회적 지원 및 질병관리를 중심으로)

  • Uichol Kim ;Chun-soo Hong ;Jeung-Gweon Lee ;Young-Shin Park
    • Korean Journal of Culture and Social Issue
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    • v.11 no.2
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    • pp.143-181
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    • 2005
  • This article examines factors that influence health and quality of life. In addition to the symptomatology and physiological functioning, the influence of the psychological functioning and interpersonal relationship on the overall health and quality of life are also investigated. Using a case-study approach, a total of 70 patients suffering from allergy or asthma were interviewed using a semi-structured questionnaire developed by the present authors. It assessed the following six areas: Cause and onset of illness, psychological functioning, health management, trust, social support received and overall health and quality of life. Based on the transactional model (Bandura, 1997; Kim & Park, 2005), the results of the case studies have been integrated and divided into three aspects: (1) Cause and onset of illness that includes physiological and environment factors; (2) mediating influences that includes psychological functioning, health management, interpersonal relationship and social support received; and (3) outcome factor that includes symptomatology, health and quality of life. The psychological functioning includes self-efficacy (self-regulated efficacy, efficacy for enlisting social support, efficacy for managing the environment, and efficacy for overcoming difficulties), positive outlook, life goals, experience of stress, and proxy control. Interpersonal relationship includes trust of family members and the physician. Health management includes receiving proper health assessment, following the advice and prescription given by the physicians, control of the environment and maintaining a healthy lifestyle. The results indicate that physiological, psychological, relational and environment factors interact with each other and affect individual's overall health and quality of life. Self-efficacy, social support received from family members, trust of physicians, and the health care system are key factors promoting healthy lifestyle and quality of life. The results indicate the need for further interdisciplinary, indigenous and cultural psychological research.