• Title/Summary/Keyword: Intervention Strategies

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Discordance Between Angiographic Assessment and Fractional Flow Reserve or Intravascular Ultrasound in Intermediate Coronary Lesions: A Post-hoc Analysis of the FLAVOUR Trial

  • Jung-Hee Lee;Sung Gyun Ahn;Ho Sung Jeon;Jun-Won Lee;Young Jin Youn;Jinlong Zhang;Xinyang Hu;Jian'an Wang;Joo Myung Lee;Joo-Yong Hahn;Chang-Wook Nam;Joon-Hyung Doh;Bong-Ki Lee;Weon Kim;Jinyu Huang;Fan Jiang;Hao Zhou;Peng Chen;Lijiang Tang;Wenbing Jiang;Xiaomin Chen;Wenming He;Myeong-Ho Yoon;Seung-Jea Tahk;Ung Kim;You-Jeong Ki;Eun-Seok Shin;Doyeon Hwang;Jeehoon Kang;Hyo-Soo Kim;Bon-Kwon Koo
    • Korean Circulation Journal
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    • v.54 no.8
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    • pp.485-496
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    • 2024
  • Background and Objectives: Angiographic assessment of coronary stenosis severity using quantitative coronary angiography (QCA) is often inconsistent with that based on fractional flow reserve (FFR) or intravascular ultrasound (IVUS). We investigated the incidence of discrepancies between QCA and FFR or IVUS, and the outcomes of FFR- and IVUS-guided strategies in discordant coronary lesions. Methods: This study was a post-hoc analysis of the FLAVOUR study. We used a QCA-derived diameter stenosis (DS) of 60% or greater, the highest tertile, to classify coronary lesions as concordant or discordant with FFR or IVUS criteria for percutaneous coronary intervention (PCI). The patient-oriented composite outcome (POCO) was defined as a composite of death, myocardial infarction, or revascularization at 24 months. Results: The discordance rate between QCA and FFR or IVUS was 30.2% (n=551). The QCA-FFR discordance rate was numerically lower than the QCA-IVUS discordance rate (28.2% vs. 32.4%, p=0.050). In 200 patients with ≥60% DS, PCI was deferred according to negative FFR (n=141) and negative IVUS (n=59) (15.3% vs. 6.5%, p<0.001). The POCO incidence was comparable between the FFR- and IVUS-guided deferral strategies (5.9% vs. 3.4%, p=0.479). Conversely, 351 patients with DS <60% underwent PCI according to positive FFR (n=118) and positive IVUS (n=233) (12.8% vs. 25.9%, p<0.001). FFR- and IVUS-guided PCI did not differ in the incidence of POCO (9.5% vs. 6.5%, p=0.294). Conclusions: The proportion of QCA-FFR or IVUS discordance was approximately one third for intermediate coronary lesions. FFR- or IVUS-guided strategies for these lesions were comparable with respect to POCO at 24 months.

Prediction Model of Exercise Behaviors in Patients with Arthritis (by Pender's revised Health Promotion Model) (관절염 환자의 운동행위 예측모형 (Pender의 재개정된 건강증진 모형에 의한))

  • Lim, Nan-Young;Suh, Gil-Hee
    • Journal of muscle and joint health
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    • v.8 no.1
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    • pp.122-140
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    • 2001
  • The aims of this study were to understand and to predict the determinent factors affecting the exercise behaviors and physical fitness by testing the Pender's revised health promotion model, and to help the patients with rheumatoid arthritis and osteoarthritis perform the continous exercise program, and to help them maximize the physical effect such as muscle strength, endurance, and functional status and mental effects including self efficacy and quality of life, and improve the physical and mental well being, and to provide a basis for the nursing intervention strategies. Of the selected variables in this study, the endogenous variables included the physical fitness, exercise score, exercise participation, perceived benefits of action, perceived barriers of action to exercise, activity-related affect(depression) and perceived self-efficacy, interpersonal influences(family support), situational factors(duration of arthritis, fatigue) and the exogenous variables included personal sociocultural factor(education level), personal biologic factor(body mass index), personal psychologic factor(perceived health status) and prior related behavior factors(previous participation in exercise, life-style). We analyzed the clinical records of 208 patients with rheumatoid arthritis and degenerative arthritis who visited the outpatient clinics at H university hospital in Seoul. Data were composed of self reported qustionnaire and good of fitness score which were obtained by padalling the ergometer of bicycle for 9 minutes. SPSS Win 8.0 and Window LISREL 8.12a were used for statistical analysis. Of 75 hypothetical paths that influence on physical fitness, exercise participation, exercise score, perceived benefits of action, perceived barriers of action to exercise, activity-related affect(depression) and perceived self-efficacy, interpersonal influences(family support), situational factors(duration of arthritis, fatigue), 40 were supported. The physical fitness was directly influenced by life-style, perceived health status, education level, family support, fatigue, which explained 12% of physical fitness. The exercise participation were directly influenced by life-style, education level, past exercise behavior, perceived benefits of action, perceived barriers of action, depression and duration of arthritis, which explained 47% of exercise participation. Exercise score were directly affected by perceived self efficacy. BMI, life-style, past exercise behavior, perceived benefits of action, family support, perceived health status. perceived barriers of action, and fatigue, which explained 70%. Perceived benefits of action was directly influenced by BMI, life-style, which explained 39%. Perceived barriers of action were directly influeced by past exercise behavior, perceived health status, which explained 7%. Perceived self efficacy were directly influeced by level of education, perceived health status, life-style, which explained 57%. Depression were directly influeced by past exercise behavior, BMI, life-style, which explained 27%. Family support were directly influeced by life-style, perceived health status, which explained 29%. Fatigue were directly influeced by BMI, life-style, perceived health status. which explained 41%. Duration of arthritis were directly influeced by life-style, past exercise behavior, BMI, which explained 6%. In conclusion, important variables for physical fitness were life-style, and variable affecting exercise participation were life-style. Perceived self-efficacy of exercise was a significant predictor of exercise score. BMI, Life-style, perceived benefits of action, family support, past exercise behavior showed direct effects on perceived self-efficacy. Therefore, disease related factor should be minimized for physical performance and well being in nursing intervention for patients with rheumatoid arthritis, and plans to promote and continue exercise should be seeked to reduce disability. In addition, Exercise program should be planned and performed by the exact evaluation of exercise according to the ability of the patients and the contents to improve the importance of exercise and self efficacy in self control program, dedicated educational program should be involved. This study suggest that the methods to reduce the disease related factors, the importance of daily life-style, recognition of benefit of exercise, and educational program to promote self efficacy should be considered in the exercise behavior promotion and nursing intervention for continous performance. The significance of this study is also thought to provide patients with chronic arthritis the specific data for maximal physical and mental well being through exercise, chronic therapeutic procedure, daily adaptation and confrontation in nursing intervention.

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A Systematic Review on clinical studies of Korean medicine for smoking cessation - Focusing on study design (한의약 금연 임상연구의 체계적 고찰 - 연구 설계를 중심으로)

  • Park, Yu Lee;Jang, Soobin;Sung, Hyun Kyung;Kweon, Seung Uk;Sung, Joo Won;Yang, Jaehyung;Park, Bongkyu;Ko, Seong-Gyu;Park, Sunju
    • Journal of Society of Preventive Korean Medicine
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    • v.19 no.3
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    • pp.115-129
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    • 2015
  • Objective : This study aims to review clinical studies evaluating effectiveness of Korean medicine for smoking cessation. It also aims to critically analyze study design of the studies and suggest strategies for future clinical studies on smoking cessation. Method : Only domestic databases such as RISS, KISS, DBPIA, NDSL, and OASIS were searched from August to November 2011 for clinical studies on smoking cessation. There was no limitation on study design, period, and language. The studies were qualitatively analyzed focusing on study design including participants, intervention, and outcome measurements. Results : Out of 537 studies searched, 27 studies were included in the analysis. 56% of the studies were observational studies, 33% were quasi-experimental studies, and 11% were randomized controlled studies. 44% and 32% of the studies were conducted at educational institutions and hospitals, respectively. The average number of the participants were 182, which ranged from 15 to 1,056. Most of the participants were male. Intervention used were mostly auricular acupuncture, and the most frequently used acupoints were Lung, Shinmun, Endocrine, Pharynx & Larynx, and Inner nose. The average length of treatment period was four weeks, and the treatment was provided twice per week. The outcomes were measured at the end of the treatment and only 26% of the studies conducted follow-up measurements. 26% of the studies utilized questionnaires of which validity was evaluated and only 15% used objective measurements such as exhaled Carbon monoxide and Cotinine test. Conclusion : Though many clinical studies on effectiveness of Korean medicine for smoking cessation were conducted, there are still debates on quality of evidence. Recently, guidelines have been developed for clinical trials evaluating effectiveness of smoking cessation program. Thus, in the future, clinical studies should be developed based on these guidelines and designed to improve validity and reliability.

Study on the Utilization of Complementary Alternative Therapy in elder Arthritics (노인 관절염 환자의 보완.대체요법 이용실태)

  • Park, Kyung-Sook;Ryoo, Eon-Na;Moon, Kyung-Sun;Lee, Won-Yu;Lee, Sung-Ock;Kim, Myung-Hee;Youn, Mi-Sun;Oh, Jung-Mi;Hwang, Yun-Young;Kim, Hyung-Aee
    • Journal of muscle and joint health
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    • v.10 no.2
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    • pp.142-155
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    • 2003
  • The purpose of this study was to investigate the rate of utilization, kinds and effective complementary-alternative therapy in elder arthritics, and then utilize the results as basic data for nursing intervention for elder arthritics. Study subjects consisted of 157 elder arthritics over 60 years old, data were collected through a structured questionnaire and face to face interviews. Data collection was done from July 2001 to August 2001. Subjects were sampled out from outpatients of department of rehabilitation of a university hospital in S city, outpatients of a local hospital in D city, and outpatient at public heath center in K and S city. Sexual distribution of subjects showed male 19.1% and the female 80.9%. The diagnosis distribution showed degenerative arthritis at 91% and reumatoid arthritis at 8.9% Duration of arthritics was 10 years over by 46.5%, duration of hospital treatment was 1-5 years by 41% The degree of pain by arthritis pointed out a mean point of 3.37 on a 5-point numeric scale 94.2% of subjects have experience complementary-alternative therapies used. Of the kind the subjects used, physiotherapy occupied 38.2%, Oriental medicine 36.3%, physical exercise 35.7%, nutritional therapy 22.3%, animal diet 8.9%, herbal diet 3.8%. The hardest thing due to arthritis represented disability in daily life by 59.8% and the pain problem by 30.5%. In conclusion, results of the study reveal that elder arthritics have used physiotherapy, Oriental medicine, physical exercise. Concrete strategies for nursing intervention about these complementary-alternative therapy are required to the established soon.

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Determinant factors of Exercise behaviors in Patients with Arthritis (관절염 환자의 운동행위 결정요인)

  • Suh, Gil-Hee;Lim, Nan-Young
    • Journal of muscle and joint health
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    • v.7 no.1
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    • pp.102-130
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    • 2000
  • The aims of this study were to understand and to predict the determinant factors affecting the exercise behaviors and physical fitness by testing the Ponder's health promotion model, and to help the patients with rheumatoid arthritis and osteoarthritis perform the continuous exercise program, and to help them maximize the physical effect such as muscle strength. endurance, and fuctional status and mental effects including self efficacy and quality of life, and improve the physical and mental wellbeing, and to provide a basis for the nursing intervention strategies. We analyzed the clinical records of 208 patients with rheumatoid arthritis and degenerative arthritis who visited the outpatient clinics at H university hospital in Seoul between October 5, 1999 and October 24, 1999. Data were composed of self reported questionnaire and good of fitness score which were obtained by pedalling the ergometer of bicycle for 9 minutes. SPSS Win 8.0 and Window LISREL 8.12a were used for statistical analysis. 24 Of 54 hypothetical paths were supported in modified model, which was considered as a proper model with improved fit index. The physical fitness was directly influenced by exercise participation behavior and education level, and indirectly by physical fitness, while fatigue, physical disability, pastexercise behavior, life-style, self-efficacy, which explained 20% of physical fitness. The exercise participation were directly influenced by perceived benefits and self-efficacy, and indirectly influenced by life-style, fatigue and physical disability, and directly and indirectly by past exercise behavior, which explained 53% of exercise participation. Exercise score were directly affected by perceived health status, perceived benefits, self efficacy, and past exercise behavior, and were indirectly affected by fatigue, physical disability, and life-style, which explained 50%. Perceived health status were directly influeced by level of education, depression, sleep disorder, and physical disability, which explained 34% of perceived health status. Perceived benefit was directly influenced by fatigue, sleep disorder, physical disability, and life-style, which explained 45%. Perceived barriers was directly influenced by fatigue, sleep disorder, and lifestyle, which explained 9%. Self- efficacy was directly influenced by fatigue, physical disability, past exercise behavior, and level of education, which explained 61%. In conclusion, important variables for physical fitness were exercise participation and level of education, and variables affecting exercise participation were perceived self-efficacy, benefits, and past exercise behavior. Perceived self-efficacy of exercise was a significant predictor of exercise participation. Life-style, fatigue, and physical disability showed direct effects on perceived benefit, perceived barriers, and self-efficacy, and indirect effects on exercise behavior. Therefore, disease related factor should be minimized for physical performance and well being in nursing intervention for patients with rheumatoid arthritis, and plans to promote and continue exercise should be soaked to reduce disability. In addition, Exercise program should be planned and performed by the exact evaluation of exercise according to the ability of the patients and the contents to improve the importance of exercise and self efficacy in self control program, dedicated educational program should be involved.

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Effects of an Anti-Smoking Program to Prevent Lung Cancer among Urban Aboriginals in Taiwan

  • Lin, Mei-Hsiang;Huang, Sheu-Jen;Shih, Whei-Mei Jean;Wang, Pao-Yu;Lin, Li-Hui;Hsu, Hsiu-Chin
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.11
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    • pp.6451-6457
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    • 2013
  • Background and Purpose: Indigenous people who leave their hometowns and move to the city to earn a living became urban aboriginals. During the process of adapting to urban living situations, they may use various coping strategies such as smoking to overcome their stress. Therefore, it is crucial to provide health education including smoking prevention, increasing knowledge regarding of tobacco hazard, self-efficacy of anti-smoking, and adjusting smoking behavior so as to empower their anti-smoking motivation to prevent lung cancer. The purpose of this study was to explore the effectiveness of an anti-smoking program on urban aboriginals in Taiwan. Methods: A quasi-experimental study design with purposeful sampling was employed. A total of 125 aboriginal subjects were recruited from two local churches at Shu Lin area in northern Taiwan. Subjects were divided into an experimental group (n =64 ) and a control group (n = 61). Both took pre-tests in order to set baseline values, and only the experimental group participated for 3-weeks in the anti-smoking program classes. Both groups took post-tests immediately after the intervention in order to evaluate the immediate effects of the teaching program, and a follow-up test was conducted four weeks after the intervention. Data were analyzed using descriptive statistics, one-way ANCOVA, and repeat measure ANCOVA. Results: After controlling for confounding variables, the results showed that there were statistically significant differences in the self-efficacy of anti-smoking and smoking behavior between experimental and control groups in the immediately post-test and the follow-up test (p < 0.05). However, there was no significant differences in the recognition of hazards of smoking at eiter time point. Conclusions and Implications for Practice: The findings of this study revealed that the anti-smoking program effectively improved self-efficacy of anti-smoking, and decreased the smoking behavior in urban aboriginals. They provide useful information as a reference regarding of aboriginal health promotion to health providers. It is imperative that anti-smoking be reinforced for those regular smokers to prevent induction of lung cancer.

Factors Affecting Health Promotion Behavior of Apheresis Blood-Donors (성분헌혈자의 건강증진행위에 영향을 미치는 요인)

  • Hong Kyong Hee;Park Ho Ran
    • Journal of Korean Public Health Nursing
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    • v.19 no.1
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    • pp.41-52
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    • 2005
  • This study was designed to provide a base for nursing intervention to help apheresis blood-donors to perform health promotion behavior effectively by surveying their health promotion behavior and by analyzing the critical factors. The study subjects were 468 participants in platelet donation at a university hospital apheresis unit in Seoul. The data for this study were collected between May and June. 2002. by questionnaire. Data were analyzed by t-test, ANOVA. Scheffe test, Pearson correlation coefficient. and stepwise multiple regression. The results were as follows. 1. The degree of performance of health promotion behavior of the subjects was a total average score of $152.9\pm21.5$ points and a mean score of 2.7 points. The highest score was 'I have a good relationship with others' in the factor of self-actualization and interpersonal support. The lowest score was 'I have my blood pressure checked regularly' in the factor of health responsibility. 2. Considering the classification according to the subjects' general characteristics. the health promotion behavior score was significantly higher for soldiers than high school students, for religious believers than atheists. and for high class economic status than mid and low class economic status. Also the health promotion behavior score was higher for those who had made more than five blood donations than those who had made zero or one donation. and for those who had made more than four blood donations than for those who had made less than four blood donations in the previous times of apheresis blood donation. The score was also higher for those not having a relationship with recipient than those having a relationship. 3. The self-efficacy related to donation. general self-efficacy and self-esteem had a significant correlation with the performance in health promotion behavior. 4. The critical factors that influenced the health promotion behavior were explained by $35.6\%$ of the general self-efficacy and by $40.2\%$ of the total of self-efficacy related to donation, and previous times of apheresis blood donation. The health promotion behavior score of apheresis blood-donors differed according to job, religion, economic status, previous times of whole blood donation, previous times of apheresis blood donation, and relationship with recipient. The health promotion behavior and self-efficacy related to donation, general self-efficacy, and self-esteem showed significant positive correlation with one another. The general self-efficacy, self-efficacy related to donation, and previous times of apheresis blood donation appeared to be the significant predictive factors of health promotion behavior. Therefore, from these study results, it is necessary to establish more effective and organized nursing intervention strategies for the health promotion behavior of apheresis blood-donors.

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A Structural Model for Health Promotion and Quality of Life in People with Cancer (건강증진과 삶의 질 구조모형 II-암환자 중심-)

  • 오복자
    • Journal of Korean Academy of Nursing
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    • v.26 no.3
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    • pp.632-652
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    • 1996
  • It has been noted that a genetic alteration of cells influenced by unhealthy lifestyle in addition to a series of other carcinogens increases the incidence of various neoplasmic diseases. Therefore the importance of a lifestyle that minimizes such an impact on health should be emphasized. Since stomach cancer, the most common neoplasmic disease in Korea, is related to personal lifestyle and as there is a possibility of its recurrence, patients with stomach cancer need to lead a healthy lifestyle. Also the quality of life which patients experience is negatively affected by the side effects of treatments and the possibility of recurrence. Therefore an effective nursing intervention to enhance quality of life and encourage healthy lifestyle is needed. The purpose of this study is to provide a basis for nursing intervention strategies to promote health and thus enhance quality of life. A hypothetical model for this purpose was constructed based on Pender's Health Promotion Model and Becker's Health Belief Model, with the inclusion of some influential factors such as hope for quality of life and health promoting behavior. The aims of study were to : 1) evaluate the effectiveness of patient's cognitive-perceptual factors on health promoting behaviors and quality of life ; 2) examine the causal relationships among perceived benefit, perceived barrier, perceived susceptibility and severity, internal locus of control, perceived health status, hope, health concept, self efficacy, self esteem health promoting behaviors & quality of life ; 3) build and test a global hypothetical model. The subjects for this study were 164 patients who were being treated for stomach cancer were approached in the outpatient clinic on a University Hospital. The data from the completed questionnaires were analyzed using Linear Structural Relationships (LISREL). The results of research are as follows : 1) Hypothetical model and the modified model showed a good fit to the empirical data, revealing considerable explanational power for health promoting behaviors(54.9%) and quality of life(87.6%) 2) Self efficacy and hope had significant effects on health promoting behaviors. Of these, hope was affected indirectly through self efficacy and self esteem. 3) Perceived health status, hope and self esteem had significant direct effect on the quality of life. Of these variables, perceived health status was the most essential factor affecting general satisfaction in life. 4) Self-efficacy, as a mediating variable, was positively affected by perceived benefit and hope. 5) Self-esteem, as a mediating variable, was positively affected by perceived health status and hope. 6) Hope was the main variable affecting self efficacy, self esteem, health promoting behaviors and quality of life. The derived model in this study could effectively be used as a reference model for further study and could suggests a direction for nursing practices

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The nature of UN support of the Korea War (유엔의 6.25전쟁 지원과 성격 -신정공세 전후 유엔의 휴전교섭 노력을 중심으로-)

  • Yang, Yong-Jo
    • Journal of National Security and Military Science
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    • s.8
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    • pp.1-48
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    • 2010
  • The purpose of this study is to examine and analyze the Untied Nations' efforts for peace on Korean peninsular after CCF's participation in Korean War. The Untied Nation tried to negotiate th peace plan between two sides from the end of 1950. Once the CCF's entry into the war had been confirmed, the war situation moved to a new phase, and the UN forces, which had guided the war in an effort to destroy the NKP A forces, and to punish North Korea, had to set up new guidelines to cope with the new situation. Accordingly, in late November, 1950, the UN forces camp, mainly the US Joint Chiefs of Staff and the United Nations Command, discussed various options, such as an expansion of the war up to the Chinese territory, a cease fire along the 38th Parallel, or a forced and inevitable evacuation. The Korean delegation to the UN insisted that "the unification of Korea should be achieved only by victory in the war. The Chinese intervention in the war is a Challenge to the UN in the same way as the North Korean invasion. The UN participation in the war was to repulse the invasion. With the same spirit we should drive back the Chinese Communists." The Korean delegation also emphasized to the friendly nations the political objective and will of unification, and that a cease fire at a threshold of unification might return us to the status quo ante bellum, and would be contrary to the Korean nation's desire. At that time, particularly, the US strongly considered the employment of nuclear weapons as one of the new strategies to cope with the Chinese invasion. The international effects of these casual remarks were realized almost at once. The British Prime Minister who had not wanted the expansion of war in the Far East, especially from the view point of the interest of NATO's security, visited Washington. so the conference had a very important meaning for the UN forces' new strategy. On the other hand, at the UN, on the 5th of December, the very day Truman and Attlee agreed to seek a cease-fire under UN auspices, a group of thirteen Asian and Arab states proposed to ask China and North Korea not to cross the 38th Parallel, and sounded out both sides about a cease fire along the 38th Parallel. The United States and the United Kingdom gave their assent, but China and North Korea gave no direct response. The CCF, who were securing the initiative of operation, were not agreeable with the proposal of the UN forces. The Untied Nation has tried to negotiate th peace plan between two sides from the December of 1950 and January of 1951. The Untied Nations' has achieved great results to negotiate for the peace plan on Korean peninsular after CCF's participation in Korean War. It's the results considering both the operation situation and political opinions.

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The Relationship between Quality of Life and Depression, Anxiety in Hemodialysis Patients (혈액투석 환자의 삶의 질과 우울, 불안과의 관계)

  • Jeon, Yeong Ae
    • Journal of Internet of Things and Convergence
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    • v.4 no.1
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    • pp.7-22
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    • 2018
  • This descriptive investigation aims to identify a relationship between QOL, depression, and anxiety in hemodialysis patients. I conducted this research on 130 subjects aged 19 or above who have received dialysis for at least one month in the hemodialysis unit at N hospital in the city of S. However, it came to 112 as I took out those who either quit, died, or filled out a questionnaire in the incorrect manner. In regards to average points of QOL on a 100-point scale, it is 57.77, demonstrating quite low QOL. Concerning average points of depression and anxiety, it is 12.25 and 10.52, respectively, showing quite a high figure. With regard to a correlation, there is a significant correlation between the three factors in hemodialysis patients: there is a negative correlation between QOL and depression (r=-.782, p<.001); a negative correlation between QOL and anxiety (r=-.719, p<.001); and a positive correlation between depression and anxiety (r=.873, p<.001). The outcome of multiple regression analysis on factors affecting QOL shows that depression is the element influencing QOL (β=-.585). Therefore, this study is significant in providing basic data for establishing intervention strategies aiming to reduce levels of depression which has the strongest impact on QOL in the patients and for developing a nursing intervention program intending to improve their QOL.