A critical assumption of the standard sample size calculation is that the response (outcome) for an individual patient is completely independent to that for any other patient. However, this assumption no longer holds when there is a lack of statistical independence across subjects seen in cluster randomized designs. In this setting, patients within a cluster are more likely to respond in a similar manner; patient outcomes may correlate strongly within clusters. Thus, direct use of standard sample size formulae for cluster design, ignoring the clustering effect, may result in sample size that are too small, resulting in a study that is under-powered for detecting the desired level of difference between groups. This paper revisit worked examples for sample size calculation provided in a previous paper using nomogram to easy to access. Then we present the concept of cluster design illustrated with worked examples, and introduce design effect that is a factor to inflate the standard sample size estimates.
The Journal of Korean Society for School & Community Health Education
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v.21
no.1
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pp.61-74
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2020
Objectives: This study aims to examine hypertension patients' quality of life by using the data of the 7th Korea National Health and Nutrition Examination Survey (1st year, 2016), identify the factors related to this, and utilize the results as basic data for intervention that can improve hypertension patients' quality of life. Methods: For the research subjects, this study extracted 1,531 patients who were diagnosed with hypertension by a doctor from the total sample of 8,150 participants of the 7th Korea National Health and Nutrition Examination Survey, and selected 1,072 patients with no missing value in the variables to be analyzed as the final research subjects. The SPSS(version25.0) program was used for the analysis of the collected data. Then, this study used a backward elimination multiple regression analysis method that applied complex sample, to examine the factors related with the finally estimated quality of life. Results: The results of this study revealed that hypertension patients' quality of life was related with age, occupation, spouse, household income, weight gain, restriction of activity, subjected health status, perceived stress, and presence of comorbidity. The final model explained 37.0% of the variance (Wald F=30.012 p<.001). Conclusions: When an intervention program is implemented for the improvement of hypertension patients' quality of life in the future, it will be effective to construct the program according to age group, employment, marital status and household income. As for the program operation, patients should get help therefrom to control weight, facilitate activities and relieve their stress, and they should be also motivated to feel healthy. Furthermore, education should be offered so that they appropriately manage their underlying disease at an early stage.
The Journal of Churna Manual Medicine for Spine and Nerves
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v.17
no.2
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pp.131-139
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2022
Objectives This study aimed to analyze the medical utilization of low back pain (LBP) patients after back surgery and estimate the medical costs of Korean and Western medicine collaborative treatment, odds ratio, and hazard ratio between the two groups using the 2019 Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS-2019). Methods Data management and descriptive analysis, logistic regression, and survival analysis were conducted for defining and estimating the LBP patients after back surgery in the NPS 2019 dataset. Results A total of 216,424 patients out of 991,189 were identified as having LBP. Among the patients with LBP, 1,734 were treated with surgery while 214,690 were not. Among those who had surgery, 937 were treated with conventional treatments only and 797 underwent Korean medicine treatments. The odds ratio of the logistic regression analysis was 0.7129, suggesting that Korean medical treatment experience group had a 28.7% lower risk of reoperation than the Western medical treatments only group. The hazard ratio of the survival analysis was 0.9145; thus, the risk probability of reoperation was estimated to be approximately 8.55% lower. The 50% risk of reoperation was 69 days (0.5044) for the conventional group, and 97 days (0.5008) for the Korean medical group in the survival analysis using the Kaplan-Meier graph. Conclusions These results could be utilized in future studies in conducting economic evaluation for estimating cost-effectiveness of Western medicine and Korean medicine treatment compared to Western medicine alone in LBP patients after back surgery in a South Korean perspective. mended and should be applied while taking the necessary precautions.
The Journal of Korean Society for School & Community Health Education
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v.23
no.2
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pp.51-64
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2022
Objectives: This study aims to examine diabetic patients' quality of life by using the data of the 8th Korea National Health and Nutrition Examination Survey (1st year, 2019), identify the factors related to this, and utilize the results as basic data for intervention that can improve diabetic patients' quality of life. Methods: For the research subjects, this study extracted 624 patients who were diagnosed with Diabetes by a doctor from the total sample of 8,110 participants of the 8th Korea National Health and Nutrition Examination Survey. The SPSS(version25.0) program was used for the analysis of the collected data. Then, this study used a backward elimination multiple regression analysis method that applied complex sample, to examine the factors related with the finally estimated quality of life. Results: The results of this study revealed that diabetic patients' quality of life was related with gender, age, occupation, restriction of activity, subjected health status. The final model explained 35.7% of the variance (Wald F=28.210, p<.001). Conclusions: In order to improve the quality of life of diabetic patients, it would be desirable to provide differentiated management by developing a customized intervention strategy that takes into account gender, age, and occupation. When managing diabetic patients, the state, local governments, and hospitals should include content that prevents and copes with restrictions on activities that may occur due to disease. In addition, it is required to prepare a strategy to induce positive perception of the subject's own health status.
Journal of Korean Academy of Fundamentals of Nursing
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v.17
no.4
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pp.508-519
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2010
Purpose: This study was done to identify the types of pain identification made by nurses caring for patients with dementia in nursing homes. Method: To collect the Q-population, 12 nurses working in nursing homes were interviewed. From the collected data, 69 statements were derived and eight patterns of pain identification were categorized. Thirty statements were derived as the Q-sample. Thirty nurses were sampled as the P-sample. The 30 Q-cards with Q-statements were Q-sorted by the P-sample. The results of the Q-sorting were coded and analyzed using the PC QUANL program. Results: Five types of pain identification were identified by nurses for patients with dementia living in nursing homes; Type 1 was named "estimating based on verbal expressions". Type 2 was named "reasoning through physical symptoms". Type 3 was named "confirming pain based on nonverbal expressions being consistent with conditions of physical function". Type 4 was named "empathizing with vocal expressions". Type 5 was named "confirming by comparison with objective pain indicators one by one". Conclusions: The results of this study indicate that comprehensive understanding of pain identification by nurses could help improve the assessment of pain in patients with dementia.
Background: Chronic obstructive pulmonary disease (COPD) is not completely reversible and requires long-term management with appropriate treatment. This study aimed to analyze trends in treatment regimens and medication costs for COPD patients using a national claims database. Methods: We conducted this analysis using National Patient Sample data from the Health Insurance Review and Assessment Service covering the period from 2015 to 2018. We have constructed a dataset comprising COPD disease classification codes J43.x and J44.x (based on KCD-7 code, J43.0 was excluded) and compiled a list of drugs fitting current guidelines. To identify trends, we calculated frequency, ratio, and compound annual growth rate (CAGR) using the numbers of prescriptions and patients. Results: The number of COPD patients was 7,260 in 2018, slightly decreased from 2015. Most of these COPD patients were aged 60 or older and included a high proportion of males (72.2%; 2018). The number of patients prescribed inhaled medications increased gradually from 2015 to 2018 (9,227 (47.1%); 2015, 9,285 (51.5%); 2018), while the number of patients prescribed systemic beta-agonists and Xanthines has decreased since 2015 (CAGR -14.7; systemic beta-agonist, -5.8; Xanthines). The per capita cost of medication has increased by 0.4% (KRW 206,667; 2018, KRW 204,278; 2015) annually during the study period. Conclusion: This study showed that treatment with inhaled medications had continuously increased in accord with changing guidelines, but oral medications were still widely used. It is necessary to emphasize the importance of inhaled medications in treating COPD to reduce additional economic burden through appropriate medication use.
Objectives: The purpose of this study was to examine the association between two major oral diseases and cardiovascular diseases. Methods: Data from the 6th Korean National Health and Nutrition Examination Survey (2013-2015) were used. The study included 12,754 adults, aged ${\geq}19years$, who participated in the questionnaire survey of health related to hypertension, stroke, myocardial infarction, and angina pectoris as well as completed blood tests, anthropometry, and oral examination. Statistical analyses included complex sample frequency, complex sample general linear, complex sample cross-tabulation, and complex sample logistic regression analyses. Results: With respect to the number of Decayed-Missing-Filled-Teeth(DMFT ), patients with hypertension (DMFT 8.05), stroke (DMFT 8.66), and angina pectoris (DMFT 8.24) showed a DMFT score of >2, compared with those who did not have these diseases (p<0.05). Patients with hypertension, stroke, myocardial infarction, and angina pectoris presented an approximately 2.7, 3.5, 4, and 3 times higher incidence of periodontal diseases, respectively, than those who did not (p<0.05). Based on the analysis of the relationship between the number of DMFT and cardiovascular diseases, patients with cardiovascular diseases had a risk of 1.033 higher DMFT than those who did not (p<0.05). As per the analysis of the relationship between periodontal diseases and cardiovascular diseases, patients with cardiovascular diseases had a 2.969 higher risk of periodontaldiseasesthanthosewithout them (p<0.05). Conclusions: Two major oral diseases were found to be associated with cardiovascular diseases. Therefore, to prevent these major oral diseases in patients with cardiovascular diseases, oral hygiene management must be actively performed.
Kang, Jeongmook;Park, Yoon-Hyung;Yang, Kwang Ik;Cruz, Jose Rene Bagani;Hwangbo, Young
Journal of Preventive Medicine and Public Health
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v.53
no.1
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pp.37-44
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2020
Objectives: This study investigated the effects of comorbid sleep disorders (SD) on the incidence of cardiovascular complications among newly-diagnosed hypertension (HTN) patients. Methods: As study population, 124 057 newly-diagnosed essential HTN patients aged 30 or older, without cardiovascular complications at diagnosis with HTN, were selected from the National Health Insurance Service-National Sample Cohort. The incidence of cardiovascular complications was calculated, Cox proportional-hazards regression model was used to analyze the risk of complications, and the population attributable fraction (PAF) for cardiovascular complications of having comorbid SD at HTN diagnosis was calculated. Results: Over 10 years, 32 275 patients (26.0%) developed cardiovascular complications. In HTN patients with comorbid SD at diagnosis of HTN, the incidence of cardiovascular complications (78.3/1000 person-years; 95% confidence interval [CI], 75.8 to 80.9) was higher than in those without comorbid SD (58.6/1000 person-years; 95% CI, 57.9 to 59.3) and the risk of cardiovascular complications was 1.21 times higher (95% CI, 1.17 to 1.25), adjusting for age, gender, income, area of residence, and comorbid diabetes mellitus. The PAF of having comorbid SD at diagnosis of HTN for the incidence of cardiovascular complications was 2.07% (95% CI, 1.69 to 2.44). Conclusions: Newly-diagnosed essential HTN patients aged 30 or older who had comorbid SD at the time of their HTN diagnosis had a higher incidence of cardiovascular complications than those without comorbid SD. Age, gender, income, area of residence, and comorbid diabetes mellitus had a significant effect on the incidence of cardiovascular complications. Approximately 2% of cardiovascular complications were found to occur due to the presence of SD.
Objectives: To lay the foundation for future research into Korean Medicine treatment for Rotator Cuff repair surgery patients by analyzing Korean Medical and Western Medical service utilization and treatment duration. Methods: Data sampling was performed on 2015's HIRA patient data (confidence level of 97%) to analyze patients' Korean Medical and Western Medical service usage tendency. Sampled groups were divided into two groups: i) Patients who completed their treatment within five months after the rotator cuff surgery (termination group), ii) Patients who were treated for more than five months after the surgery (continuation group). Then the patients' Korean Medical and Western Medical service usage tendency was investigated and information of these patients are arranged. Results: Out of 1,453,486 patients who were gathered for sampling, 2,461 patients in total had gone through rotator cuff repair surgery. The termination group had 517 patients and the continuation group had 541 patients. The proportion of patients who visited a Korean Medicine clinic was lower in the termination group than the continuation group. Conclusion: The continuation group received more treatments (both in Western Medicine and Korean Medicine) and spent more on medical expenses compared to the termination group. Further research is highly recommended for more efficient Western Medicine and Korean Medicine treatments and reduced medical expenditure.
Park, So Young;Jung, Jae Yun;Kwak, Young Ho;Kim, Do Kyun;Suh, Dong Bum
Journal of Trauma and Injury
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v.25
no.4
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pp.152-158
/
2012
Purpose: To understand the epidemiology of head trauma and the utilization of brain CT in Korea, we analyzed a national sampling data set, the National Patient Sample obtained from the Health Insurance Review and Assessment Service. Methods: We retrospectively collected and analyzed demographic and clinical data on enrolled patients from the National Patient Sample based on medical claims data for 2009. The data included patient's age, sex, treatment date, diagnosis codes, procedure codes related with CT, holiday or night consultation fee, and fee for emergency management services. Results: In 2009, the estimated population with head trauma was 819,059(1.8%), and the rate of brain CT utilization was 22.4%. Children ages 5 to 15 were the most commonly injured group(22.8%), but had the lowest brain CT utilization(16.5%). The mean age of the estimated population with head trauma was $34.9{\pm}0.5years$ old, and male patients accounted for 60.5% of that population. Intracranial injury was found in 8.6% of all head traumas, and the rate of intracranial injury in children was lower than it was in adults(4.1% vs. 10.9%, p<0.001). Twenty- three percent of patients with head trauma visited the emergency department (ED). More patients with head trauma visited medical facilities in the daytime on weekdays(66.5% vs. 33.5%, p<0.001), but head CT was performed more frequently at night or on weekends/holidays(16.1% vs. 34.7%, p<0.001) There is low incidence of head trauma in the winter in children (p<0.001). In the multivariate logistic regression analysis, patients who were adults, female, or ED visitors were more likely to undergo brain CT (odds ratio (OR): 1.65, 95% confidence interval (CI): 1.47-1.84; OR: 1.40, 95% CI: 1.27-1.54; OR: 7.80, 95% CI: 6.91-8.80, respectively). Conclusion: In this study, we analyzed the national epidemiologic trend for head trauma, and the pattern of utilization of brain CT.
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