• 보건행정학회지
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• 제25권1호
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• pp.3-10
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• 2015

Background: Previous studies showed differences in healthcare utilization among insurance types. This study aimed to analyze the difference in healthcare utilization for percutaneous transluminal coronary angioplasty inpatients by insurance types after controlling factors affecting healthcare utilization using propensity score matching (PSM). Methods: The 2011 national inpatient sample based on health insurance claims data was used for analysis. PSM was used to control factors influencing healthcare utilization except insurance types. Length of stay and total charges were used as healthcare utilization variables. Patients were divided into National Health Insurance (NHI) and Medical Aid (MA) patients. Factors representing inpatients (gender, age, admission sources, and Elixhauser comorbidity index) and hospitals (number of doctors, number of beds, and location of hospitals) were used as covariates in PSM. Results: Tertiary hospitals didn't show significant difference in length of stay and total charges after PSM between two insurance types. However, MA patients showed significantly longer length of stay than that of NHI patients after PSM in general hospitals. Multivariate regression analysis provided that admission sources, Elixhauser comorbidity index, insurance types, number of doctors, and location of hospitals (province) had significant influences on the length of stay in general hospitals. Conclusion: Study results provided evidences that healthcare utilization was differed by insurance types in general hospitals. Health policy makers will need to prepare interventions to influence the healthcare utilization differences between insurance types.

• 근관절건강학회지
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• 제17권1호
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• pp.68-78
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• 2010

Purpose: This study was conducted to determine the effects of Tai-Chi exercise and self-help management program applying laughter therapy in patients with osteoarthritis. Methods: This quasi-experimental study recruited a sample of 61 patients with osteoarthritis (experimental group: 30, control group: 31) through the community healthcare centers located in Seoul and Kyung Gi area. The primary outcome measures included symptoms of osteoarthritis, basic physical performance, fatigue, and depression assessed before and after the study. The data were analyzed using SPSSWIN V. 12.0. Results: At the end of the six-week intervention, left shoulder flexibility (t=2.011, p=.049), 6m walking speed (t=3.639, p=.001), and right balance (t=-2.30, p=.025) were significantly improved in the control group. Fatigue (t=3.012, p=.004), stiffness (t=2,093, p=.041), right shoulder flexibility (t=2.138, p=.037), right balance (t=-2.065, p=.043), and 6m walking speed (t=2.683, p=.009) were significantly improved in the experimental group. Conclusion: A twice a week, 6-week tai-chi exercise self-help management program applying laughter therapy is effective in decreasing fatigue and stiffness. Osteoarthritis is one of common chronic diseases that the patients should be required to continue self management for the rest of their life. Therefore, there is a need to develop the more effective self-help management program and nursing intervention to motivate them to maintain their own self-help management.

• 성인간호학회지
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• 제27권3호
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• pp.251-261
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• 2015

Purpose: The aim of this study was to identify the levels of and the related factors to health literacy and health behavior compliance in patients with coronary artery disease. Methods: A cross-sectional survey was conducted with a convenience sample of 121 hospitalized patients with coronary artery disease. The structured questionnaires were used to measure the levels of health literacy and health behavior compliance. Results: The average linguistic health literacy score was $32.23{\pm}21.46$, the functional health literacy score was $6.51{\pm}5.08$, and the health behavior compliance score was $61.66{\pm}15.53$. The levels of education (${\beta}$=.35), income (${\beta}$=.27), and perceived health status (${\beta}$=.21) were found significant, explaining 41.8% of the variance in linguistic health literacy. The levels of education (${\beta}$=.23), income (${\beta}$=.27), age (${\beta}$=-.24), and family support (${\beta}$=.22) were found to be significant, explaining 50.9% of the variance in functional health literacy. The levels of education (${\beta}$=.27), family support (${\beta}$=.20), and linguistic health literacy (${\beta}$=.40) were found to be the significant factors, which explained 45.1% of the variance in health behavior compliance. Linguistic health literacy specifically explained 9.5% of health behavior compliance. Conclusion: Health literacy was associated with health behavior compliance, influencing the factors of health behavior compliance. These findings suggest that the interventions for improving health literacy are necessary to enhance health behavior compliance in patients with coronary artery disease.

• Journal of Preventive Medicine and Public Health
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• 제38권1호
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• pp.61-70
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• 2005

Objectives : To develop a tool for multidimensional measurement of the quality of life, which was psychometrically sound, short, and easy to administer for patients with hypertension. Methods : A sample of 1,115 hypertensive patients aged 20 or above in Cheong-Song County was studied from June 1997 to October 1998. In the development of the instrumental stage, the authors first conceptualized the quality of life. Item generation, item reduction, and questionnaire formatting were followed. Item-level (item descriptive, missing%, item internal consistency, item discriminant validity) analysis, scale-level (scale descriptive, floor and ceiling effect) analysis, and other tests(Cronbach's alpha, inter-dimension correlations, factor analysis, clinical validity) were performed to evaluate the validity and reliability of the new measurement scale. After 1 year, responsiveness and confirmatory factor analysis were performed. Results : The results of both item-level and scale-level analyses were acceptable. An acceptable degree of internal consistency was observed for each of the dimensions (Cronbach's alpha was 0.60 or higher). Inter-dimension correlations were below 0.50 and the factor analysis result was the same as the intended dimension structure. Correlation coefficients between perceived health status, stress and dimensions were proven to be acceptable. The result of comparing dimensional score means among ADL and MMSE-K groups above 60 years was statistically significant(p<0.05). The result of confirmatory factor analysis concluded that the dimensional structure model was well fitted. However, the result of responsiveness test using sensitivity and specificity was unsatisfactory. Conclusions : The newly developed measurement scale is psychometrically reliable and valid instrument for measuring quality of life in hypertensive patients.

• 지역사회간호학회지
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• 제24권4호
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• pp.419-426
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• 2013

Purpose: The purpose of this study is to examine factors influencing medication adherence in patients with hypertension. Methods: This study carried out a secondary analysis of data from the 2008 Korean National Health and Nutrition Examination Survey (KNHANES). Stratified sampling was used to select a participant sample that was representative of patients with hypertension throughout the country. Using the SPSS/WIN 18.0 program, data were analyzed using descriptive statistics, $x^2$ test, t-test, and logistic regression. Results: Of the patients with hypertension, 8.8% had showed non-adherence to medication. Medication adherence was associated with age, spouse, Medicare insurance, number of other diseases, and current smoking status. The cases with older age, a spouse, Medicare insurance, higher number of other diseases, and no current smoking status showed significantly high medication adherence. Conclusion: Nursing interventions and further studies are needed to achieve high levels of medication adherence based on factors influencing medication adherence such as age, spouse, Medicare insurance, number of other disease, and current smoking status.

• 여성건강간호학회지
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• 제20권1호
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• pp.83-91
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• 2014

Purpose: The purpose of this study was to identify relationships of resilience, Post-Traumatic Stress Disorder(PTSD), and quality of life of breast cancer patients. The findings from this study would provide baseline data needed for nursing intervention. Methods: A sample of 129 breast cancer patients was recruited from three hospitals in J and C cities in Korea. The survey was conducted with participants by utilizing self-reported questionnaires. Results: Quality of life showed statistically significant differences on religion (t=2.11, p=.033) and hobby (t=2.79, p=.006). Resilience and PTSD had a negative correlation (r=-.22, p=.010). Resilience and quality of life of the participants had a positive correlation (r=.58, p<.001), whereas PTSD and quality of life had a negative correlation (r=-.45, p<.001). Significant predictors of quality of life were resilience and PTSD. These variables explained 44.9% of the variance in quality of life. Conclusion: Findings indicate that as resilience of breast cancer patients rose higher and PTSD got lower, their quality of life increased. Based on these results, nursing interventions directed towards improving resilience and relieving PTSD is proposed.

• 대한두개안면성형외과학회지
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• 제25권2호
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• pp.71-76
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• 2024

Background: The rising incidence of dialysis-dependent end-stage renal disease (ESRD) has underscored the need for collaboration between plastic surgeons and nephrologists, particularly concerning preoperative and postoperative management for facial reconstruction. This collaboration is essential due to a scarcity of comprehensive information in this domain. Methods: A study initiated in January 2015 involved 10 ESRD cases on dialysis undergoing Mohs micrographic surgery for facial skin cancer, followed by reconstructive surgery under general anesthesia. To ensure surgical safety, rigorous measures were enacted, encompassing laboratory testing, nephrology consultations, and preoperative dialysis admission. Throughout surgery, meticulous control was exercised over vital signs, electrolytes, bleeding risk, and pain management (excluding nonsteroidal anti-inflammatory drugs). Postoperative assessments included monitoring flap integrity, hematoma formation, infection, and cardiovascular risk through plasma creatinine levels. Results: Adherence to the proposed guidelines yielded a notable absence of postoperative wound complications. Postoperative plasma creatinine levels exhibited an average decrease of 1.10 mg/dL compared to preoperative levels, indicating improved renal function. Importantly, no cardiopulmonary complications or 30-day mortality were observed. In ESRD patients, creatinine levels decreased significantly postoperatively compared to the preoperative levels (p< 0.05), indicating favorable outcomes. Conclusion: The consistent application of guidelines for admission, anesthesia, and surgery yielded robust and stable outcomes across all patients. In particular, the findings support the importance of adjusting dialysis schedules. Despite the limited sample size in this study, these findings underscore the effectiveness of a collaborative and meticulous approach for plastic surgeons performing surgery on dialysis-dependent patients, ensuring successful outcomes.

• 한국의료질향상학회지
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• 제7권2호
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• pp.204-216
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• 2000

Background : There has been a concern that the quality of care provided to end-stage renal disease (ESRD) patients in the United States may not be as good as recommended. This paper illustrates a composite measure to assess, the quality of care received by ESRD patients undergoing in-center hemodialysis by incorporating outcomes for 4 major treatment areas. The 4 treatment areas are: dialysis treatments, anemia control, nutritional management, and blood pressure control. Methods : The major data source for the study was the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study Wave 1 (DMMS-1) d Sixteen categories of a composite quality indicator were constructed by combining 4 dichotomous variables (16=2*2*2*2). representing the optimal vs. less than optimal level of outcome for each of the 4 treatment outcome measure respectively. Optimal outcome level for each treatment area was defined based on the recommendation from the National Kidney Foundation: (a) delivered dialysis doses (Kt/V) ${\geq}$ 1.2; (b) hematocrit level ${\geq}$ 30%; (c) serum albumin concentration ${\geq}$ 3.8g/dl ; and (d) blood pressure of <140 / <90mmHg. The 16 quality indicator were ranked according to their relative quality weights, which were estimated from its association with the relative risk of survival, adjusting for patient's baseline severity and dialysis facility characteristics. Results : Out of the entire sample of 2,179 patients, only 229 (10%) meet th recommended outcome levels for all 4 treatment areas. Overall, the study patients were distributed evenly over the 16 quality indicators, indicating a great variation in the quality of ESRD care. It appears that the rank of the 16 quality-indicators is driven by serum albumin concentration, suggesting that serum albumin concentration may be the most powerful predictor of ESRD patient survival among the 4 outcome measures. Conclusion : The developed quality indicator has the advantage of describin a range of care for dialysis patients and thus providing a more complete picture of care as compared to previous studies that have focused on only single or few components of the ESRD care.

• 동의생리병리학회지
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• 제24권3호
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• pp.519-524
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• 2010

This clinical study was done to examine comparison the prevalence of metabolic syndrome and obesity index between patients with silent lacunar infarction and normal controls. We compared the components of metabolic syndrome and obesity index between patients silent lacunar infarction(n=62) and normal controls(n=72). The analysis of the data was done by Frequency Analysis, two sample t-test, Chi-square Test. Hypertension and diabetes mellitus was significantly higher in patients of silent lacunar infarctions. Body mass index (BMI), waist-hip ratio (WHR), body fat percentage, obesity ratio, metabolic syndrome were higher significantly in patients of silent lacunar infarctions than normal controls. Although statistically insignificant, waist circumference showed relatively higher in patients of silent lacunar infarction. This result emphasizes the importance of managing that hypertension, diabetes, body mass index (BMI), waist-hip ratio (WHR), body fat percentage, obesity ratio, metabolic syndrome in silent lacunar infarction.

• 대한간호학회지
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• 제21권3호
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• pp.257-267
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• 1991

This study investigated the effects of nursing in formation given verbally and a booklet on the knowledge, Physical symptoms, anxiety and daily activities of patients recovering from open heart surgery from just before discharge to six weeks after discharge. The convenience sample was of patients who had undergone open heart surgery in Seoul National University Hospital. The first 25 patients who agreed to participate in the study became the control group. They did not receive the intentional information but the usual nursing care. The next 28 patients became the experimental group who received a booklet about their post-discharge care which was discussed with them by the researcher before discharge. This study used a non equivalent control group non - synchronized quasiexperimental design. The tools included a 30 item knowledge scale, a 9 item physical symptom scale, Spielberger's state anxiety scale, and a 28 item daily activity scale. The instruments were applied before discharge and at two and six weeks after discharge. For data analysis, frequency, t-test, Pearson's Correlational Coefficient and Cronbach's $\alpha$ were used. The results were as follows : 1. Information given through the booklet was effective in increasing the knowledge of patients recovering from open heart surgery. The experimental group's knowledge was higher at 2 weeks after discharge than prior to discharge (P＜0.05). 2. There was no significant difference in physical symptoms between the two groups at two and six weeks after discharge. 3. Information given through the booklet was effective in decreasing the State Anxiety two weeks after discharge (P＜0.001) but at six weeks after discharge, there was no significant difference in anxiety between the control and the experimental groups. 4. There was no significant difference in daily activity between the two groups at two and six weeks after discharge. 5. There was a negative correlation between knowledge at discharge and at 2 weeks and anxiety at 2 weeks after discharge. There was a positive correlation between knowledge at discharge and daily activity at 2 weeks after discharge. There was a negative correlation between knowledge at 2 weeks and Physical symptom at 6 weeks after discharge.