• Tuberculosis and Respiratory Diseases
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• 제67권5호
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• pp.422-429
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• 2009

Background: The discomfort caused by chronic cough, that is persistent for more than 3 weeks, causes a number of patients to seek medical attention. However, the underlying disorder often remains undetermined despite thorough examinations, and is considered to be idiopathic. This study compared the efficacy of inhaled corticosteroid with conventional cough suppressants on chronic idiopathic cough. Methods: Eligible patients with chronic idiopathic cough were randomly assigned to either the inhaled fluticasone group or the codeine plus levodropropizine oral administration group. The subjects in each group took their planned medication for 2 weeks. After the trial, comparative analyses of outcomes were performed in terms of the remnant cough (%) at the end of treatment, drug compliance, and adverse drug events. Results: Seventy-seven patients were enrolled in this randomized trial; 38 to the inhaled fluticasone group and 39 to the codeine plus levodropropizine group. The remnant cough was 41.0${\pm}$35.8% in the inhaled fluticasone group, and 32.4${\pm}$32.0% in the codeine+levodropropizine group (p=0.288). Drug compliance was 95.4${\pm}$7.4% and 81.8${\pm}$18.6% in the inhaled fluticasone and the codeine+levodropropizine group, respectively (p<0.001). Nine patients had adverse drug events in the codeine+levodropropizine group compared to one in the inhaled fluticasone group (p<0.001). Conclusion: Short-term inhaled corticosteroid is not inferior to conventional antitussive agents in controlling chronic idiopathic cough without significant adverse events.

• Tuberculosis and Respiratory Diseases
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• 제69권3호
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• pp.163-170
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• 2010

Background: Pulmonary tuberculosis remains a health concern in Korea despite major progress in the development of new strategies for diagnosing and treating tuberculosis. In particular, the diagnosis of newly developed pulmonary tuberculosis is on the rise in elderly persons. The aim of this study was to investigate the clinical, radiographic characteristics, and treatment outcomes of pulmonary tuberculosis in the elderly. Methods: The medical records of 113 young (<65 years old) and 112 elderly (${\geq}65$ years old) pulmonary tuberculosis patients diagnosed at Chungnam National University hospital between January 2007 and December 2008 were reviewed. Results: There was no difference in the prevalence of typical symptoms between the younger and the elderly group. Dypsnea was the only symptom that occurred more frequently in the elderly group (16.8% vs 5.5%, p=0.008). On radiological study, pneumonic infiltration type was more common in the elderly group (28.6% vs 16.8%, p=0.035). Sputum Acid fast bacilli smear positivity rate was similar between the 2 groups. Elderly patients with anti-tuberculosis medication had more frequent adverse drug reactions; however, there was no significant difference between the 2 groups in the number of patients required to stop medication due to an adverse drug reaction. There were more patients lost to follow-up in the elderly group (22/112, 19.6% vs 11/113, 9.7%, p=0.036). Conclusion: The majority of elderly patients did not complete the treatment, resulting in a poorer outcome. Therefore, we need to make an effort to support the continued screening of elderly patients by making this economically feasible.

• 대한지역사회영양학회지
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• 제3권1호
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• pp.76-93
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• 1998

Three hundred sixty-two(male 131, female 231) elderly aged over 65 in Chungb- uk area were interviewed to determine the disease states and drug usage patterns. The prebalence of disease was 78% and women reported more chronic diseases(83%) than men(71%). Elderly who live with spouse and have an occupation have a lower rate of disease. Average number of diseases of the elderly was $1.8\pm{1.1}$, and women$(2.1\pm{1.3)}$ have significantly higher average number of diseases than that of men$(1.4\pm{0.7)}$. Also the elderly in urban areas$(2.1\pm{1.4)}$ have significantly higher number of diseases than that of the elderly in rural areas$(1.6\pm{0.9)}$. Arthritis, hypertension, cardiovascular and gastric diseases were the most frequently listed chronic diseases in order for both men and women. Anemia and fracture of bone were relatively higher in women than in men. Particularly, the arthritis of the urban elderly have a rate of 1.5 times higher than that of the rural elderly. Fifty-two percent of the elderly were currently using drugs ; among drug users 71.2% used prescription drugs and 20.5% used nonprescription drugs. The average number taken per person was 2.1$\pm$1.4 and there was no sex or age difference. However, the elderly in rural areas $(2.7\pm{1.7)}$ consumed a significantly higher number of drugs than those in urban areas$(1.7\pm{0.7)}$. The average number of prescripti- on drugs taken was 2.0$\pm$1.4 while the average of nonprescription drugs taken was $(1.3\pm{0.6)}$. Analgesics and antihypertensive drugs were most commonly used. Vitamin and analgesics were the most frequently used self-prescribed drugs. It was noted that potential adverse drug interaction by concominant drug consumption for arthritis and antihypensive drug, abuse of digestants and antiacid without treatment of the underlying disease, and misuse of quick-acting bowel medications were problematic for the elderly. In addition drugs used for the elderly have some adverse effect on the digestive system. The types and composition of drugs used by the elderly were identified and presented. Medication compliance was poor and 13.5% reported adverse reactions such as edema, heartburn, nausea, and difficulty with eating. Seventeen percent of the elderly obtained drugs arranged by those other than medical staff. Also, even among those elderly who obtained drugs prescribed by a doctor, 69.1% of subjects had not receive instruction about potential adverse reactions. These results suggest that nutritional problems related to drug usage might exist and so dietitians, either individually or as members of health teams, need to have a better understanding of drug-nutrient interaction and closer supervision, and drug information/education service should therefore be provided to prevent or minimize adverse drug reaction in elderly users of medication.

• 재활간호학회지
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• 제15권2호
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• pp.91-99
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• 2012

Purpose: The purpose of this study was to identify the frequency and status of mentally ill patients who registered in a community health center (CHC) but they could not be accessed. Methods: A total of 233 mentally ill individuals who were registered to a CHC in B Metropolitan City participated in this survey. Data were collected from December 1 to 31, 2010 and analyzed. Results: There were 140 (60.1%) community dwelling mentally ill patients who had been registered to that CHC but were not accessible. The major reasons of this inaccessibility were patients' rejection to be accessed (27.1%) and the wrong or missing address in hospital's discharge note (22.9%). The nursing problems of the subjects were rejection of medication (93.4%); poor personal hygiene (85.8%); violence including harassment of family member(s), assault, property destruction, threat with weapon (38.7%); and so on. Among 159 cases of referrals and requests for help immediate action with patient's compliance were only 8.8%. Conclusion: The findings show that mentally ill patients who had registered to the CHC but were not able to be accessed failed to be managed properly. This would become risk factors of social problems which threat to the community as well as individuals. Thus, we need to prepare programs for this population to make them take medicine at a minimum.

• 한국콘텐츠학회논문지
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• 제20권11호
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• pp.342-353
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• 2020

본 연구는 COPD 환자의 일상적인 자가관리와 증상악화 시 대처 경험을 알아보고자 시행되었다. 32명의 COPD 환자를 대상으로 1:1 면담을 시행하였으며 수집된 자료는 내용분석을 시행하였다. 연구결과 COPD 환자의 일상생활 자가관리에 대한 경험은 '질병예방활동을 수행함', '가벼운 운동을 시행함', '약물복용방법을 준수함', '식이관리를 시행함', '휴식을 취함' 의 5가지 주제가 도출되었다. 그리고 COPD 증상 악화시 대처에 대한 경험은 '의료서비스를 이용함', '충분하게 휴식을 취함', '처방약물을 복용함', '호흡법을 시행함' 의 4가지 주제가 도출되었다. COPD 환자의 증상 악화시 구체적인 증상 및 대처법에 대한 교육이 필요하며 자가관리 및 증상악화 시 대처 경험 중 자가관리 관련 선행문헌에 포함되지 않은 항목의 과학적 효과를 확인하는 연구가 필요하다.

• Journal of Preventive Medicine and Public Health
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• 제47권4호
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• pp.236-243
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• 2014

Objectives: Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness. Methods: We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes) and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis. Results: Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants' compliance with treatment. Conclusions: For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established.

• Asian Pacific Journal of Cancer Prevention
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• 제15권21호
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• pp.9225-9232
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• 2014

Ensuring adherence to chemotherapy is important to prevent disease progression, prolong survival and sustain good quality of life. Capecitabine is a complex chemotherapeutic agent with many side effects that might affect patient adherence to treatment. This cross sectional study aimed to determine adherence to capecitabine and its contributing factors among cancer outpatients in Malaysia. One hundred and thirteen patients on single regime capecitabine were recruited from Hospital Sultan Ismail and Hospital Kuala Lumpur from October 2013 to March 2014. Adherence was determined based on adherence score using validated Medication Compliance Questionnaire. Patient socio-demographics, disease, and treatment characteristics were obtained from medical records. Satisfaction score was measured using the validated Patient Satisfaction with Healthcare questionnaire. The mean adherence score was 96.1% (standard deviation: 3.29%). The significant contributing factors of adherence to capecitabine were Malay ethnicity [${\beta}=1.3$; 95% confidence interval (CI): 0.21, 2.43; p value=0.020], being female [${\beta}=1.8$; 95%CI: 0.61, 2.99; p value=0.003]), satisfaction score [${\beta}=0.08$; 95%CI: 0.06, 1.46; p value=0.035], presence of nausea or vomiting [${\beta}=2.3$; 95%CI: 1.12, 3.48; p value <0.001] and other side effects [${\beta}=1.45$; 95%CI: 0.24, 2.65; p value=0.019]. Adherence to capecitabine was generally high in our local population. Attention should be given to non-Malay males and patients having nausea, vomiting or other side effects. Sufficient information, proactive assessment and appropriate management of side effects would improve patient satisfaction and thus create motivation to adhere to treatment plans.

• Asian Pacific Journal of Cancer Prevention
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• 제17권4호
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• pp.2329-2336
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• 2016

Background: Despite the existence of established guidelines advocating the use and value of chemotherapy order templates, chemotherapy orders are still handwritten in many hospitals in Lebanon. This manuscript describes the implementation of standardized chemotherapy order templates (COT) in a Lebanese tertiary teaching hospital through multiple steps. Initial Assessment: An initial assessment was conducted through a retrospective appraisal of completeness of handwritten chemotherapy orders for 100 adult patients to serve as a baseline for the project and identify parameters that might afford improvement. Choice of solution: Development of over 300 standardized pre-printed COTs based on the National Comprehensive Cancer Network templates and adapted to the practice culture and patient population. Implementation: The COTs were implemented, using Kotter's 8-step model for leading change, by engaging health care providers, and identifying and removing barriers. Evaluation: Assessment of physicians' compliance with the new practice (122 orders assessed) was completed through two phases and allowed for the identification of areas of improvement. Lessons Learned: Overall, COT implementation showed an average improvement in order completion from 49.5% (handwritten orders) to 77.6% (phase 1-COT) to 87.6% (phase 2-COT) reflecting an increase of 38.1% between baseline and phase 2 and demonstrating that chemotherapy orders completeness was improved by pre-printed COT. As many of the hospitals in Lebanon are moving towards standardized COTs and computerized physician order entry (CPOE) in the next few years, this study provides a prototype for the successful implementation of COT and demonstrates their role in promoting quality improvement of cancer care.

• Tuberculosis and Respiratory Diseases
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• 제72권5호
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• pp.426-432
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• 2012

Background: Varenicline is an effective smoking cessation aid. However, smokers prescribed with varenicline do not always receive varenicline for 12 weeks, as recommended. This study analyzed the subjects who received varenicline and investigated the effect of varenicline treatment duration on the success rate of 6-month smoking cessation. Methods: This study retrospectively analyzed 78 subjects, who received varenicline, out of the 105 smokers that had visited the smoking cessation clinic after medical examination from September 2007 to December 2009. Results: The subjects were all males. Twenty-two subjects (28.2%) had varenicline treatment for 12 weeks or longer; 18 subjects (23.1%) for 8~12 weeks; 22 subjects (28.2%) for 4~8 weeks; and 16 subjects (20.5%) for less than 4 weeks. The total success rate of the 6-month smoking cessation was 47.4%. The success rate of the 6-month smoking cessation was 63.6% in the group that received varenicline for 12 weeks or longer, which was higher than 41.1% of the group that early terminated the varenicline treatment (p=0.074). The period of varenicline treatment was extended for one more week, the odds ratio of the 6-month smoking cessation success increased to 1.172-folds (p=0.004; 95% confidence interval, 1.052~1.305). Adverse events occurred in 30.8% of the subjects who received varenicline, but no serious adverse events were found. Conclusion: If varenicline treatment period is extended, the odds ratio of the success rate for the 6-month smoking cessation increases. Therefore, an effort to improve drug compliance for varenicline in clinical practices could be helpful for the long-term success of smoking cessation.

• 지역사회간호학회지
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• 제18권4호
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• pp.572-582
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• 2007

Purpose: This study was to evaluate the effects of visiting nursing intervention on self care behavior and blood pressure with high risk of cerebrovascular diseases. Method: A one-group pretest-posttest was designed. Data collection was done in 150 participants from March. 2003 to November, 2003 at a public health center. Self care behavior was assessed by the scores of smoking, alcohol, diet, exercise, stress and medication compliance. The scores of knowledge related cerebrovascular diseases, blood pressure, blood glucose were estimated. The Participants were intervened in with basic assessment, emotional support, education. This program took a period ranging from 3 months to 7 months depending on the cerebrovascular risk level. The mean number of visiting times was 1.67 per month. Result: 1. Knowledge level was improved(t=-2.542, p= .012). 2. Systolic and diastolic pressure were lower(t=5.439, p<.001; t=4.966, p<.001) 3. Self care level was higher (t=-12.981, p=.001) after the intervention. Conclusion: The visiting nursing intervention was found to have an effect on the scores of knowledge, self care behavior and blood pressure with high risk of cerebrovascular diseases. The results provided evidences for the importance of visiting nursing intervention in the high risk factor of cerebrovascular disease for self care.