• Women's Health Nursing
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• v.8 no.2
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• pp.151-164
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• 2002

PURPOSE: Estrogen replacement therapy is indicated for the relief of hot flushes and urogenital atrophy, the prevention of osteoporosis and the reduction in risk of cardiovascular disease. The present study assessed by blood pressure, heart rate variability, and climacteric symptoms in menopausal women before treatment and at 1 month during estrogen replacement therapy. METHODS: The study sample consisted of 16 healthy menopausal women (range 49 to 59 years, mean : 53.4 years) attending menopausal clinics for the complaint of climateric symptoms at S. hospital in Chunchoen. They were all non-smokers and no patient had symptoms or evidence of cardiovascular disease. They took estrogen replacement therapy (conjugated estrogen 0.625 mg with or without medroxy progesteron 2.5mg) for 1 month. Blood pressure, heart rate variability(heart period and vagal tone) through ECG, and climacteric symptom were measured in all subjects before treatment and at 1 month during treatment. Climacteric symptom questionnaire which was developed by Neugarten et al.(1963) was modified with 20 items of question(Cronbach's alpha = 88 -.89). The data was collected from Sept. 1. 2000 to July. 30. 2001. RESULTS: There was no significant difference in mean systolic and diastolic pressure between the baseline and at 1 month during treatment. The mean heart period and vagal tone were slightly increased, but difference of mean heart period and vagal tone were not statistically significant between the baseline and at 1 month during treatment. The score of climacteric symptoms decreased significantly from the baseline after treatment. CONCLUSIONS: Even though, this study did not show that estrogen replacement therapy led decrease of blood pressure and increase heart rate variability, climacteric symptoms reduced much in all subjects after taking drugs. These results suggest that there is need to repeat study with long term period.

• Korean Journal of Adult Nursing
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• v.26 no.2
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• pp.191-202
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• 2014

Purpose: This study was aimed to survey the actual caregiving conditions of family caregivers who are caring patients with rare and incurable diseases using home ventilators at home, and to clarify any factors affecting their burdens and quality of life. Methods: A questionnaire survey was performed by the 159 subjects, and the questionnaires contained the actual conditions of caregiving activities, and caregiver's burdens and quality of life. The collected data was analyzed by ANOVA, Pearson's correlation, and stepwise linear regressions. Results: The mean of burden scores was 3.55 out of 5, and influencing variables included the relationships with patient (spouse), respite (moderate), health status, and diagnosis (non ALS), with the explanatory power of 30.0%. The mean of the quality of life was 2.58 point, and the influencing variables included burdens, health status, and respite (enough), with the explanatory power of 39.0%. Conclusion: In order to improve the quality of life among family caregivers caring for patients with using a home ventilator, it is required to develop strategies for reducing caregiving burdens as well as to introduce family respite welfare systems to family caregivers.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.7
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• pp.3173-3177
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• 2016

Background: The Ministry of Public Health (MOPH) in Lebanon provides cancer drugs free of charge for uninsured patients who account for more than half the total case-load. Other categories of cancer care are subsidized under more stringent eligibility criteria. MOPH's large database offers an excellent opportunity to analyze the cost of cancer treatment in Lebanon. Materials and Methods: Using utilization and spending data accumulated at MOPH during 2008-2013, the cost to the public budget of cancer drugs was assessed per case and per drug type. Results: The average annual cost of cancer drugs was 6,475$ per patient. Total cancer drug costs were highest for breast cancer, followed by chronic myeloid leukemia (CML), colorectal cancer, lung cancer, and Non-Hodgkin's lymphoma (NHL), which together represented 74% of total MOPH cancer drug expenditure. The annual average cancer drug cost per case was highest for CML ($31,037), followed by NHL ($11,566). Trastuzumab represented 26% and Imatinib 15% of total MOPH cancer drug expenditure over six years. Conclusions: Sustained increase in cancer drug cost threatens the sustainability of MOPH coverage, so crucial for socially vulnerable citizens. To enhance the bargaining position with pharmaceutical firms for drug cost containment in a small market like Lebanon, drug price comparisons with neighboring countries which have already obtained lower prices may succeed in lowering drug costs.

• Korean Journal of Adult Nursing
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• v.25 no.1
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• pp.62-73
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• 2013

Purpose: This study was conducted to examine the effects of tailored supportive education on physical, psychological status and quality of life in the patients with congestive heart failure (CHF) who had not participated previously in cardiac rehabilitation program. Methods: This study was used a non-equivalent control pre-post design, conducted on 64 CHF patients under medical treatment in a hospital. The experimental group (n=31) received the tailored supportive educational program (once 1~2 days before discharge and 6 times after discharge through outpatient visits or telephone contact: once every week for the first 4 weeks after discharge and once every 2 weeks for the remaining 4 weeks). The control group (n=33) received a traditional discharge education. Data were analyzed using descriptive statistics, ${\chi}^2$-test, Fisher's exact test, t-test and repeated measure ANOVA using the SPSS/ WIN 18.0 program. Results: Participants in the experimental group showed the significantly increased scores of the quality of life (F=16.01, p<.001), and the significantly decreased scores of physical function (F=7.27, p=.009), depression (F=8.25, p=.006) and anxiety (F=4.11, p=.047), when compared to those of the control group. Conclusion: The findings indicated tailored supportive education was an effective intervention care in physical, emotional status and quality of life for CHF patients.

• Journal of Korean Clinical Nursing Research
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• v.18 no.2
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• pp.205-214
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• 2012

Purpose: The purposes of this study were to develop the constipation assessment tool for identifying their bowel movement patterns, and to provide basic information for the assessment and intervention protocol on constipation for patients with terminal cancers. Methods: The study followed the steps: the first step was to build a conceptual framework based on literature review; the second step was to develop a tentative instrument by analyzing the conceptual framework and existing instruments; the third step was to test content validity and reliability; and the final step was to apply the tool to patients with terminal cancers (N=112). Results: The constipation assessment tool was consisted of total nine items; under the categories of subjective and objective data for diagnosis had 4 items, and under the initial assessment category which includes stool type, physical examination, and abdomen X-ray had 5 items. Conclusion: The constipation assessment tool developed in this study is very easy to use and useful in nursing practice, especially in hospice and palliative care setting. Particularly this tool has items on patient assessment which would be considered as an evidence for choosing nursing interventions. Based on the constipation assessment tool, the development and application of intervention protocol on constipation for patients with terminal cancers is warranted in future research.

• Archives of Plastic Surgery
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• v.39 no.4
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• pp.397-403
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• 2012

Background Nonabsorbable sutures are favorable for repairing flexor tendons. However, absorbable sutures have performed favorably in an animal model. Methods Two-strand sutures using the interlocking modified Kessler method with polydioxanone absorbable sutures 4-0 were used to repair completely ruptured flexor tendons in 55 fingers from 41 consecutive patients. The medical records of average 42 follow up weeks were analyzed retrospectively. The data analyzed using the chi-squared test, and Fisher's exact test was used for postoperative complications. The results were compared with those of other studies. Results Among the index, middle, ring, and little fingers were injured in 9, 17, 16, and 13 fingers, respectively. The injury levels varied from zone 1 to 5. Of the 55 digits in our study, there were 26 (47%) isolated flexor digitorum profundus (FDP) injuries and 29 (53%) combined FDP and with flexor digitorum superficialis injuries. Pulley repair was also conducted. Concomitant injuries of blood vessels and nerves were found in 17 patients (23 fingers); nerve injuries occurred in 5 patients (10 fingers). Two patients had ruptures (3.6%), and one patient had two adhesions (3.6%). Using the original Strickland criteria, all the patients were assessed to be excellent or good. Also, fibrosis and long-term foreign body tissue reactions such as stitch granuloma were less likely occurred in our study. Compared to the Cullen's report that used nonabsorbable sutures, there was no significant difference in the rupture or adhesion rates. Conclusions Therefore, this study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repairs.

• Journal of Hospice and Palliative Care
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• v.16 no.1
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• pp.33-41
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• 2013

Purpose: This study was conducted to examine how nurses' death anxiety and terminal care stress affect their terminal care performance in the clinical setting. Methods: The study enrolled 180 registered nurses with experience of attending dying patients at a university hospital located in Seoul, Korea. Collected data were analyzed with descriptive statistics, one-way ANOVA and Pearson's correlation using SPSS 18.0 for Windows. Results: Nurses showed significant differences in the level of death anxiety and terminal care stress as well as terminal care performance by working division, marital status, educational background and hospice training. A significant relationship was found between terminal care stress and terminal care performance. Conclusion: The study results showed that efforts to ease nurses' death anxiety and terminal care stress could improve their terminal care performance. Further study should be conducted to investigate other factors that affect nurses' terminal care performance from various perspectives and develop a terminal care manual which can be used as guidance for nurses in charge of terminal patient care.

• Health Policy and Management
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• v.21 no.2
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• pp.249-262
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• 2011

Since May 1st in 2008, the products of ginkgo biloba extract have had to be used with the patient's out-of-pocket payment due to reimbursement restriction guidelines. This study aims to analyze the policy effects of reimbursement restriction on pharmaceutical expenditures using interrupted time series(ITS) analysis. We retrieved monthly NHI claims data for the period between May, 2005 and December 2009. The ingredients identified as a substitute for ginkgo biloba have similar indications based on the similar pharmacological activities. The effects of changes in reimbursement scope were evaluated both for all relevant pharmaceuticals within the same therapeutic class and for 2 separate groups : ginkgo biloba's and its substitutes. According to the study results, restrictions on reimbursement scope resulted in savings of the drug expenditures in the targeted therapeutic class. Direct restriction on ginkgo biloba was associated with a decrease in expenditure level by 60.1% and changes in trend from an average increase rate of 1.4% to an average decrease rate of 1.5% for the therapeutic class, with a dramatic decrease in expenditure level(-191.5%) for ginkgo biloba itself, but with an increased expenditure level(+50.1%) and changes in trend from an average increase rate of 2.0% to an average decrease rate of 1.0% for the substitute group. Further policy to restrict nicergoline was associated with additional decrease in expenditure level for the therapeutic class. Additionally, we could identify the balloon effect - a new policy squeezing one part results in bulging out elsewhere. After the restriction of ginkgo biloba, the utilization of and expenditures on its substitutes increased significantly. In conclusion, we demonstrated that consecutively introduced policies effectively reduced overall expenditures on the therapeutic class of interest. Some ingredients played as a substitute while others did not. Further studies need to be conducted to identify which factors determine a substitute.

• Journal of Digital Convergence
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• v.14 no.1
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• pp.291-303
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• 2016

The purpose of this study has been done to identify the influencing factors on rehabilitation motive of stroke patients. A sample of 138 stroke patients in Long-term Care and rehabilitation hospitals completed questionnaires through face - to - face interviews. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and Stepwise multiple regression. Rehabilitation motive of stroke pacients was correlated with empowerment (r=.467, p<.001), but not with perceived stress(r=.-.186, p=.029). In a multiple regression, empowerment (${\beta}=.432$, p<.001) and primary care-giver (${\beta}=.175$, p=.023) were associated with rehabilitation motive. These factors attributed to 24% of the total variance in rehabilitation motive. Therefore, the study finding suggests that these significant factors should be considered when developing and implementing convergent care strategies for stroke patients in order to promote their rehabilitation motive.

• Korean Parent-Child Health Journal
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• v.15 no.2
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• pp.71-79
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• 2012

Purpose: This study was conducted to examine the effects of simulation-based practice using standardized patients for the care of woman with postpartum hemorrhage as related to clinical performance competence and critical thinking deposition of nursing students. Methods: A nonequivalent control group pre-post test experimental design was used. Fifty four third year students were recruited, 29 students for the experimental group and 25 students for the control group. The simulation-based practice about nursing care related to postpartum hemorrhage included skill training, team-based practice, and debriefing. It was implemented with the experimental group for about 30 minutes in October 6, 2011. Data were analyzed using frequency, ratio, chi-square, Fisher's exact probability, and t-test using the SPSS/WIN program. Results: The experimental group who had the simulation-based practice showed significantly higher knowledge and skills of clinical performance competence than the control group (t=2.19, p=.003). But the experimental group who had the simulation-based practice did not show significantly higher critical thinking deposition than the control group (t=-0.32, p=.748). Conclusion: The results indicate that a simulation-based practice is an effective teaching method to improve knowledge and skills for clinical performance competence of nursing students. Further study is needed to identify the effect of a simulation-based practice on nursing attitudes.