• Journal of Preventive Medicine and Public Health
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• 제50권1호
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• pp.29-37
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• 2017

Objectives: The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization. Methods: We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates. Results: In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index. Conclusions: Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

• Journal of Chest Surgery
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• 제32권6호
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• pp.525-531
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• 1999

배경: 본 연구는 1981년 11월부터 1997년 6월까지 관상동맥 우회술을 받은 500례의 협심증 환자를 대상으로 술전 진단, 수술방법, 수술사망률, 수술합병증, 술후 증상의 재발과 치료에 대해 알아보았다. 대상 및 방법: 500례 중 남자는 330례, 여자는 170례였고 평균 연령은 57.4$\pm$8.9세였다. 술전 환자의 평가를 위해 심전도, 심에코, MIBI scan, 내경동맥과 대퇴동맥에 대한 Duplex Sono, CK, LDH를 포함한 일반적인 혈액 검사, 관상동맥 조영술 등을 시행하였으며, 술후 부정맥과 심근경색증 등의 합병증에 대한 판정 지표로 삼았다. 결과: 술전 진단으로 불안정성 협심증이 282례 (56.4%), 안정성 협심증이 141례 (28.2%), 심근경색후 협심증이 58례 (11.6%), 급성 심근경색증이 8례 (1.6%), 이형 협심증이 7례 (1.4%), 경피적 관상동맥확장술 실패가 4례 (0.8%)였다. 술전 관상동맥 조영술 상 삼혈관 질환이 263례 (52.6%), 이혈관 질환이 93례 (18.6%), 단일혈관 질환이 71례 (14.2%)였으며, 좌주관상동맥 질환이 68례 (13.6%), 그외 5례(1.0%) 있었다. 환자들은 술전 여러 가지 관상동맥 질환의 위험인자들에 노출되어 있었으며 고혈압, 흡연, 비만, 당뇨 등의 빈도가 점차 증가하고 있었다. 수술은 대복재정맥 1143문합, 내흉동맥 442문합, 요골동맥 17문합, 위대망막 동맥 1문합으로 환자당 평균 3.2$\pm$1.2문합을 시행하였으며, 인공판막 치환술 또는 성형술이 동시에 시행된 경우가 31례 (6.2%), 관상동맥 내막절제술 또는 성형술이 27례 (5.4%), 좌주관상동맥 성형술이 13례 (2.6%), 내경동맥 내막절제술이 5례 (1.0%), Maze 술식이 3례 (0.6%), 기타 술식이 11례 (2.2%) 등에서 시행되었다. 수술시간은 대동맥차단 시간이 평균 99$\pm$67분이었다. 수술사망률은 6.8% (34/500)이었고, 여성, 심근경색증 \ulcorner과거력, 급성 심근경색증과 응급수술 등이 유의한 위험인자로 나타났다. 합병증으로서 부정맥 109례 (21.8%), 신경학적 합병증 27례 (5.4%), 출혈 25례 (5.0%), 수술전후 심근경색증 25례 (5.0%), 종격동염을 포함한 창상감염 20례 (4.0%), 저심박출증 18례 (3.6%), 급성 신부전증 12례 (2.4%), 폐렴 등의 기타 합병증이 10례(2.0%)있었다. 술후 추적기간은 평균 25$\pm$23개월이었으며, 증상의 재발로 인한 재수술은 5명의 환자에서 시행되었다. 결론: 수술경험의 축적, 심근보호법의 다양한 적용, 심기능 보조장치의 적극적인 사용으로 고위험군 환자의 증가에도 불구하고 수술사망률을 감소시킬 수 있으리라 기대된다.

• 대한간호학회지
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• 제39권6호
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• pp.788-795
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• 2009

Purpose: The purpose of this study was to define and clarify the concept of 'resilience' in patients with cardiovascular diseases. Methods: A hybrid model was used to develop the concept of resilience. The model included a field study carried out in Cheonan, Korea. The participants in this study were 9 patients with cardiovascular diseases who underwent a percutaneous coronary intervention. Results: The concept of resilience was found to be a complex phenomenon having meanings in two dimensions: the personal-dispositional and interpersonal dimensions. Four attributes and seven indicators were defined. Conclusion: A resilient person was defined as one who has a positive attitude toward restoration, the power to reconstruct and control his/her disease (personal dimension), and support from a supportive system with supportive persons (interpersonal dimension). In the clinical setting, resilience plays an important role in managing the care plans of cardiovascular patients. Therefore, nurses who work closely with patients suffering from cardiovascular diseases should be aware of the attributes and indicators of resilience to enhance the resilience of their patients.

• 한국자원식물학회지
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• 제26권6호
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• pp.678-685
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• 2013

The objective of this study was to examine the effect of 7 traditional Korean formulations (7TKFs) on intimal thickening of rat carotid artery injured by balloon catheter in vivo and on the proliferation of human smooth muscle cells (HASMCs) and secretion of matrix metalloproteinase-2 (MMP-2) in vitro. 7TKFs (400 mg/kg) were administered orally for 4 weeks from the day of balloon injury in the rats. HASMC proliferation was assessed by 3-(4,5-dimethylthiazol-2)-2,5-diphenyltetrazolium bromide (MTT) assay while enzymatic action of MMP-2 was carried out by gelatin zymography. Among 7TKFs, Samhwang-sasim-tang (SST), Banha-sasim-tang (BST) and Kegi-honghwa-tang (KHT) significantly reduced the intimal thickening by suppressing HASMC proliferation and MMP-2 expression in both extracellular and intracellular levels. Thus, the results suggest that SST, BST and KHT can be considered as a therapeutic value in the prevention of atherosclerosis because restenosis after PTCA (percutaneous transluminal coronary angioplasty) is supposed to be 'accelerated atherosclerosis'.

• 대한간호학회지
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• 제33권8호
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• pp.1153-1160
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• 2003

Purpose. 1) To identify the time taken from symptom onset to the arrival at the hospital (pre-hospital delay time) and time taken from the arrival at the hospital to the initiation of the major treatment (in-hospital delay time) 2) to examine whether rapid treatment results in lower mortality. 3) to examine whether the pre- and in-hospital delay time can independently predict in-hospital mortality. Methods. A retrospective study with 586 consecutive AMI patients was conducted. Results. Pre-hospital delay time was 5.25 (SD=10.36), and in-hospital delay time was 1.10 (SD=1.00) hours for the thrombolytic therapy and 50.24 (SD=121.18) hours for the percutaneous transluminal coronary angio-plasty (PTCA). In-hospital mortality was the highest when the patients were treated between 4 to 48 hours after symptom onset using PTCA (p=.02), and when treated between 30 minutes and one hour after hospital arrival using thrombolytics (p=.01). Using a hierarchical logistic regression model, the pre- and in-hospital delay times did not predict the in-hospital mortality. Conclusion. Pre- and in-hospital delay times need to be decreased to meet the desirable therapeutic time window. Thrombolytics should be given within 30 minutes after arrival at the hospital, and PTCA should be initiated within 4 hours after symptom onset to minimize in-hospital mortality of AMI patients.

• 한국보건간호학회지
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• 제28권3호
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• pp.565-573
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• 2014

Purpose: Health Insurance Review & Assessment Service (HIRA) launched an Acute Myocardial Infarction(AMI) assessment for the Payment For Performance(Quality Incentives) Pilot Project from July 2007. Assessment measures of AMI were composed of five process measures and one outcome measure, and each measure was incorporated into one composite quality score to Pay for Performance. Method: For calculation of composite quality score, we considered weighting for the measures using the Delphi method. The questionnaire was composed of three measure groups, 'Reperfusion rate'(Fibrolytic therapy received within 60 minutes of hospital arrival, Primary Percutaneous Coronary Intervention within 120 minutes of hospital arrival), 'Medication prescription rate'(Aspirin at arrival, Aspirin prescribed at discharge, Beta-blocker prescribed at discharge) and 'Survival Index'(30-day mortality rate). Result: A panel composed of 18 and completed a questionnaire by allocation of 10 scores to the three above mentioned measure groups. The Delphi was carried out until three rounds of surveys. In conclusion, each measure group was weighted differently and the 10 scores were allocated as 4.5 to 'Reperfusion rate', 2.5 to 'Medication prescription rate', and 3.0 to 'Survival Index'. Conclusion: The results of this study proposed the calculation method for weighting of Acute Myocardial Infarction quality indicators.

• 기본간호학회지
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• 제13권1호
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• pp.42-49
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• 2006

Purpose: This study was done to evaluate the effectiveness of cardiac rehabilitation education individualized to PCI patients in order to improve their knowledge of these diseases and to lessen their anxiety. Method: A Quasi experimental design with non-equivalent control group non-synchronized design was used. The experimental group had the PCI operation for ischemic heart disease and individualized cardiac rehabilitation education and counseling twice for 25 minutes each time using an educational booklet developed by the authors. The effects of the education were analyzed using a knowledge assessment tool, state anxiety inventory and anxiety visual analogue scale. Results: The experimental group who received the individualized cardiac rehabilitation education showed a high level of knowledge about diseases compared to the control group and particularly showed a significant difference in knowledge about the drugs used for treatment. However, no significant difference was observed between the two groups in the level of state anxiety and anxiety visual analogue scale. Conclusion: Individualized cardiac rehabilitation education did not reduce anxiety but it was effective in enhancing the participants' knowledge about the diseases. Thus, it can be utilized effectively in addressing risk factors in ischemic heart diseases by providing education individualized according to patients' demands and knowledge levels.

• Bulletin of the Korean Chemical Society
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• 제28권3호
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• pp.397-402
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• 2007

Restenosis after percutaneous coronary intervention (PCI) continues to be a serious problem in clinical cardiology. To solve this problem, drug eluting stents (DES) with antiproliferative agents have been developed. Variable local drug delivery systems in the context of stenting require the development of stent manufacture, drug pharmacology and coating technology. We have worked on a system that integrates electrophoretic deposition (EPD) technology with the polymeric nanoparticles in DES for local drug delivery and a controlled release system. The surface morphology and drug loading amount of DES by EPD have been investigated under different operational conditions, such as operation time, voltage and the composition of media. We prepared poly-D,L-lactide-co-glycolic acid (PLGA) nanoparticles embedded with curcumin, which was done by a modified spontaneous emulsification method and used polyacrylic acid (PAA) as a surfactant because its carboxylic group contribute negative charge to the surface of CPNPs (?53.5 ± 5.8 mV). In the process of ‘trial and error' endeavors, we found that it is easy to control the drug loading amount deposited onto the stent while keeping uniform surface morphology. Accordingly, stent coating by EPD has a wide application to the modification of DES using various kinds of nanoparticles and drugs.

• 성인간호학회지
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• 제26권2호
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• pp.203-213
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• 2014

Purpose: The purpose of this study was to understand and describe the every day life experience of patients with acute myocardial infarction (AMI) during the recovery period after Percutaneous Coronary Intervention (PCI) using a qualitative approach. Methods: Twelve patients with AMI participated in this study. Their age ranged from 42 to 75. The data were collected by individual in-depth interviews and all interviews were audio-taped and transcribed verbatim. The transcribed data were analyzed using traditional qualitative content analysis. Results: Six sub-themes emerged from the data as follows: Getting to know about illness, getting motivated for health behavior, putting an effort into health behavioral change, having difficulties maintaining health behavior, setting up coping strategies for health behavior and having a need for a tailored education. The results of this study showed how the health behaviors of patients with AMI are related to their every day life experiences. Conclusion: The results of this study could help health professionals to better understand patients with AMI and design effective educational interventions to improve their health behaviors.

• 보건행정학회지
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• 제13권4호
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• pp.115-130
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• 2003

Reperfusion delay in patients with acute myocardial infarction leads to increased morbidity and mortality. We sought to measure the rates of reperfusion delay and to identify factors associated with reperfusion delay after arrival to hospitals. We included 360 patients who had acute myocardial infarction with ST-elevation or left bundle branch block on electrocardiogram and received reperfusion therapy from the three participating academic medical centers from 1997 to 2000. Through retrospective chart review, we collected data about time to reperfusion therapy, patient and hospital factors potentially associated with reperfusion delay. Factors independently associated with reperfusion delay were determined by logistic regression analysis. Median door­to­needle time was 60.0 minutes, and median door­to­balloon time was 102.5 minutes. According to recommendation of the American College of Cardiology/American Heart Association Guidelines, 226 out of 264(85.6％) of thrombolytic patients and 43 out of 96(44.8％) percutaneous transluminal coronary angioplasty(PTCA) patients experienced reperfusion delay. The significant factors associated with delay were type of reperfusion therapy, patient factors including hypertension and delayed symptom onset to presentation(>4 hours), and hospital factors including nocturnal presentation(6pm∼8am), weekend, and an individual hospital. A significant proportion of patients experienced reperfusion delay. The identified predictors of reperfusion delay may help design a hospital system to reduce the delay in reperfusion therapy