Psychometric properties of the end-of-life care decision inventory (EOL-CDI): a mixed-methods study.

BACKGROUND: End-of-life care decision-making has become important to support dignity and quality of life for patients who are facing death in Korea, along with the enactment of the Life-Sustaining Treatment Act in 2018. However, it seems that the concepts and policies related to the law are not yet familiar to health care providers or the general public. This unfamiliarity can hinder efficient end-of-life care discussions. Therefore, the purpose of this study was to propose a valid and reliable tool to explore the level of understanding of concepts and attributes related to end-of-life care decisions. METHODS: This is a mixed-methods study design. A relevant law and literature analysis, expert consultation, cognitive interviews of 10 adults, and cross-sectional survey for psychometric tests using data from 238 clinical nurses were performed to update a tool developed before the life-sustaining treatment Act was enacted in Korea. RESULTS: 29 items of the draft version were polished in terms of literacy, total length, and scoring method via cognitive interviews and finalized into 21 items through psychometric tests and expert consultations. The 21 items conformed to the Rasch unidimensional paramenters. CONCLUSION: A tool to identify the level of understanding of concepts related to end-of-life care decisions was proposed through a rather rigorous process to ensure feasibility and validity/reliability. We recommend the proposed tool to apply to the adult population and nurses for evaluation and educational purposes.

Diagnostic performance of contrast-enhanced multidetector computed tomography and gadoxetic acid disodium-enhanced magnetic resonance imaging in detecting hepatocellular carcinoma: direct comparison and a meta-analysis.

The purpose of this study was to directly (head-to-head) compare the per-lesion diagnostic performance of contrast-enhanced computed tomography (CT) (also referred to as CT hereafter) and gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging (also referred to as MRI hereafter) for the detection of hepatocellular carcinoma (HCC). Studies reporting direct per-lesion comparison data of contrast-enhanced multidetector CT and Gd-EOB-DTPA-enhanced MR imaging that were published between January 2000 and January 2015 were analyzed. The data of each study were extracted. Systematic review, paired meta-analysis, and subgroup analysis were performed. Twelve studies including 627 patients and 793 HCC lesions were analyzed. The sensitivity estimates of MRI and CT were, respectively, 0.86 (95% CI 0.76-0.93) and 0.70 (95% CI 0.58-0.80), with significant difference (P < 0.05). The sensitivity estimates were both 0.94 (95% CI 0.92-0.96) (Chi-square 4.84, degrees of freedom = 1, P > 0.05). In all subgroups, Gd-EOB-DTPA-enhanced MR imaging was more sensitive than multidetector CT for the detection of HCC, and specificity estimates of both tests maintained at a similarly high level in all conditions: sensitivity estimates of both tests were reduced in studies where patients were diagnosed with HCC solely by liver explant or in those where HCC lesions were small (≤2 cm, especially when ≤1 cm). But in all situations, sensitivities of MRI were higher than those of CT with or without significance. Gd-EOB-DTPA-enhanced MR imaging showed better per-lesion diagnostic performance than multidetector CT for the diagnosis of HCC in patients with cirrhosis and in small hepatic lesions.

Impact of GNB3-C825T, ADRB3-Trp64Arg, UCP2-3'UTR 45 bp del/ins, and PPARγ-Pro12Ala polymorphisms on Bofutsushosan response in obese subjects: a randomized, double-blind, placebo-controlled trial.

Obesity is known to be influenced by a number of genes, including the ß3 subunit of G protein (GNB3), ß3-adrenergic receptor (ADRB3), uncoupling protein 2 (UCP2), and peroxisome proliferator activated receptor gamma (PPARγ). The single nucleotide polymorphisms (SNPs) of the above genes, such as GNB3-C825T, ADRB3-Trp64Arg, UCP2-3'UTR 45 bp del/ins, and PPARγ-Pro12Ala, are associated with obesity and body mass index. The present study evaluates the impact of Bofutsushosan, a traditional Eastern Asian herbal medicine with known anti-obesity properties, on obese subjects according to the presence of the above-mentioned SNPs. Upon randomization, the volunteers were allocated to receive Bofutsushosan (n=55) or placebo (n=56) treatments for 8 weeks. Following the treatment schedule, significant reductions in total cholesterol and significant improvement in the Korean version of obesity-related quality of life scale were seen in the Bofutsushosan-treated group, but not in placebo. Bofutsushosan exerted significant anti-obesity effects on a number of parameters in the carriers of the GNB3-825T allele, but only on waist circumference in the GNB3-C/C homozygote. Significant anti-obesity impact of Bofutsushosan was also seen on a number of obesity-indices in both ADRB3-Arg64 carriers and ADRB3-Trp64 homozygotes, as well as in UCP2-D/D carriers, but not in UCP2-D/I+I/I variants. The effect of Bofutsushosan was more pronounced in PPARγ-Pro/Pro genotype compared to PPARγ-Pro/Ala variants. Thus, the results revealed differential responses of the subjects to the anti-obesity effects of Bofutsushosan treatment according to the polymorphism of the vital obesity-related genes. Our study provides new insight into individualized clinical applications of Bofutsushosan for obesity.

Awareness of advance directives among Korean nurses.

Awareness of advance directives (AD) among 293 nurses working in acute hospitals was evaluated through a structured questionnaire. Nurses were poorly acquainted with AD. Education about AD and related concepts are required in college and field experience to improve practice and communication with patients at the end of life.

[Factors influencing health-related quality of life in Korean medicaid beneficiaries].

PURPOSE: The purpose of this study was to identify the factors which influence health-related quality of life (HRQoL) in Korean Medicaid beneficiaries. The relationships among sociodemographic factors, health status, health behavior, and HRQoL were analyzed METHODS: Data from the 2007 survey on Health Services Use and Health Status of Medicaid Beneficiaries conducted by the Ministry for Health Welfare and Family Affairs were examined. To analyze the sample survey data, descriptive statistics, correlation and hierarchical multiple survey regression analysis with SAS 9.1.3 package were used with SURVEYMEANS and SURVEYREG procedures, which incorporate the sample design into the analyses in order to make statistically valid inference for the whole Medicaid population. RESULTS: The HRQoL correlated with limitations in Activities of Daily Living (ADL) (r=-.509, p<.001), stress (r=-.387, p<.001), depression (r=-.385, p<.001), alcohol consumption (r=.216, p<.001), and exercise (r=.293, p<.001). Significant factors that affect HRQoL of Medicaid beneficiaries were gender, region, limitations in ADL, stress, depression, alcohol consumption, and regular exercise. These variables explained 44.6% of HRQoL (F= 215.00, p<.001). CONCLUSION: The results indicate that to improve the HRQoL of Medicaid beneficiaries it is important to develop nursing intervention programs that focus on psychological health and health behavior and to give consideration to differences in gender and region.

[Family caregivers' experiences utilizing a nursing home for their elderly family members].

PURPOSE: The purpose of this study was to explore and describe the experiences of the family caregivers using a nursing home for their elderly family members. METHOD: Participants for this study were 1 man and 9 women caregivers. Data was collected through in-depth interviews from October, 2005 to April, 2006 and analyzed using Strauss and Corbin's grounded theory methodology. RESULTS: "Finding a way to live together" emerged as a core category and it reflected expanding consciousness allowing them to see each other in a more positive view. The basic social process of "finding a way to live together" includes 3 phases: 1) recognizing the problems, 2) finding solutions to the problems, and 3) accepting the changes in their surrounding. Lack of privacy, family troubles, extreme distress, and unavailable caregivers are reflected in the process of recognizing the problems. The process of finding solutions was making a decision, obtaining family agreement, choosing the best nursing home, and enduring the financial burden. Possible outcomes of the last phase include recovering peace of mind and continuing conflict. CONCLUSION: Findings from this study offer suggestions for developing a strategy to help not only the elderly but also the family caregivers.