BACKGROUND: It is important time for middle-aged because they should shift to a healthy elderly by utilization of correct health information and healthy behaviors. The aim of this study was to investigate the level of health information orientation (HIO) and identify the factors influencing HIO according to socio-demographic and health related characteristics of middle aged in community. METHODS: A cross-sectional descriptive study was conducted by self-reported using structured questionnaires. The data was collected from June to July 2014 with 465 middle aged and 40 to 64 years old living in the community. Multiple stepwise regression analysis was used to examine the determinant of HIO. RESULTS: In the two sub-domains of HIO, health information engagement mean score was 2.30±1.09 and the health information apprehension level was 1.34±1.15 on average (maximum 4 points). Regression analysis showed that the sub-domains of HIO, the level of health information engagement was significantly higher in the 40-49 age group than 50-64 age group (β=-0.094, P=0.048) and high school or above education level (β=0.224, P<0.001). Those who pay more than 100,000 won per month (β=0.097, P=0.047) were significantly high in the level of health information apprehension. CONCLUSIONS: In order to improve the level of HIO, it is necessary to implement tailored health promotion education considering the sociodemographic and health related characteristics of the subjects. It is required in the future, the development of tools and multidimensional factors that are appropriate for the middle-aged when identifying the factors influencing of health information orientation.
Aged ; Education ; Health Promotion ; Health Status ; Humans ; Middle Aged

PURPOSE: The purpose of this study was to develop a heart health diary to promote self-care ability among patients with heart failure (HF), and to identify the diary's effect on self-care adherence, self-efficacy, and physical activity. METHODS: A randomized control-group pretest-posttest design was adopted using block randomization. A calender-typed health diary was developed and it included a self-care checklist and education information on HF management. The experimental group were given guided counseling and education for 8 weeks and wrote a daily health diary during that period. Data were collected from the outpatient department of a tertiary medical center from February to April 2016. To verify the hypotheses, data for the experimental group (n=28) and control group (n=33) were analysed using the independent t-test with SPSS/WIN 21.0. RESULTS: At the end of 8 weeks the experimental group had significantly higher scores for self-care adherence (t=-2.48, p =.016) and exercise related self-efficacy (t=-3.44, p =.001) compared to the control group. CONCLUSION: The findings show that the application of a patient-directed heart health diary is an effective nursing intervention for improving HF patients' self-care adherence and exercise self-efficacy. Strategies to promote dietary self-efficacy are necessary along with further studies including repeated research with an increasing intervention period. Healthcare providers need to encourage the utilization of a health diary for HF patients as a tool for evaluation and for implementation that leads to self-care.
Checklist ; Counseling ; Education ; Health Personnel ; Heart Failure* ; Heart* ; Humans ; Medical Records* ; Motor Activity ; Nursing ; Nursing Care ; Outpatients ; Random Allocation ; Self Care*

BACKGROUND AND OBJECTIVES: This examined the association of cognitive function with self-care and major adverse cardiac events (MACE) among heart failure (HF) patients. SUBJECTS AND METHODS: In this prospective study, 86 outpatients with HF completed face-to-face interviews including neuropsychological testing to evaluate cognitive function and the use of the Self-Care of Heart Failure Index to measure self-care. Functional status was assessed with the New York Heart Association (NYHA) classification. Follow-up data on MACE were obtained at 24 months after enrollment. RESULTS: Compared with the Korean norm values, more than half of the HF patients had cognitive deficits in global function (33.0%), immediate recall (65.1%), delayed recall memory (65.1%), and executive function (60.5%). Patients with symptomatic HF (> or =NYHA class II) had the higher risk for substantially poor cognitive function in all areas of cognitive function than asymptomatic HF patients (NYHA class I, p<0.05). Most patients demonstrated poor self-care adequacy in maintenance (84.9%), management of symptoms (100%), and confidence (86.0%). After adjustment for age and gender, memory function was significantly associated with self-care confidence (odds ratio 1.41, 95% confidence interval 1.03-1.92, p=0.033). No relationship was found between cognition and self-care maintenance. There were 19 MACE's during the 24-month follow-up. Patients without MACE had a significantly higher global cognitive function (p=0.024), while no cognitive domains were significant predictors of MACE when adjusted for age and gender. CONCLUSION: HF patients with memory loss have poorer self-care confidence. Studies are warranted to examine the functional implication of cognitive deficits and adverse outcomes in a larger sample.
Classification ; Cognition ; Executive Function ; Follow-Up Studies ; Heart ; Heart Failure* ; Humans ; Memory ; Memory Disorders ; Memory, Short-Term ; Neuropsychological Tests ; Outpatients ; Prospective Studies ; Self Care*

Percutaneous cardiopulmonary support (PCPS) provides hemodynamic and pulmonary support simultaneously and is increasingly used in medical practice. However, the presence of extracorporeal circulation and the use of heparin means it is not free of side effects, and use of PCPS for longer than 96 h is associated with poor prognosis. Therefore, along with the decision of when to apply or discontinue PCPS, an integrated team approach between the surgeon and the anesthesiologist to prevent and/ or manage PCPS-related complications is of paramount importance when the patient's physical status mandates prolonged use of PCPS. We hereby report 2 cases addressing successful management of postoperative cardiogenic shock, refractory to pharmacologic support, with early and prolonged application of PCPS in patients who underwent surgical anterior ventricular endocardial restoration and coronary artery bypass surgery.
Coronary Artery Bypass ; Extracorporeal Circulation ; Hemodynamics ; Heparin ; Humans ; Prognosis ; Shock, Cardiogenic ; Thoracic Surgery

Percutaneous cardiopulmonary support (PCPS) provides hemodynamic and pulmonary support simultaneously and is increasingly used in medical practice. However, the presence of extracorporeal circulation and the use of heparin means it is not free of side effects, and use of PCPS for longer than 96 h is associated with poor prognosis. Therefore, along with the decision of when to apply or discontinue PCPS, an integrated team approach between the surgeon and the anesthesiologist to prevent and/ or manage PCPS-related complications is of paramount importance when the patient's physical status mandates prolonged use of PCPS. We hereby report 2 cases addressing successful management of postoperative cardiogenic shock, refractory to pharmacologic support, with early and prolonged application of PCPS in patients who underwent surgical anterior ventricular endocardial restoration and coronary artery bypass surgery.
Coronary Artery Bypass ; Extracorporeal Circulation ; Hemodynamics ; Heparin ; Humans ; Prognosis ; Shock, Cardiogenic ; Thoracic Surgery

A 56-year old female who had an atrial septal defect with tricuspid regurgitation received a patch repair and tricuspid annuloplasty. During weaning from cardiopulmonary bypass (CPB), bright red blood filled the endotracheal tube and breathing circuit. We suctioned the blood through the endotracheal tube. The bleeding was massive (about 400 ml) but the airway could be cleared with endotracheal suction. We irrigated endotracheal tube with normal saline with phenylephrine. The weaning of CPB was done and protamine was administered. The bleeding ceased when protamine was administered. Weaning from CPB was accomplished uneventfully. We found a little bleeding in the right main stem bronchus by flexible bronchoscopy but did not do any more procedures. In the intensive care unit, the patient had stable vital signs and good respiratory function. The patient was extubated without any problems at postoperative 1 day and transferred to ward without any complications.
Bronchi ; Bronchoscopy ; Cardiopulmonary Bypass* ; Female ; Heart Septal Defects, Atrial ; Hemoptysis* ; Hemorrhage ; Humans ; Intensive Care Units ; Middle Aged ; Phenylephrine ; Respiration ; Suction ; Tricuspid Valve Insufficiency ; Vital Signs ; Weaning

PURPOSE: Hypothermia adversely affects the coagulation that could be of clinical significance in patients receiving clopidogrel. We evaluated the influence of hypothermia on transfusion requirements in patients undergoing isolated off-pump coronary artery bypass surgery (OPCAB) who continued clopidogrel use within 5 days of surgery. MATERIALS AND METHODS: Protocol-based, prospectively entered data of 369 patients were retrospectively reviewed. The time-weighted average of intraoperative temperatures and the temperature upon ICU admission (TWA-temp) was assessed. Patients were divided into normothermia (> or =36degrees C, n=224) and hypothermia (<36degrees C, n=145) group. The transfusion requirement for perioperative blood loss was assessed and compared. RESULTS: Patients with hypothermia were older and had lower body surface area (BSA) than patients with normothermia. Age and BSA adjusted transfusion requirement was significantly larger in the hypothermia group [patients requiring transfusion: 64% versus 48%, p=0.003; number of units: 0 (0-2) units versus 2 (0-3) units, p=0.002]. In multivariate analysis of predictors of perioperative multiple transfusion requirements, hypothermia was identified as an independent risk factor along with age, female gender, BSA, chronic kidney disease, and congestive heart failure. CONCLUSION: Hypothermia was associated with increased transfusion requirement in patients undergoing OPCAB who received clopidogrel in proximity to surgery. Considering the high prevalence and the possibility of hypothermia being a modifiable risk factor, aggressive measures should be undertaken to maintain normothermia in those patients.
Aged ; Coronary Artery Bypass, Off-Pump/*methods ; Female ; Humans ; Hypothermia/*physiopathology ; Male ; Middle Aged ; Retrospective Studies ; Ticlopidine/*analogs & derivatives/therapeutic use

PURPOSE: Prolonged duration of cardiopulmonary bypass aggravates the degree of inflammation and coagulopathy. We investigated the influence of 6% hydroxyethyl starch (HES) 130/0.4 on coagulation and inflammation compared with albumin when used for both cardiopulmonary bypass priming and perioperative fluid therapy in patients undergoing complex valvular heart surgery. MATERIALS AND METHODS: Fifty four patients were randomly allocated into albumin-HES, albumin-nonHES, and HES-HES groups. The cardiopulmonary bypass circuit was primed with 5% albumin in the albumin-HES and albumin-nonHES group, and with HES in the HES-HES group. As perioperative fluid, only plasmalyte was used in the albumin-nonHES group whereas HES was used up to 20 mL/kg in the albumin-HES and albumin-HES group. Serial assessments of coagulation profiles using the rotational thromboelastometry and inflammatory markers (tissue necrosis factor-alpha, interleukin-6, and interleukin-8) were performed. RESULTS: Patients' characteristics and the duration of cardiopulmonary bypass (albumin-HES; 137+/-34 min, HES-HES; 136+/-47 min, albumin-nonHES; 132+/-39 min) were all similar among the groups. Postoperative coagulation profiles demonstrated sporadic increases in clot formation time and coagulation time, without any differences in the actual amount of perioperative bleeding and transfusion requirements among the groups. Also, inflammatory markers showed significant activation after cardiopulmonary bypass without any differences among the groups. CONCLUSION: Even in the presence of prolonged duration of cardiopulmonary bypass, HES seemed to yield similar influence on the ensuing coagulopathy and inflammatory response when used for priming and perioperative fluid therapy following complex valvular heart surgery compared with conventional fluid regimen including albumin and plasmalyte.
Aged ; Blood Coagulation/drug effects ; Cardiac Surgical Procedures/*methods ; Cardiopulmonary Bypass/methods ; Female ; Humans ; Hydroxyethyl Starch Derivatives/*therapeutic use ; Male ; Middle Aged

Kawasaki disease (KD) is an acute, self-limiting, small-vessel vasculitis with an unknown cause that affects children between the ages of 6 months and 5 years. Its important acute complication is coronary artery aneurysm. Myocardial infarction caused by thrombus formation inside the aneurysm or by organic obstructive lesion following the regression of aneurysm is the principal cause of death in KD. However, coronary artery aneurysms and stenosis requiring surgery are rare in KD. We report an our experience about anesthetic management of child undergone off-pump coronary artery bypass grafting surgery because of coronary artery aneurysm associated with KD.
Anesthesia ; Aneurysm ; Cause of Death ; Child ; Constriction, Pathologic ; Coronary Artery Bypass, Off-Pump ; Coronary Disease ; Coronary Vessels ; Humans ; Infarction ; Mucocutaneous Lymph Node Syndrome ; Myocardial Infarction ; Thrombosis ; Transplants ; Vasculitis

Calcification of the cardiac chambers is among the challenges associated with reoperative cardiac surgeries by increasing the risk of systemic embolization. We experienced a case of an unexpected detected mass by intraoperative transesophageal echocardiography during weaning from cardiopulmonary bypass in a patient undergoing trido mitral and tricuspid valve replacement surgery. The surgically removed mass was identified as calcified tissue. This case shows the importance of careful echocardiographic evaluation of the left heart in patients undergoing repeat valve surgery given their greater potential for embolic sources.
Calcium* ; Cardiopulmonary Bypass ; Echocardiography* ; Echocardiography, Transesophageal ; Heart ; Heart Atria ; Humans ; Reoperation ; Thoracic Surgery ; Tricuspid Valve ; Weaning