The sample of this study consisted of 140 informal caregivers who provided care to the older adults(over 60 years of age) in Great Cleveland, USA. Self-rated questionnaires were utilized to collect information. The purpose of the study was to identify coping strategies most frequently utilized by informal caregivers of older adults and to examine predictors of the caregivers' health responses to the caregiving situation applying Lazarus and Folkman stress model(1984). Stepwise multiple regression was used to identify significant predictors among caregivers' demographic-socio-economic factors, older adult's dependency of activities of daily living(ADLs), caregiver's appraisal to the caregiving situation, and coping strategies. Informal caregivers (N=140) included in the study utilized help-seeking and problem-solving coping strategies more than self-blame and minimization of threat coping strategies. Caregivers' responses to the caregiving situation were observed by caregivers' perceived physical health, depression and life satisfaction. For perceived physical health, threat appraisal, older adult's dependency on ADLs, existential growth coping strategy, and monthly income accounted for 25% of the variance. Caregivers who appraised the caregiving situation as more threatening, reported higher dependency on ADLs, used more existential growth coping strategy, and had higher monthly income reported better physical health. For depression, threat appraisal, stress appraisal, existential growth coping strategy, self-blame coping strategy, and monthly income accounted for 48% of the variance. Caregivers who used more existential growth coping and less self-blame coping, appraised the situation as less threatening, less stressful, and had higher monthly income reported less depression. For life satisfaction, self-blame coping, existential growth coping, monthly income, stress appraisal accounted for 49% of the variance. Caregivers who used more existential growth coping, less self-blame coping, less stress appraisal, lower monthly income reported better life satisfaction. In conclusion, informal caregivers in this study utilized positive coping strategies such as problem-focused, existential growth, help-seeking, rather than negative coping strategies including self-blame. When they utilized positive coping strategies more often, caregivers experienced higher perceived physical health, higher life satisfaction and lower depression. Therefore, nursing intervention which utilized positive coping strategies is needed to enhance informal caregivers to have positive health responses to the caregiving demands.
Activities of Daily Living ; Adult* ; Caregivers* ; Depression ; Humans ; Nursing ; Surveys and Questionnaires

The study was conducted to confirm the construct of individual perception and preference for work characteristics as personal factors influencing Korean nurses' job satisfaction. The subjects of the study were 231 nurses who are currently working in intensive care units and have been for a minimum of 6 months. The study used the Staff Perception and Preference Scale(Song et al., 1997) to measure the individual's perception and preference on the technical, practice, and management components of the ideal work environment. The Korean version of the Staff Perception and Preference Scale consists of 16 items on perception and 13 on preference with each item related on a scale from 1 (not at all) to 4 (a great deal). Psychometric testing revealed that the preference and perception scale is internally consistent with Chronbach's alphas of .83 for perception scale and .80 for preference scale. The subscales of the perception and preference scale also showed acceptable reliability for the early stage of the development of the instruments with Chronbach alphas of .62-.76 and .69-.83 respectively. Criterion0related validity of the scale was tested by examining correlations with individual growth need that is conceptually close to individual preference, but not to individual perception. Individual growth need was significantly related to individual preference(r=.63, p<.05), but the correlation with the perception scale was not significant. A separate factor analysis for the each of perception and preference scales was performed with a three-factor loading solution based on a previous study. The results on the staff perception scale confirmed with varimax rotation that the items were cleanly and strongly loaded on technique, practice and management components, which together explained 50.7% of the variance. The factor analysis on the staff preference scale also yielded a three factor solution that explained 56.7% of the variance, but items on technique and management components were loaded together. This phenomena may due to the current nursing delivery system in Korea where nurses never experience either shared governance nor case management, and as a results they may not be able to consider management roles as their potential extended roles. Therefore, more efforts should be given to enhance nurses' autonomy and decision making in the technique, practice and management components of their work environment. Meanwhile, there is a need for continuously confirming and developing tools for individual perception and preferences to effectively enhance job satisfaction among Korea nurses through innovative work environments.
Case Management ; Decision Making ; Humans ; Intensive Care Units ; Job Satisfaction ; Korea ; Nursing ; Psychometrics ; Weights and Measures*

The purposes of this study were to determine the factors that influence job satisfaction for ICU nurses and to analyze group differences in job satisfaction based on the nurses' preference and perception of the work environment with an enhanced professional role. A total of 231 nurses who had been working in Intensive Care Units at least for 6 months at selected university hospitals participated in the study while head nurses or those with administrative positions were excluded. The study participants had an average of 33 months of clinical experience with an age range of 23 to 40 years. The data were analyzed by utilizing SPSSWIN and the results are as follows. 1) Hierarchical multiple regression analysis showed that work characteristics defined by Job characteristics theory and nurses' preference/ perception of ideal work environment together explained 33% of variance in job satisfaction. Skill variety, task identity and autonomy as well as individual perception of work environment were significant variables for explaining job satisfaction. Job satisfaction was not significantly related to age, marital status, education, and clinical experience. 2) The groups classified by nurses' preference and perception of work environment were significantly different in their job satisfaction. Nurses with high preference and high perception showed significantly higher general and specific job satisfaction than other nurses. The nurses who showed high preference but perceived their work environment as not reflecting ideal job characteristics reported the lowest job satisfaction among the groups. In conclusion, the role of individual preference and perception of the work environment in explaining the relationship between the redesign of work environment and job satisfaction was supported by the study. The preferences of nurses to the innovative work characteristics should be considered in the process of enhancing job characteristics to lead job satisfaction and low turn over and ultimately to improve quality of care.
Education ; Hospitals, University ; Intensive Care Units ; Job Satisfaction* ; Marital Status ; Nursing, Supervisory ; Professional Role

The purpose of the study was to identify the effects of inpatient cardiac rehabilitation programs on motivation, the performance of health behavior, and quality of life in patients with coronary artery disease. The subjects consisted of 31 patients who participated in the rehabilitation program during their hospital stay, and were compared with 34 patients who did not participate. The study results are as follows: 1. The mean of cardiac risk factor scores for the subjects was 22.5 (SD = 5.5) at the level of low to moderate risk with some possibility to improve. The physiological and behavioral risk factors for the subjects were also in the normal range or slightly above the normal range. 2. The motivation level to preform health behaviors for both groups was improved after discharge. Also, perceived self-efficacy was significantly higher for the program participants than for the comparison group at the post-test. 3. The performance of cardiac related health behaviors improved for both groups after discharge, but there were no significant differences between the two groups. The program participants reported better performance in most health behaviors at the post-test, but the results failed to reach a statistical significant level. 4. As for motivation and health behavior, the subjects in the both groups showed an improved quality of life after the discharge. In addition, the program participants produced significantly higher scores in health and functioning dimension than the comparison group during the post-test. In conclusion, the study partially supported the effects of the inpatient cardiac rehabilitation program to motivate and improve the quality of life, and provide the need to apply early rehabilitation interventions for the patients after cardiac events. Further study with a longitudinal design is also suggested to verify the effect of cardiac rehabilitation program from hospitalization to discharge and subsequently to fully recover to the level of pre-hospitalized state.
Coronary Artery Disease* ; Coronary Vessels* ; Health Behavior ; Hospitalization ; Humans ; Inpatients* ; Length of Stay ; Motivation ; Quality of Life* ; Reference Values ; Rehabilitation* ; Risk Factors

The purpose of the study was to identify the effects of inpatient cardiac rehabilitation programs on motivation, the performance of health behavior, and quality of life in patients with coronary artery disease. The subjects consisted of 31 patients who participated in the rehabilitation program during their hospital stay, and were compared with 34 patients who did not participate. The study results are as follows: 1. The mean of cardiac risk factor scores for the subjects was 22.5 (SD = 5.5) at the level of low to moderate risk with some possibility to improve. The physiological and behavioral risk factors for the subjects were also in the normal range or slightly above the normal range. 2. The motivation level to preform health behaviors for both groups was improved after discharge. Also, perceived self-efficacy was significantly higher for the program participants than for the comparison group at the post-test. 3. The performance of cardiac related health behaviors improved for both groups after discharge, but there were no significant differences between the two groups. The program participants reported better performance in most health behaviors at the post-test, but the results failed to reach a statistical significant level. 4. As for motivation and health behavior, the subjects in the both groups showed an improved quality of life after the discharge. In addition, the program participants produced significantly higher scores in health and functioning dimension than the comparison group during the post-test. In conclusion, the study partially supported the effects of the inpatient cardiac rehabilitation program to motivate and improve the quality of life, and provide the need to apply early rehabilitation interventions for the patients after cardiac events. Further study with a longitudinal design is also suggested to verify the effect of cardiac rehabilitation program from hospitalization to discharge and subsequently to fully recover to the level of pre-hospitalized state.
Coronary Artery Disease* ; Coronary Vessels* ; Health Behavior ; Hospitalization ; Humans ; Inpatients* ; Length of Stay ; Motivation ; Quality of Life* ; Reference Values ; Rehabilitation* ; Risk Factors

No abstract available.
Angiography, Digital Subtraction ; Venous Thrombosis

Purpose: For precision medicine, exploration and monitoring of molecular biomarkers are essential. However, in advanced gastric cancer (GC) with visceral lesions, an invasive procedure cannot be performed repeatedly for the follow-up of molecular biomarkers. Materials and Methods: To verify the clinical implication of serial liquid biopsies targeting circulating tumor DNA (ctDNA) on treatment response, we conducted targeted deep sequencing for serially collected ctDNA of 15 HER2-positive metastatic GC patients treated with anti-PD-1 inhibitor in combination with standard systemic treatment. Results: In the baseline ctDNAs, 14 patients (93%) harbored more than one genetic alteration. A number of mutations in wellknown cancer-related genes, such as KRAS and PIK3CA, were identified. Copy number alterations were identified in eight GCs (53.3%), and amplification of the ERBB2 gene (6/15, 40.0%) was the most recurrent. When we calculated the mean variant allele frequency (VAF) of mutations in each ctDNA as the molecular tumor burden index (mTBI), the mTBI trend was largely consistent with the VAF profiles in both responder and non-responder groups. Notably, in the longitudinal analysis of ctDNA, mTBI provided 2–42 weeks (mean 13.4 weeks) lead time in the detection of disease progression compared to conventional follow-up with CT imaging. Conclusion Our data indicate that the serial genetic alteration profiling of ctDNA is feasible to predict treatment response in HER2-positive GC patients in a minimally invasive manner. Practically, ctDNA profiles are useful not only for the molecular diagnosis of GC but also for the selection of GC patients with poor prognosis for systemic treatment (ClinicalTrials.gov identifier:NCT02901301).

PURPOSE: We conducted a randomized, multicenter, phase III trial to compare S-1 plus docetaxel (DS) with S-1 plus cisplatin (SP) as adjuvant chemotherapy for stage III gastric cancer patients. MATERIALS AND METHODS: Stage III gastric cancer patients who had received curative gastrectomy with D2 lymphadenectomy were randomized into equal groups to receive adjuvant chemotherapy of eight cycles of DS (S-1 70 mg/m2/day on days 1-14 plus docetaxel 35 mg/m2on days 1 and 8) every 3 weeks or SP (S-1 70 mg/m2/day on days 1-14 plus cisplatin 60 mg/m2on day 1) every 3 weeks. The primary endpoint was 3-year disease-free survival (DFS) rate. RESULTS: Between November 2010 and July 2013, 153 patients (75 patients to DS and 78 patients to SP) were enrolled from 8 institutions in Korea. After the capecitabine plus oxaliplatin was approved based on the CLASSIC study, itwas decided to close the study early. With a median follow-up duration of 56.9 months, the 3-year DFS rate between two groups was not significantly different (49.14% in DS group vs. 52.5% in SP group). The most common grade 3-4 adverse event was neutropenia (42.7% in DS and 38.5% in SP, p=0.351). SP group had more grade 3-4 anemia (1.3% vs. 11.5%, p=0.037), whereas grade 3-4 hand-foot syndrome (4.1% vs. 0%, p=0.025) and mucositis (10.7% vs. 2.6%, p=0.001) were more common in DS group. Fifty-one patients (68%) in DS group and 52 (66.7%) in SP group finished planned treatment. CONCLUSION: Our findings suggest that SP or DS is an effective and tolerable option for patients with curatively resected stage III gastric cancer.
Anemia ; Capecitabine ; Chemotherapy, Adjuvant* ; Cisplatin ; Disease-Free Survival ; Follow-Up Studies ; Gastrectomy ; Hand-Foot Syndrome ; Humans ; Korea ; Lymph Node Excision ; Mucositis ; Neutropenia ; Stomach Neoplasms*

Background: The benefits of transradial access (TRA) over transfemoral access (TFA) for bifurcation percutaneous coronary intervention (PCI) are uncertain because of the limited availability of device selection. This study aimed to compare the procedural differences and the in-hospital and long-term outcomes of TRA and TFA for bifurcation PCI using secondgeneration drug-eluting stents (DESs). Methods: Based on data from the Coronary Bifurcation Stenting Registry III, a retrospective registry of 2,648 patients undergoing bifurcation PCI with second-generation DES from 21 centers in South Korea, patients were categorized into the TRA group (n = 1,507) or the TFA group (n = 1,141). After propensity score matching (PSM), procedural differences, in-hospital outcomes, and device-oriented composite outcomes (DOCOs; a composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization) were compared between the two groups (772 matched patients each group). Results: Despite well-balanced baseline clinical and lesion characteristics after PSM, the use of the two-stent strategy (14.2% vs. 23.7%, P = 0.001) and the incidence of in-hospital adverse outcomes, primarily driven by access site complications (2.2% vs. 4.4%, P = 0.015), were significantly lower in the TRA group than in the TFA group. At the 5-year follow-up, the incidence of DOCOs was similar between the groups (6.3% vs. 7.1%, P = 0.639). Conclusion The findings suggested that TRA may be safer than TFA for bifurcation PCI using second-generation DESs. Despite differences in treatment strategy, TRA was associated with similar long-term clinical outcomes as those of TFA. Therefore, TRA might be the preferred access for bifurcation PCI using second-generation DES.