PURPOSE: The purpose of this study was to evaluate the effect of abdominal massage on alleviating pain caused by the injection of recombinant gonadotropin for In Vitro Fertilization (IVF) among infertile women. METHODS: This study employed a nonequivalent control group non-synchronized design. A total sample of 149 infertile women who never experienced in vitro fertilization was recruited at C fertility center. Seventy women were assigned into experimental group and 79 into controls. The experimental group had been informed to do abdominal massage prior to the injection and to record their subjective pain using visual analogue scale. The control group had been informed to record their subjective pain in the same way just after the injection. RESULTS: Compared to the pre-tested pain scores, the pain scores in experimental group were significantly reduced by 0.7 points, whereas the control group increased by 0.9 points (t=-4.55, p=.001). CONCLUSION: This study confirms that the use of abdominal massage prior to the injection is an effective way to alleviate pain on injection site. This massage may be a useful intervention for infertile women about pain alleviation.
Female ; Fertility ; Fertilization in Vitro* ; Gonadotropins ; Humans ; In Vitro Techniques* ; Massage*

BACKGROUND: This study evaluated the continuous abstinence rates from smoking at 12-month after a hospital-based smoking cessation program was applied for smokers hospitalized for acute myocardial infarction. METHODS: Among those who are hospitalized for acute myocardial infarction from January 2012 to December 2013, ninety-eight smokers agreed to quit smoking were eligible for follow up to 12 months. Each of them underwent six consecutive sessions (first during admission, the other 5 sessions after discharge) of behavioral modification, counseling for withdrawal symptoms, and anti-smoking advices by a trained nurse. Exhaled carbon monoxide measurements less than 6 ppm were used to confirm the smoking cessation status of each participant. RESULTS: Mean age of all participants was 55.2±10.8 years old, and their continuous abstinence rates at 1, 3, 6, 12 months were 63.3%, 49.0%, 43.9%, and 37.8% for each. The continuous abstinence rate from smoking after 12 months was 69.7% and significantly higher in those who completed the 6 sessions than 21.5% in those who completed 5 sessions or less (P<0.001). After adjustment for general and smoking-related characteristics, multivariate logistic regression analysis revealed that full participation relative to 5 or less participation was significantly associated with higher continuous abstinence rate from smoking at 12 months (odds ratio: 7.96; 95% confidence interval: 2.07-30.55). CONCLUSIONS: The consistency of participating in a hospital-based smoking cessation program, described herein, significantly improved success rates of smoking cessation in patients discharged after acute myocardial infarction. Hospital-based smoking cessation program based on education and counseling should be included as an important part of patient management for acute myocardial infarction.
Carbon Monoxide ; Counseling ; Education ; Follow-Up Studies ; Humans ; Logistic Models ; Myocardial Infarction* ; Smoke* ; Smoking Cessation* ; Smoking* ; Substance Withdrawal Syndrome

OBJECTIVE: Despite successful efforts to shorten the door-to-balloon time in patients with ST-segment elevation myocardial infarction (STEMI), pre-hospital delayremains a problem. We evaluated the factors related to pre-hospital delay using the Jeonbuk regional cardiovascular center database. METHODS: From 2010 to 2013, a total of 384 STEMI patients were enrolled. We analyzed the onset time, door time, and balloon time, and the patients were grouped according to pre-hospital delay (120 minutes). Clinical and socio-demographic variables were compared. RESULTS: 53.2% of patients had prolonged onset-to-door time (median 130, interquartile range [IQR] 66~242 minutes), and 68.5% of patients did not achieve <120 minute of total ischemic time (median 175, IQR 110~304 minutes). Pre-hospital delay was more frequent in patients with old age, female, no local residence, low education level, transfer via other hospital and no use of emergency squad (119). Only 20% of patients used 119, and 119 team responded in a prompt manner (call to scene time 6 min), but 41.6% of patients was transported to non-PCI-capable hospitals. Multivariate analysis revealed that transfer via other hospital [Odds ratio (OR) 2.5, 95% confidence interval (CI) 1.6-4.1, p<0.001), use of 119 (OR 0.4, 95% CI 0.2-0.6, p<0.001), age >60 years (OR 1.8, 95% CI 1.1-3.0, p=0.031) and hypertension (OR 1.9, 95% CI 1.2-2.9, p=0.047) were independent predictors of pre-hospital delay. CONCLUSIONS: The present study demonstrated a significant pre-hospital delay in the treatment of STEMI patients in the Province of Jeonbuk. Public campaigns and education are needed to raise the public awareness of STEMI and the use of 119.
Education ; Emergencies ; Emergency Medical Services ; Female ; Humans ; Hypertension ; Jeollabuk-do* ; Multivariate Analysis ; Myocardial Infarction* ; Time-to-Treatment

OBJECTIVES: Intensified competitiveness in the healthcare industry has increased the number of healthcare centers and propelled the introduction of customer relationship management (CRM) systems to meet diverse customer demands. This study aimed to develop the information system success model of the CRM system by investigating previously proposed indicators within the model. METHODS: The evaluation areas of the CRM system includes three areas: the system characteristics area (system quality, information quality, and service quality), the user area (perceived usefulness and user satisfaction), and the performance area (personal performance and organizational performance). Detailed evaluation criteria of the three areas were developed, and its validity was verified by a survey administered to CRM system users in 13 nationwide health promotion centers. The survey data were analyzed by the structural equation modeling method, and the results confirmed that the model is feasible. RESULTS: Information quality and service quality showed a statistically significant relationship with perceived usefulness and user satisfaction. Consequently, the perceived usefulness and user satisfaction had significant influence on individual performance as well as an indirect influence on organizational performance. CONCLUSIONS: This study extends the research area on information success from general information systems to CRM systems in health promotion centers applying a previous information success model. This lays a foundation for evaluating health promotion center systems and provides a useful guide for successful implementation of hospital CRM systems.
Delivery of Health Care ; Health Care Sector ; Health Information Management ; Health Promotion ; Information Systems ; Medical Informatics

BACKGROUND: Chronic heart failure (HF) is a leading cause of morbidity and mortality in industrialized countries. Raised resting heart rate (HR) is a marker of cardiovascular risk in general population, as well as in patients with hypertension and coronary artery disease. We studied the association between HR and cardiovascular events in patients with Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) registry. METHODS: CION-J registry was a multicenter, prospective database for chronic HF. From January 2010 to December 2010, 356 HF patients who clinically stabilized at least 2 weeks were analyzed. According to resting HR, the patients divided into the tertile (lower tertile < 70/min, n = 129; middle tertile 70-80/min, n = 114; upper tertile > 80/min, n = 113). Clinical outcomes during 6-month period were compared by resting HR. RESULTS: Patients with upper tertile revealed higher New York Heart Association (NYHA) class than in those with lower tertile. From the lower to the upper tertile, the incidence of composite events of death, non-fatal myocardial infarction, ischemic stroke, and hospitalization for HF were increased(3.1%, 4.4%, 16.8%, respectively; p < 0.001). Patients with upper tertile had a higher predictive value for the incidence of death (hazard ratio, 5.8; p = 0.036) and hospitalization for HF (hazard ratio, 6.4; p < 0.001) than in those with middle and lower tertile. In multivariate analysis, NYHA class III/IV, resting HR > 80/min, and ejection fraction < 35% were independent predictors of adverse events. CONCLUSIONS: High resting HR (> 80/min) is a prognostic factor in chronic HF. Optimal treatment to reduce HR should be emphasized to improve prognosis of HF.
Coronary Artery Disease ; Developed Countries ; Heart ; Heart Failure ; Heart Rate ; Hospitalization ; Humans ; Hypertension ; Incidence ; Multivariate Analysis ; Myocardial Infarction ; New York ; Prognosis ; Prospective Studies ; Stroke

BACKGROUND/AIMS: Contrast-induced nephropathy (CIN) is an important complication of diagnostic coronary angiography (CAG) and percutaneous coronary intervention (PCI). We investigated the incidence and predictors of the development of CIN in acute coronary syndrome (ACS) patients with renal dysfunction undergoing PCI. METHODS: From January 2005 to June 2010, we evaluated the clinical, laboratory, and angiographic data of 406 patients with ACS who had a serum creatinine > or = 1.3 mg/dL and underwent CAG or PCI. The patients were divided into two groups according to the development of CIN (CIN, n = 92; no CIN, n = 314). RESULTS: Of the 406 patients, 92 (22.7%) developed CIN. The development of CIN was associated with a lower baseline body mass index (p = 0.001), decreased left ventricular ejection fraction (LVEF) (p < 0.001), decreased creatinine clearance (CrCl) (p < 0.001), lower albumin (p < 0.001), lower hemoglobin (p = 0.003), higher N-terminal pro B type natriuretic peptide (p = 0.001), and greater contrast medium volume (CMV) (p = 0.021). On multiple logistic regression analysis, LVEF < 40% (OR, 4.080; 95% CI, 2.087-7.977; p < 0.001), albumin < 3.5 g/dL (OR, 2.042; 95% CI, 1.211-3.440; p = 0.007), and CMV/CrCl > or = 3.5 (OR, 1.964; 95% CI, 1.243-3.101; p = 0.004) were independent predictors of CIN. The cut-off value for CMV/CrCl was 3.5, and that for albumin was 3.55 g/dL. CONCLUSIONS: CIN occurred in 22.7% of the patients with ACS and renal dysfunction who underwent CAG or PCI. Independent predictors of CIN were decreased LVEF, decreased albumin, and increased CMV/CrCl ratio.
Acute Coronary Syndrome ; Body Mass Index ; Coronary Angiography ; Creatinine ; Hemoglobins ; Humans ; Incidence ; Logistic Models ; Percutaneous Coronary Intervention ; Stroke Volume

BACKGROUND AND OBJECTIVES: The renin-angiotensin-aldosterone system has been implicated in the pathogenesis of neointimal hyperplasia, and a role for angiotensin II in the migration and proliferation of vascular smooth muscle cells in restenotic lesions has been proposed. The aim of this study was to determine the anti-proliferative and anti-inflammatory effects of ramiprilat-coated stents in a porcine coronary overstretch restenosis model. SUBJECTS AND METHODS: Pigs were randomized into two groups in which the coronary arteries {16 pigs (16 coronaries in each group)} had a 3.0x17 mm ramiprilat-coated MAC stent or a 3.0x17 mm control MAC stent (AMG, Munich, Germany) implanted with oversizing (stent-to-artery ratio, 1.3 : 1) in porcine coronary arteries, and histopathologic analysis was assessed 28 days after stenting. RESULTS: There were no significant differences in the injury and inflammation scores between the two groups (1.20+/-0.43 vs. 1.23+/-0.57, p=0.8; and 1.21+/-0.39 vs. 1.25+/-0.49, p=0.6, respectively). Within the neointima, most inflammatory cells were lymphohistiocytes. Significant positive correlations existed between inflammatory cell counts and the neointima areas (r=0.567, p<0.001), and between inflammatory cell counts and the percent area stenosis (r=0.478, p<0.001). There was no significant difference in the inflammatory cell counts normalized to the injury (110+/-89 vs. 123+/-83, p=0.4) and fibrin scores (0.15+/-0.06 vs. 0.17+/-0.07, p=0.8) between the 2 groups. There were trends toward a smaller neointima area (1.06+/-0.51 mm2 vs. 1.28+/-0.35 mm2, p=0.083) and a smaller percent area stenosis (18.9+/-8.7% vs. 21.8+/-7.2%, p=0.088) in the ramiprilat-coated stent group. CONCLUSION: Although the ramiprilat-coated stent did not show significant inhibitory effects on neointimal hyperplasia, the ramiprilat-coated stent showed good effects on the inflammatory reaction and arterial healing similar to the control stent in a porcine coronary restenosis model.
Angiotensin II ; Angiotensin-Converting Enzyme Inhibitors ; Cell Count ; Constriction, Pathologic ; Coronary Restenosis ; Coronary Vessels ; Fibrin ; Hyperplasia ; Inflammation ; Muscle, Smooth, Vascular ; Neointima ; Renin-Angiotensin System ; Stents ; Swine

BACKGROUND/AIMS: Carvedilol is an antioxidant that inhibits smooth muscle cell proliferation and migration. The aim of this study was to investigate the beneficial effects of carvedilol-loaded stents on 2-year clinical outcomes after stent implantation in patients with coronary artery disease. METHODS: We performed a prospective trial with male subjects to compare the safety and effects of carvedilol-loaded BiodivYsio(R) stents implanted into 20 patients with those of bare-metal BiodivYsio(R) stents implanted into 21 patients for de novo coronary lesions. The primary end point was the degree of neointimal hyperplasia, which was measured by intravascular ultrasound (IVUS) 6 months after the procedure; the secondary end point was major adverse cardiac events (MACE) at 2 years after implantation. All carvedilol and control stents were deployed successfully. RESULTS: A 2-year follow-up was completed for 19 patients (95%) in the carvedilol stent group and 20 patients (95%) in the control stent group. IVUS showed a trend toward a larger luminal area (6.86 +/- 2.59 vs. 5.47 +/- 1.52 mm2, p = 0.267), smaller neointimal area (1.34 +/- 0.70 vs. 2.40 +/- 1.73 mm2, p = 0.18), and reduced net decrease in luminal area (-0.78 +/- 0.97 vs. -1.89 +/- 1.78 mm2, p = 0.106) in the carvedilol stent group compared with the control stent group, respectively. There were no significant differences in the incidence of MACE (10.5 vs. 30.0%, respectively, p = 0.132) between the groups at 2 years after stent implantation. Stent thrombosis did not occur in either group after 2 years. CONCLUSIONS: The carvedilol-loaded stents tended to inhibit neointimal hyperplasia without the occurrence of cardiac death, myocardial infarction, or stent thrombosis at 2-year follow-up.
Aged ; *Angioplasty, Balloon, Coronary ; Carbazoles/*administration & dosage ; Coronary Artery Disease/*therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Propanolamines/*administration & dosage ; Prospective Studies ; *Stents ; Treatment Outcome ; Ultrasonography, Interventional

BACKGROUND/AIMS: Long-term antiarrhythmic drug therapy remains the principal approach for suppressing atrial fibrillation (AF) and maintaining sinus rhythm. In this study, we examined the differing electrophysiological effects of various antiarrhythmic drugs on the cardiac chamber and atrial selectivity in patients with AF. METHODS: We analyzed 134 patients (60.4 +/- 12.5 years, M:F = 1.14:1) who were administered a single antiarrhythmic agent for AF over 6 months: amiodarone (group A), flecainide (group F), or propafenone (group P). The P wave, QRS complex duration and dispersion, and QT interval and its dispersion were evaluated using a standard 12-lead electrocardiogram. RESULTS: There was no significant difference in age, gender ratio, or associated diseases among the three groups. In group A, Pmax, Pmin, P dispersion, QRSmax, QRSmin, and QRS dispersion were shorter than in groups F and P, whereas Pmax/QRSmax was the highest in group A (A = 1.2, F = 0.9, P = 1.0; p < 0.01). QTcmax and QTcmin were longer in group A, whereas QTc dispersion and the QT peak to end (A = 13.3 +/- 11.2, F = 30.7 +/- 24.9, P = 31.8 +/- 21.6; p < 0.01) were shorter in group A than in the other groups. CONCLUSIONS: Amiodarone had a weaker, but more selective, inhibitory effect on intra-atrial conduction, and inhibited ventricular repolarization more effectively and homogenously than flecainide or propafenone. These differing electrophysiological effects may contribute to the superior effectiveness and safety of amiodarone over flecainide or propafenone.
Amiodarone ; Anti-Arrhythmia Agents ; Atrial Fibrillation ; Electrophysiology ; Flecainide ; Humans ; Propafenone

BACKGROUND/AIMS: To analyze the clinical effects of continuing to smoke in patients with acute myocardial infarction (AMI), clinical outcomes of those continuing or ceasing smoking were compared. METHODS: In total, 498 patients with AMI who underwent percutaneous coronary intervention (PCI) from January to December 2007 were enrolled. Of these patients, 407 (63.9 +/- 11.9 years, males 70%) with 1-year follow-ups were analyzed. Based on risk factors for smoking, patients were divided into two groups: Group I (smokers, n = 164, 57.9 +/- 11.2 years) and Group II (nonsmokers, n = 243, 68.0 +/- 10.6 years). Additionally, Group I patients were subdivided by cessation of smoking after discharge: Group IA (current smokers, n = 95, 56.8 +/- 10.5 years) and IB (past smokers, n = 69, 59.4 +/- 12.0 years). Clinical characteristics, coronary angiographic and procedural findings, and 1year major adverse cardiac events (MACE) were analyzed. RESULTS: During the 1-year follow-up period, MACE developed in 112 patients (27.6%) and death in 42 patients (10.3%). In terms of smoking habits at admission, there was no significant difference in the 1-year MACE between current smokers (Group I) and nonsmokers (Group II). In the subgroup analysis, there were no significant difference in clinical characteristics between Groups IA and IB. Mortality was significantly higher in Group IA than in Group IB during the 1-year clinical follow-up (11% vs. 0%; p = 0.005). CONCLUSIONS: Of the AMI patients who underwent PCI, mortality was significantly higher in current smokers than in past smokers after PCI.
Follow-Up Studies ; Humans ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Risk Factors ; Smoke ; Smoking