Jeongeun Kim

Development of a Health Information Technology Acceptance Model Using Consumers’ Health Behavior Intention

Background For effective health promotion using health information technology (HIT), it is mandatory that health consumers have the behavioral intention to measure, store, and manage their own health data. Understanding health consumers’ intention and behavior is needed to develop and implement effective and efficient strategies. Objective To develop and verify the extended Technology Acceptance Model (TAM) in health care by describing health consumers’ behavioral intention of using HIT. Methods This study used a cross-sectional descriptive correlational design. We extended TAM by adding more antecedents and mediating variables to enhance the model’s explanatory power and to make it more applicable to health consumers’ behavioral intention. Additional antecedents and mediating variables were added to the hypothetical model, based on their theoretical relevance, from the Health Belief Model and theory of planned behavior, along with the TAM. We undertook structural equation analysis to examine the specific nature of the relationship involved in understanding consumers’ use of HIT. Study participants were 728 members recruited from three Internet health portals in Korea. Data were collected by a Web-based survey using a structured self-administered questionnaire. Results The overall fitness indices for the model developed in this study indicated an acceptable fit of the model. All path coefficients were statistically significant. This study showed that perceived threat, perceived usefulness, and perceived ease of use significantly affected health consumers’ attitude and behavioral intention. Health consumers’ health status, health belief and concerns, subjective norm, HIT characteristics, and HIT self-efficacy had a strong indirect impact on attitude and behavioral intention through the mediators of perceived threat, perceived usefulness, and perceived ease of use. Conclusions An extended TAM in the HIT arena was found to be valid to describe health consumers’ behavioral intention. We categorized the concepts in the extended TAM into 3 domains: health zone, information zone, and technology zone.

Celecoxib induces hepatic stellate cell apoptosis through inhibition of Akt activation and suppresses hepatic fibrosis in rats

Background and aims: Activated hepatic stellate cells (HSCs) but not quiescent HSCs express cyclo-oxygenase-2 (COX-2), suggesting that the COX-2/prostanoid pathway has an active role in hepatic fibrogenesis. However, the role of COX-2 inhibitors in hepatic fibrogenesis remains controversial. The aim of this study was to investigate the antifibrotic effects of celecoxib, a selective COX-2 inhibitor. Methods: The effects of various COX inhibitors—that is, ibuprofen, celecoxib, NS-398 and DFU, were investigated in activated human HSCs. Then, the antifibrotic effect of celecoxib was evaluated in hepatic fibrosis developed by bile duct ligation (BDL) or peritoneal thioacetamide (TAA) injection in rats. Results: Celecoxib, NS-398 and DFU inhibited platelet-derived growth facor (PDGF)-induced HSC proliferation; however, only celecoxib (⩾50 μM) induced HSC apoptosis. All COX inhibitors completely inhibited prostaglandin E2 (PGE2) and PGI2 production in HSCs. Separately, PGE2 and PGI2 induced cell proliferation and extracellular signal-regulated kinase (ERK) activation in HSCs. All COX inhibitors attenuated ERK activation, but only celecoxib significantly inhibited Akt activation in HSCs. Celecoxib-induced apoptosis was significantly attenuated in HSCs infected with adenovirus containing a constitutive active form of Akt (Ad5myrAkt). Celecoxib had no significant effect on PPARγ (peroxisome proliferator-activated receptor γ) expression in HSCs. Celecoxib inhibited type I collagen mRNA and protein production in HSCs. Oral administration of celecoxib (20 mg/kg/day) significantly decreased hepatic collagen deposition and α-SMA (α-smooth muscle actin) expression in BDL- and TAA-treated rats. Celecoxib treatment significantly decreased mRNA expression of COX-2, α-SMA, transforming growth factor β1 (TGFβ1) and collagen α1(I) in both models. Conclusions: Celecoxib shows a proapoptotic effect on HSCs through Akt inactivation and shows antifibrogenic effects in BDL- and TAA-treated rats, suggesting celecoxib as a novel antifibrotic agent of hepatic fibrosis.

Information technology and patient safety in nursing practice: an international perspective

Abstract When people become patients, they place their trust in their health care providers. As providers assume responsibility for their diagnosis and treatment, patients have a right to expect that this will include responsibility for their safety during all aspects of care. However, increasing epidemiological data make it clear that patient safety is a global problem. Improved nursing care may prevent many adverse events, and nursing must take a stronger leadership role in this area. Although errors are almost inevitable, safety can be improved, and health care institutions are increasingly making safety a top priority. Information technology provides safety benefits by enhancing communication and delivering decision-support; its use will likely be a cornerstone for improving safety. This paper will discuss the status of patient safety from an international viewpoint, provide case studies from different countries, and discuss information technology solutions from a nursing perspective.

Factors that affect the diagnostic accuracy of liver fibrosis measurement by Fibroscan in patients with chronic hepatitis B

Aliment Pharmacol Ther 2010; 32: 498–505

Is clopidogrel premedication useful to reduce thromboembolic events during coil embolization for unruptured intracranial aneurysms

BACKGROUND:Thromboembolism is a common complication related to coil embolization of intracranial aneurysms. OBJECTIVE:To identify factors related to thromboembolic events during coil embolization for unruptured intracranial aneurysms and to evaluate the role of clopidogrel premedication to prevent thromboembolisms. METHODS:Since March 2006, clopidogrel has been administered to patients with unruptured aneurysms before coil embolization (the clopidogrel group) in our institution. The clopidogrel group (416 patients with 485 aneurysms) and the historical control group (140 patients with 159 aneurysms who received no antiplatelet premedication) were compared to find the efficacy of clopidogrel premedication. Various factors, including age, sex, body weight, and medical history of hypertension, diabetes mellitus, hyperlipidemia, smoking, previous stroke, and heart disease, as well as clopidogrel premedication, were analyzed in relationship to the development of a procedure-related thromboembolism. RESULTS:Procedure-related thromboembolic events tended to occur less frequently in the clopidogrel group compared with the control group (7.4% vs 12.6%; P = .05), and clopidogrel premedication could modify the risk in female patients from 11.1% to 5.2% (P = .04). The use of multiple logistic regression analysis identified clopidogrel premedication (P = .03), smoking (P = .002), and hyperlipidemia (P = .02) as significant factors related to the formation of thromboembolism. CONCLUSION:Clopidogrel premedication seems to have a beneficial effect in reducing the number of procedure-related thromboembolisms during coil embolization for unruptured intracranial aneurysms, especially in female patients. Smoking and hyperlipidemia were independent risk factors related to thromboembolism.

Shaping and navigating methods of microcatheters for endovascular treatment of paraclinoid aneurysms.

OBJECTIVETo determine whether the use of a specific shape and a navigating method of microcatheters are suitable for placement at paraclinoid aneurysms. METHODSThe clinical data from 122 patients with 132 paraclinoid aneurysms that underwent endovascular treatments during a 2.5-year period were retrospectively reviewed. Microcatheter shapes were classified as “straight,” “primary curves” (45, 90, and J), “preshaped-C,” “pigtail” (simple, right, and left), and “S” (simple, right, left, and preshaped). The navigating methods were classified as antegrade/retrograde microcatheter shift, wire-steering, looping, and coil/wire guiding. The shapes and navigating methods were compared among 3 aneurysm groups, which were categorized as superior, medial, and other, based on direction. RESULTSShapes were significantly different between the 3 groups; the most commonly engaged shape in the superior group, medial group, and other group was S (55%), pigtail (60%), and primary (56%), respectively. The straight and S shapes were used in 5 (83%) and 18 (86%) cases, respectively, in the superior group, whereas the pigtail shape was used in 50 (86%) cases in the medial group. Aside from pigtail-simple shape, the side of pigtail, right vs left, coincided with the side of the internal carotid artery involved in every case of the medial group. The navigating methods were not significantly different among the 3 groups. CONCLUSIONA specific shape by paraclinoid aneurysm direction tends to be suitable for the first trial of microcatheter shapes. Operators may reduce unnecessary struggling time of intra-aneurysmal placement of microcatheters by practicing the use of that shape.

Results of a Survey on Medical Error Reporting Systems in Korean Hospitals

BACKGROUND Recent data suggest that medical injuries, or adverse events, represent an important international problem, and that many are caused by errors. Spontaneous reporting is the main tool used to detect errors and adverse events in most countries, and reporting systems are believed to be important for improving patient safety. Increasingly, such reporting can be done using information systems, and information systems are widely used in Korea. However, few data are available regarding the use of electronic medical error reporting systems in Korea. OBJECTIVES The objectives of this study were to investigate the present status of reporting system of Korean hospitals, and to compare the current status of medical error reporting systems with that of other health information sub systems. METHODS The chairs of nursing departments of all 283 hospitals nationwide with more than 100 beds were surveyed using a structured questionnaire. The response rate was 35%. In addition, two reports on the national use of health information systems in Korea from 1999 and 2003 were analyzed. RESULTS Among reporting hospitals (n=99), medical errors were reported on paper in 75 hospitals (77%), verbally in 30 hospitals (30%), using word processing in 13 hospitals (13%), and using the hospital information system in only three hospitals (3%). In contrast, there was widespread and increasing use of health information technology (HIT) in areas such as medication administration, inpatient and outpatient order entry, and radiology. CONCLUSIONS While HIT is increasingly widely used in Korea in many areas, it is not being used for error reporting. Increasing the use of electronic reporting systems, and systemically evaluating the medical errors and adverse events reported, represent essential steps for reducing systemic errors and improving patient safety.

An evaluation of Web-based education as an alternative to group lectures for diabetes self-management.

This study evaluated the efficacy of Web-based diabetes self-management education for newly diagnosed patients with type II diabetes as an alternative to group lectures. Using a non-equivalent control group, pretest-post-test design, the participants in the Web group (n = 15) took part in a Web-based diabetes self-management program, while those in the lecture group (n = 16) attended 3 h of group lectures provided by health-care professionals specializing in diabetes care. The outcome variables were measured at the baseline (T0), and 6 weeks (T1) and 3 months (T2) after the interventions. The glycosylated hemoglobin (HbA1c) percentage and diabetes care knowledge in the Web group improved significantly from T0 to T1, while the diabetes care behavior improved significantly from T0 to T1 and from T1 to T2. The diabetes care knowledge and diabetes care behavior in the lecture group improved significantly from T0 to T1, but the HbA1c percentage did not change significantly between any times. These results show the potential of the Web-based program as an alternative to group lectures for diabetes self-management education.

Analysis of health consumers' behavior using self-tracker for activity, sleep, and diet.

BACKGROUND With the ever-increasing availability of health information technology (HIT) enabling health consumers to measure, store, and manage their health data (e.g., self-tracking devices), more people are logging and managing their own health data for the purpose of promoting general well-being. To develop and implement effective and efficient strategies for improving personal monitoring devices, a rigorous theoretical framework to explain the health consumers attitude, intention, and behavior needs to be established. The aim of this study is to verify the HIT acceptance model (HITAM) in the context of the health consumers attitude, behavioral intention, and behavior of utilizing self-trackers. Furthermore, the study aims to gain better understanding of self-tracking behavior in the context of logging daily activity level, sleep patterns, and dietary habits. SUBJECTS AND METHODS Forty-four female college students were selected as voluntary study participants. They used self-trackers for activity, sleep, and diet monitoring for 90 or more consecutive days. The logged data were analyzed and fitted to the HITAM to verify whether the model was suitable for capturing the various behavioral and intention-related characteristics observed. RESULTS The overall fitness indices for the HITAM using the field data yielded an acceptable fitness to the model, with all path coefficients being statistically significant. The model accounts for 66.8% of the variance in perceived usefulness, 43.9% of the variance in perceived ease of use, 83.1% of the variance in attitude, and 48.4% of the variance in behavioral intention. The compliance ranking of self-tracking behavior, in order of decreasing compliance, was activity, sleep, and diet. This ranking was consistent with that of ease of use of the personal monitoring device used in the study. CONCLUSIONS The HITAM was verified for its ability to describe the health consumers attitude, behavioral intention, and behavior. The analysis indicated that the ease of use of a particular HIT device stands as the most significant barrier in the way of increasing the efficacy of self-tracking.

Factors influencing health-promoting behaviors in Korean breast cancer survivors.

PURPOSE The purpose of this study was to examine the relationships among internal health locus of control, depression, social support, and health-promoting behaviors in Korean breast cancer survivors and to identify factors influencing health-promoting behaviors. METHOD A predictive design was used. The data were collected by questionnaires from a convenience sample of 258 breast cancer survivors in Korea during 2007. The data were analyzed using descriptive statistics, t-tests, one-way ANOVA, Pearsons correlation coefficients, and stepwise multiple regression. RESULTS When differences of health-promoting lifestyle based on demographic and illness-related characteristics were examined, no significant differences were found except for undergoing chemotherapy. Internal health locus of control, depression, and social support were correlated significantly with the health-promoting lifestyle. As a result of stepwise multiple regression analysis, social support, depression, and chemotherapy were discovered to account for 34.98% of the variance in health-promoting lifestyle. The variable that most affected a health-promoting lifestyle was social support, followed by chemotherapy and depression. CONCLUSIONS The results of the study clearly demonstrate the importance of social support and depression in explaining the occurrence of a health-promoting lifestyle among Korean breast cancer survivors.