Translating genomic testing results for pediatric critical care: Opportunities for genetic counselors.

Genomic sequencing (GS), such as whole genome and exome sequencing, is rapidly being integrated into pediatric critical care settings. Results are being used to make high impact decisions including declarations of futility, withdrawal of care, and rationing of scarce resources. In this qualitative study, we conducted interviews with clinicians involved in the care of critically ill children with congenital heart disease (CHD) to investigate their views on implementation of GS into clinical practice. Interviews were transcribed and inductively analyzed for major themes using grounded theory and thematic analysis. Three major themes emerged surrounding the use of genomic information in the high-stakes, time pressured decision making that characterizes clinical care of critically ill children with CHD: (a) that clinicians felt they did not have sufficient training to accurately assess genetic results despite pressure to incorporate results into clinical decisions; (b), that they desire knowledge support from genetic specialists, such as genetic counselors, who both understand the critical care context and are available within the time constraints of critical care clinical pressures; and (c), that clinicians feel a pressing need for increased genetics education to be able to safely and appropriately incorporate GS results into clinical decisions Our data suggest that genetics specialists may need a stronger presence in the pediatric critical care setting.

Beyond Consent: Building Trusting Relationships With Diverse Populations in Precision Medicine Research.

With the growth of precision medicine research on health data and biospecimens, research institutions will need to build and maintain long-term, trusting relationships with patient-participants. While trust is important for all research relationships, the longitudinal nature of precision medicine research raises particular challenges for facilitating trust when the specifics of future studies are unknown. Based on focus groups with racially and ethnically diverse patients, we describe several factors that influence patient trust and potential institutional approaches to building trustworthiness. Drawing on these findings, we suggest several considerations for research institutions seeking to cultivate long-term, trusting relationships with patients: (1) Address the role of history and experience on trust, (2) engage concerns about potential group harm, (3) address cultural values and communication barriers, and (4) integrate patient values and expectations into oversight and governance structures.

Protecting posted genes: social networking and the limits of GINA.

The combination of decreased genotyping costs and prolific social media use is fueling a personal genetic testing industry in which consumers purchase and interact with genetic risk information online. Consumers and their genetic risk profiles are protected in some respects by the 2008 federal Genetic Information Nondiscrimination Act (GINA), which forbids the discriminatory use of genetic information by employers and health insurers; however, practical and technical limitations undermine its enforceability, given the everyday practices of online social networking and its impact on the workplace. In the Web 2.0 era, employers in most states can legally search about job candidates and employees online, probing social networking sites for personal information that might bear on hiring and employment decisions. We examine GINA's protections for online sharing of genetic information as well as its limitations, and propose policy recommendations to address current gaps that leave employees' genetic information vulnerable in a Web-based world.

The ELSI Virtual Forum, 30 Years of the Genome: Integrating and Applying ELSI Research.

This paper reports our analysis of the ELSI Virtual Forum: 30 Years of the Genome: Integrating and Applying ELSI Research, an online meeting of scholars focused on the ethical, legal, and social implications (ELSI) of genetics and genomics.

Clinical Outcomes of Boston Type-I Keratoprosthesis Implantation: A 4-year Retrospective Study in South Korea

Purpose@#To evaluate the long-term results of Boston type-I keratoprosthesis implantation in Korea. @*Methods@#Medical records of six patients (six eyes) who underwent Boston type-I keratoprosthesis implantation between August 2018 and November 2019 were retrospectively reviewed for more than 36 months. @*Results@#The mean follow-up period was 44.3 ± 7.0 months. Best corrected visual acuity (BCVA) improved significantly for all six eyes, from 2.33 ± 0.51 logarithm of the minimum angle of resolution (logMAR) to 0.67 ± 0.59 logMAR. The vision recovered immediately after the surgery in all patients. Retroprosthetic membrane developed in three of the patients, but the visual acuity remained unchanged. Anatomical success was achieved in all six eyes after Boston type-I keratoprosthesis implantation. @*Conclusions@#The long-term analysis of Boston type-I keratoprosthesis implantation showed a faster recovery and improved visual acuity compared with conventional penetrating keratoplasty. Without the use of systemic immunosuppressants, all six eyes showed long-term survival of the Boston keratoprosthesis. Boston type-I keratoprosthesis implantation may be used in patients with recurrent graft failure after keratoplasty. This was the first study investigating the long-term results of Boston keratoprosthesis implantation in Korean patients.

Colonoscopic Screening and Risk of All-Cause and Colorectal Cancer Mortality in Young and Older Individuals / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#The incidence of early-onset colorectal cancer (CRC) and associated mortality have been increasing. However, the potential benefits of CRC screening are largely unknown in young individuals. We aimed to evaluate the effect of CRC screening with colonoscopy on all-cause and CRC mortality among young (aged < 45 years) and older (aged ≥ 45 years) individuals. @*Materials and Methods@#This cohort study included 528,046 Korean adults free of cancer at baseline who underwent a comprehensive health examination. The colonoscopic screening group was defined as those who reported undergoing colonoscopy for CRC screening. Mortality follow-up until December 31, 2019 was ascertained based on nationwide death certificate data from the Korea National Statistical Office. @*Results@#Colonoscopic screening was associated with a lower risk of all-cause mortality in both young and older individuals. Multivariable-adjusted time-dependent hazard ratios (95% confidence intervals) for all-cause mortality comparing ever- to never-screening were 0.86 (0.75-0.99) for young individuals and 0.71 (0.65-0.78) for older individuals. Colonoscopic screenings were also associated with a reduced risk of CRC mortality without significant interaction by age, although this association was significant only among participants aged ≥ 45 years, with corresponding time-dependent hazard ratios of 0.47 (0.15-1.44) for young individuals and 0.52 (0.31-0.87) for those aged ≥ 45 years. @*Conclusion@#Colonoscopic CRC screening decreased all-cause mortality among both young and older individuals, while significantly decreased CRC mortality was observed only in those aged ≥ 45 years. Screening initiation at an earlier age warrants more rigorous confirmatory studies.

Association between drinking behaviors and components of metabolic syndrome in subjects in their 20s and 30s: data obtained from the Korea National Health and Nutrition Examination Survey (2016–2018)

BACKGROUND/OBJECTIVES@#Numerous studies have examined the relationship between drinking behaviors and metabolic syndrome (MetS) for adults, but these include very few studies for young adults. This study therefore undertook to investigate the association between drinking behaviors and components of MetS among adult drinkers aged 20–30 years. @*SUBJECTS/METHODS@#Using the 2016–2018 Korea National Health and Nutrition Examination Survey data, drinking behaviors of adults in the age group 20–30 years were divided into 4 groups: 1) group A, good drinking habits; 2) group B, frequent binge drinking but not frequent drinking; 3) group C, frequent drinking but not frequent binge drinking; 4) group D, frequent drinking and binge drinking. The association between MetS components and drinking behaviors was analyzed by applying multiple logistic regression analysis. @*RESULTS@#We determined the prevalence risk compared to group A. In men, the prevalence risk of high triglyceride (TG) increased 2.051-fold in group C and 1.965-fold in group D.Moreover, in group D, the prevalence risk of low high density lipoprotein cholesterol (HDL-C) increased 0.668-fold, high blood pressure (BP) increased 2.147-fold, and MetS increased 1.567-fold. In women, there was an increased prevalence risk of low HDL-C (0.353-fold) and MetS (3.438-fold) in group C, whereas group D showed increased prevalence risk of abdominal obesity (2.959-fold), high TG (1.824-fold, and low HDL-C (0.424-fold). @*CONCLUSIONS@#Our study indicates that frequent drinking increases the risk of high TG, whereas frequent and binge drinking increases the risk of high TG, low HDL-C, high BP, and prevalence of MetS in men. In women, frequent drinking without binge drinking increases the risk of low HDL-C and MetS, whereas frequent and binge drinking increases the risk of abdominal obesity, high TG, and low HDL-C. We propose that improvements in the drinking behaviors can reduce the prevalence of MetS.

Intervention for Married Immigrant Women in Korea: A Systematic Review

Purpose@#This study aimed to review the intervention programs designed for married immigrant women living in Korea. @*Methods@#A total of 39 articles published from 2010 to 2020 were selected and analyzed using domestic and international web-based academic databases according to a systematic literature review procedure. The selected studies were evaluated for quality according to RoB (Risk of Bias) and RoBANS (Risk of Bias for Non-randomized studies). Additionally, intervention programs and outcome variables were based on the Nursing Intervention Classification (NIC) and Nursing Outcome Classification (NOC) system. @*Results@#According to the NIC categories, 69.2% of the interventions were in the behavioral domain, and 23.1% were in the family domain. The outcome variables primarily measured in NOC categories were psychological well-being (45.8%), health knowledge (11.0%), and health belief (10.2%). The quality of the selected studies was low overall in random sequence generation, allocation concealment, blinding of participants and personnel, and blinding of outcome data in randomized controlled trials (RCT) studies and confounding variables, blinding of outcome data, and incomplete outcome bias in non-RCT studies. @*Conclusion@#Based on the results of this study, future studies will have to consider the characteristics of the subjects, life cycle, daily life, or language limitations. In addition, it is necessary to develop high-quality programs through continuous research on currently and frequently used interventions and outcome variables and on other various mediations and to verify the outcome variables.

Factors Influencing COVID-19 Preventive Behaviors in Nursing Students: Knowledge, Risk Perception, Anxiety, and Depression

Purpose@#The purpose of this study was to survey the Coronavirus Disease 2019 (COVID-19) related knowledge, risk perception, preventive behaviors, depression, and anxiety levels among nursing students, and to identify factors that influence preventive behaviors. @*Methods@#An online survey was conducted among nursing students from October 7, 2020 to October 12, 2020. The data were analyzed using independent t-test, one-way ANOVA, Pearson’s correlation coefficients, and multiple regression. @*Results@#A total of 222 nursing students participated in this study. The correct answer rate for COVID-19 knowledge was 90.0%, risk perception was 5.51 ± 1.26, and the rate for preventive behaviors was 92.5%. The depression score was 6.28 ± 4.63; 59.9% of nursing students had depression, and the anxiety score was 5.56 ± 3.98; 59.9% of nursing students had anxiety. COVID-19 preventive behaviors had a positive correlation with COVID-19 knowledge (r = .30, p < .001), COVID-19 risk perception (r = .18, p = .009), and anxiety (r = .21, p = .001).Factors influencing COVID-19 preventive behaviors by multiple regression were identified as COVID-19 knowledge, anxiety, physical health status before and after COVID-19, grade, practical experience after COVID-19, and COVID-19 risk perception (F = 12.46, p < .001, R 2 = 25.8%). @*Conclusion@#The results of this research on factors influencing COVID-19 prevention behaviors can be used in the future to develop appropriate health policies for individual and community infectious disease prevention behaviors.

Intervention for Married Immigrant Women in Korea: A Systematic Review

Purpose@#This study aimed to review the intervention programs designed for married immigrant women living in Korea. @*Methods@#A total of 39 articles published from 2010 to 2020 were selected and analyzed using domestic and international web-based academic databases according to a systematic literature review procedure. The selected studies were evaluated for quality according to RoB (Risk of Bias) and RoBANS (Risk of Bias for Non-randomized studies). Additionally, intervention programs and outcome variables were based on the Nursing Intervention Classification (NIC) and Nursing Outcome Classification (NOC) system. @*Results@#According to the NIC categories, 69.2% of the interventions were in the behavioral domain, and 23.1% were in the family domain. The outcome variables primarily measured in NOC categories were psychological well-being (45.8%), health knowledge (11.0%), and health belief (10.2%). The quality of the selected studies was low overall in random sequence generation, allocation concealment, blinding of participants and personnel, and blinding of outcome data in randomized controlled trials (RCT) studies and confounding variables, blinding of outcome data, and incomplete outcome bias in non-RCT studies. @*Conclusion@#Based on the results of this study, future studies will have to consider the characteristics of the subjects, life cycle, daily life, or language limitations. In addition, it is necessary to develop high-quality programs through continuous research on currently and frequently used interventions and outcome variables and on other various mediations and to verify the outcome variables.

Factors Influencing COVID-19 Preventive Behaviors in Nursing Students: Knowledge, Risk Perception, Anxiety, and Depression

Purpose@#The purpose of this study was to survey the Coronavirus Disease 2019 (COVID-19) related knowledge, risk perception, preventive behaviors, depression, and anxiety levels among nursing students, and to identify factors that influence preventive behaviors. @*Methods@#An online survey was conducted among nursing students from October 7, 2020 to October 12, 2020. The data were analyzed using independent t-test, one-way ANOVA, Pearson’s correlation coefficients, and multiple regression. @*Results@#A total of 222 nursing students participated in this study. The correct answer rate for COVID-19 knowledge was 90.0%, risk perception was 5.51 ± 1.26, and the rate for preventive behaviors was 92.5%. The depression score was 6.28 ± 4.63; 59.9% of nursing students had depression, and the anxiety score was 5.56 ± 3.98; 59.9% of nursing students had anxiety. COVID-19 preventive behaviors had a positive correlation with COVID-19 knowledge (r = .30, p < .001), COVID-19 risk perception (r = .18, p = .009), and anxiety (r = .21, p = .001).Factors influencing COVID-19 preventive behaviors by multiple regression were identified as COVID-19 knowledge, anxiety, physical health status before and after COVID-19, grade, practical experience after COVID-19, and COVID-19 risk perception (F = 12.46, p < .001, R 2 = 25.8%). @*Conclusion@#The results of this research on factors influencing COVID-19 prevention behaviors can be used in the future to develop appropriate health policies for individual and community infectious disease prevention behaviors.

Early-Phase SPECT/CT for Diagnosing Osteomyelitis:A Retrospective Pilot Study

Objective@#The aim of this pilot study was to investigate the potential of early-phase single-photon emission computed tomography (SPECT)/computed tomography (CT) using technetium-99m methyl diphosphonate ( 99m Tc-MDP) for diagnosing osteomyelitis (OM). @*Materials and Methods@#Twenty-one patients with suspected OM were enrolled retrospectively. Three-phase bone scan (TPBS), early-phase SPECT/CT (immediately after blood pool planar imaging), and delayed-phase SPECT/CT (immediately after delayed planar imaging) were performed. The final diagnoses were established through surgery or clinical follow-up for over 6 months. We compared three diagnostic criteria based on (I) TPBS alone, (II) combined TPBS and delayed-phase SPECT/ CT, and (III) early-phase SPECT/CT alone. @*Results@#OM was diagnosed in 11 of 21 patients (nine surgically and two clinically). Of the 11 OM patients, criterion-I, criterion-II, and criterion-III were positive in six, seven, and 10 patients, respectively. Of the 10 non-OM patients, criterion-I, criterion-II, and criterion-III were negative in five, five, and seven patients, respectively. The sensitivity/specificity/ accuracy of criterion-I, criterion-II, and criterion-III for diagnosing OM were 54.5%/50.0%/55.0%, 63.6%/50.0%/57.1%, and 90.9%/70.0%/87.5%, respectively. @*Conclusion@#This pilot study demonstrated the potential of using the early-phase SPECT/CT to diagnose OM. Based on the results, prospective studies with a larger sample size should be conducted to confirm the efficacy of early-phase SPECT/CT.

Early-Phase SPECT/CT for Diagnosing Osteomyelitis:A Retrospective Pilot Study

Objective@#The aim of this pilot study was to investigate the potential of early-phase single-photon emission computed tomography (SPECT)/computed tomography (CT) using technetium-99m methyl diphosphonate ( 99m Tc-MDP) for diagnosing osteomyelitis (OM). @*Materials and Methods@#Twenty-one patients with suspected OM were enrolled retrospectively. Three-phase bone scan (TPBS), early-phase SPECT/CT (immediately after blood pool planar imaging), and delayed-phase SPECT/CT (immediately after delayed planar imaging) were performed. The final diagnoses were established through surgery or clinical follow-up for over 6 months. We compared three diagnostic criteria based on (I) TPBS alone, (II) combined TPBS and delayed-phase SPECT/ CT, and (III) early-phase SPECT/CT alone. @*Results@#OM was diagnosed in 11 of 21 patients (nine surgically and two clinically). Of the 11 OM patients, criterion-I, criterion-II, and criterion-III were positive in six, seven, and 10 patients, respectively. Of the 10 non-OM patients, criterion-I, criterion-II, and criterion-III were negative in five, five, and seven patients, respectively. The sensitivity/specificity/ accuracy of criterion-I, criterion-II, and criterion-III for diagnosing OM were 54.5%/50.0%/55.0%, 63.6%/50.0%/57.1%, and 90.9%/70.0%/87.5%, respectively. @*Conclusion@#This pilot study demonstrated the potential of using the early-phase SPECT/CT to diagnose OM. Based on the results, prospective studies with a larger sample size should be conducted to confirm the efficacy of early-phase SPECT/CT.

Association between Perceived Susceptibility to Fine Dust Exposure and Wearing Masks, Attitude toward Respiratory Disease Prevention Education in Farmers / 農村醫學 地域保健

Objectives@#This study aimed to investigate health risk awareness pertaining to fine dust exposure and the use of face masks in farmers, as well as their attitude toward education regarding fine dust-related respiratory disease prevention. @*Methods@#In total, 295 farmers were interviewed in a survey using a structured questionnaire to obtain data on general characteristics, farming-related characteristics, health risk awareness pertaining to fine dust exposure, attitude toward education on fine dust-related respiratory disease prevention and the use of face masks. This study was analyzed the correlation between the perceived susceptibility to fine dust exposure and willingness to participate in education on fine dust-related respiratory disease prevention. @*Results@#The mean score for perceived susceptibility to fine dust exposure was 3.8 (out of 5), and the participants were highly willing to receive education on fine dust-related respiratory disease prevention. In Multiple response analysis of reactions to exposure to fine dust generated during work, 221 participants responded that they practiced at least one preventive action; participants gave a positive response to "wearing masks" (56.1%), "personal hygiene, such as hand washing." (52.9%). In terms of education methods, 94 (33.6%) participants preferred to learn online or via text messages. @*Conclusions@#The significant correlation between the perceived susceptibility to fine dust exposure and willingness to participate in education on fine dust-related respiratory disease prevention shows the importance of promoting education on prevention. The results of this study can help understand as reference for education on fine dust-related respiratory disease prevention.

Analysis of Factors Affecting Breakfast Eating Behavior of Children in Indonesia: An Application of the Health Belief Model / 대한지역사회영양학회지

OBJECTIVES: This study investigates the current state of consuming breakfast among elementary school students residing in Malang, East Java, Indonesia, and to identify factors that influence breakfast behavior.METHODS: The research model was set up as per the health belief model, and slightly modified by adding the subjective normative factors of the theory of planned behavior. The survey was conducted from July 17 to August 15, 2017 using a questionnaire, after receiving the permission PNU IRB (2017_60_HR).RESULTS: The subjects were 77 boys (49.4%) and 79 girls (50.6%) suffering from malnutrition with anemia (21.2%) and stunting ratio of Height for Age Z Score (HAZ) (11.5%). Furthermore, moderate weakness (14.8%) and overweight and obesity (12.3%) by Body Mass Index for Age Z Score (BMIZ) were coexistent. According to the results obtained for breakfast, 21.8% did not eat breakfast before school, with 18.8% of the reasons for skipping breakfast being attributed to lack of food. Even for subjects partaking breakfast, only about 10% had a good balanced diet. The average score of behavioral intention on eating breakfast was 2.60 ± 0.58. The perceived sensitivity, perceived severity, perceived benefits, and self-efficacy of the health belief model correlated with breakfast behavior. Of these, self-efficacy (β=0.447, R²=0.200) and perceived sensitivity (β=0.373, R²=0.139) had the greatest effect on breakfast behavior. Mother was the largest impact person among children.CONCLUSIONS: In order to increase the level of breakfast behavior intention among children surveyed in Indonesia, we determined the effectiveness by focus on education which helps the children recognize to be more likely to get sick when they don't have breakfast, and increase their confidence in ability to have breakfast on their own. We believe there is a necessity to seek ways to provide indirect intervention through mothers, as well as impart direct nutrition education to children.

Ultraviolet B-induced Senescence Model Using Corneal Fibroblasts and the Anti-aging Effect of Angiogenin

Purpose@#To establish a corneal-fibroblast senescence model induced by ultraviolet B (UVB) exposure and to investigate the anti-senescence effect of angiogenin (ANG). @*Methods@#Fibroblasts were exposed to UVB (1 mJ/cm 2 ) and then cultured with ANG-containing solution for 24 hours. The 24-hour culture procedure was repeated for three days after UVB irradiation. Cell viability was evaluated using the 3-[4, 5–dimethylthiazol-2-yl]-2, 5-diphenyltetrazolium bromide (MTT) assay. The degree of senescence was assessed using the ratio of senescence-associated (SA)-β-gal-stained cells to total cells. The expression of age-related factors and degree of DNA damage were assessed via Western blot. Samples were divided into a non-UVB group, a UVB group without ANG treatment, and a UVB group with ANG treatment after irradiation (UVB + ANG). @*Results@#Cell viability in the UVB + ANG group was 11% higher than that in the UVB group (p < 0.05). The UVB + ANG group exhibited a 10% lower degree of SA-β-gal staining compared with the UVB group (p < 0.05). Western blot analysis showed that there was reduced expression of p53, p21, p16, and RB in the UVB + ANG group compared with the UVB group. The expression of phosphorylated histone (Y-H2AX) and p38 in the UVB + ANG group was less than that in the UVB group. @*Conclusions@#Senescence in corneal fibroblasts is induced by UVB, and ANG may exert an anti-aging effect by regulating the cell cycle through p53, p21, p16, and RB and reducing DNA damage.

Cellular Senescence in Pterygium

Purpose@#To determine cellular senescence in pterygium by studying the expression of senescence-related markers. @*Methods@#Impression cytology was performed on 28 eyes of 28 patients diagnosed with pterygium or pinguecula from August2019 to January 2020. From the obtained specimen, the expression of senescence-associated beta galactosidase (SA-β-gal),p16, and interleukin (IL)-1β was examined. @*Results@#The average percentage of SA-β-gal positive cells was significantly higher for the pterygium group (67.63 ± 16.61%)compared to the control group (32.64 ± 8.98%) (p< 0.01). The fluorescent expression intensity of IL-1β was higher in the pterygiumgroup (22.53 ± 19.21) compared to the control group (11.38 ± 6.30) (p= 0.02), and the p16 fluorescence expression intensitywas also higher in the pterygium group, showing 42.79 ± 23.65, compared to the control group values (26.73 ± 18.34)(p = 0.01). @*Conclusions@#Cellular senescence specific markers, SA-β-gal, IL-1β, and p16, were expressed in pterygium, indicating a newpossible framework for the development and progression of pterygium.

Pars Plana Posterior Capsulectomy during Phacovitrectomy

PURPOSE: To evaluate the efficacy and safety of pars plana posterior capsulectomy (PPPC) during phacovitrectomy. METHODS: In this retrospective study, 76 patients (76 eyes) who underwent phacovitrectomy were enrolled. The patients were divided into two groups according to whether PPPC was performed during phacovitrectomy. In group A, PPPC using a vitreous cutter was combined with phacovitrectomy; in group B, only phacovitrectomy was performed. The best-corrected visual acuity (BCVA), predicted and actual refractive errors, adverse events, and posterior capsular opacity (PCO) were analyzed and compared between the two groups. RESULTS: Age, sex, and pre- and postoperative BCVA were not significantly different between group A (n = 37) and group B (n = 39). No intraoperative complications were identified in either group. In group A, the actual refraction (postoperative 2 months) was −0.44 ± 0.88 diopters (D) and a mild hyperopic shift was found compared to the preoperative predicted refraction (−0.56 ± 0.40 D). In group B, the actual refraction was −0.70 ± 0.72 D and a mild myopic shift was found compared to the preoperative predicted refraction (−0.60 ± 0.81 D). The difference in refraction shifts between the two groups was not significant but very close to it (p = 0.050). In group A, yttrium-aluminum-garnet (YAG) laser posterior capsulotomy was not required. However, PCO was observed in 10 eyes in group B, 6 of which subsequently underwent YAG laser posterior capsulotomy at the last follow-up. Lens instability such as dislocation or subluxations was not observed during the follow-up period. CONCLUSIONS: PPPC combined with phacovitrectomy may lead to hyperopic refractive changes. However, this was a safe and effective approach to prevent PCO and additional YAG laser posterior capsulotomy.

Factor Analysis of the Insomnia Severity Index and Epworth Sleepiness Scale in Shift Workers

Eye Drop Chart for Improvement of Topical Eye Drops Administration and Adherence

PURPOSE: To evaluate the efficacy of an eye drop chart and to determine the factors contributing to adherence enhancement using the eye drop chart. METHODS: In this prospective study, enrolled glaucoma patients were educated on the administration of eye drops and use of the eye drop chart. They were required to complete a questionnaire on demographic characteristics and adherence. After 3 months, they completed a second questionnaire on adherence and satisfaction with the use of the eye drop chart. Changes in instillation behavior, relationships between performance scores and demographic characteristics, as well as factors contributing to the improvement of performance scores were analyzed. RESULTS: Forty-seven patients were enrolled in this study. The performance scores were significantly better for those who administered the eye drops by themselves (p = 0.002), those with an annual income > 60 million won (p = 0.036), and patients with at least a college degree (p = 0.002). After using the eye drop chart for 3 months, the average intraocular pressure was significantly reduced (p = 0.041) and the performance score was improved (p = 0.019). The working area (p = 0.009) and eye drop applicator (p = 0.001) were correlated with performance score enhancement. CONCLUSIONS: The eye drop chart was a cost-effective tool for improving the adherence and instillation practices of glaucoma patients. Adherence was improved among patients with more indoor activity, and those who practiced self-instillation. It is expected that the respective conditions of such patients would be more efficiently improved in a clinical setting.