Relationships among Handgrip Strength, Blood Pressure, Dialysis Adequacy, Dialysis Symptoms, and Depression in Hemodialysis Patients / 재활간호학회지

Purpose@#This study aimed to determine relationships among handgrip strength (HGS), blood pressure, dialysis adequacy, dialysis symptoms, and depression in hemodialysis patients. @*Methods@#Data from 150 subjects were obtained and analyzed, following a descriptive approach. @*Results@#The average grip strength of the subjects was lower than the standard value for both men and women, and the grip strength differed significantly according to age, gender, education level, monthly income, and BMI. The physiological indicators that showed significant results with the study variables were hemoglobin, serum calcium, and serum phosphorus. The average dialysis adequacy (Kt/V) of the subjects was higher than the normal standard, and there were significant differences according to age, gender, education level, monthly income, dialysis period, number of accompanying diseases, and BMI. The subject's depression score had a significant negative correlation with dialysis adequacy, and the dialysis symptom score and depression score had a significant positive correlation. @*Conclusion@#General characteristics, dialysis-related characteristics, and physiological indicators of hemodialysis patients were analyzed in detail, and differences between these characteristics and grip strength, blood pressure, dialysis adequacy, dialysis symptoms, and depression were also examined. It is necessary to provide delicate nursing according to the individual characteristics of the patient.

The effect of clinical practice belonging, satisfaction with major, and work values on career identity of nursing students / 한국간호교육학회지

Purpose@#This exploratory study aims to identify the influence of clinical practice belonging, satisfaction with major, and work values on the level of career identity among nursing students. @*Methods@#The subjects of this study are 251 senior students from three nursing departments located in a metropolitan city. Using SPSS 22.0, the study uses technical statistics, t-test, One-way ANOVA, correlation, and multiple regression analysis. @*Results@#The average scores for clinical practice belonging, satisfaction with major, and work values were 3.61, 3.87, and 3.70 out of 5.00, respectively, and 2.85 out of 4.00 for career identity. The factors affecting students' career identity were clinical practice belonging, aptitude, satisfaction with clinical practice, satisfaction with major, indoor work, service and employment at hospitals with 40 percent being explained by these variables. @*Conclusion@#Through this study we found that clinical practice belonging has the greatest impact on career identity. In order to enhance clinical practice belonging, universities and clinical institutions need to develop new programs and curricula.

Study on the Relationship between Hand Grip Strength, Depression, Somatic Symptoms and Health-related Quality of Life of the Elderly in Rural Area / 재활간호학회지

Purpose@#The purpose of the study was to investigate relationships between Hand Grip Strength (HGS), depression, somatic symptoms and Health-Related Quality of Life (HRQoL) among the elderly. @*Methods@#The data were collected from 138 elderly people living in rural area from June 23 to August 13, 2019. The data were analyzed by descriptive statistics, t-test, One-way ANOVA and Pearson correlation coefficient with SPSS 25 version. @*Results@#The average HGS of the subjects was 19.56kg. HGS in aged (F=7.833, p=.001), women (t=-11.258, p<.001) and elderly without spouses (t=3.804, p<.001) were found to be lower in the group. There was a positive correlation between HGS with HRQoL (r=.411, p=.001), and a negative relationship between HGS both with depression (r=-.285, p<.001) and with somatic symptoms (r=-.307, p<.001). Among the variables HRQoL appeared in the most significant correlation with HGS. @*Conclusion@#The results of this study showed that elderly experienced poor HGS and the elderly with low HGS had more severe depression, somatic symptoms and HRQoL.HGS will be suggested an independent indicator for identifying and predicting depression, somatic symptoms and HRQoL in the elderly. Evidence study to estimate HGS and to identify effect of HGS on depression, somatic symptoms and HRQoL for elderly is needed.

Validity and Reliability of Rehabilitation Nursing Competency Measurement Tools by Clinical Career Stage / 재활간호학회지

Purpose@#This is a methodological study investigating the validity and reliability of the rehabilitation nursing competency measurement tools by clinical career stage for rehabilitation nurses. @*Methods@#Data were collected from 475 rehabilitation nurses at 13 rehabilitation hospitals across South Korea. Questionnaires were organized based on the ARN (Association of Rehabilitation Nurses) competency model for professional rehabilitation nursing. We verified content validity, construct validity (using factor analysis), convergent validity (using correlation with clinical performance ability), and reliability. @*Results@#The CVI (Content Validity Index) of the measurement tools were all above CVI=.75 except for one item for beginner. After analyzing the measurement tools, there were 7 factors for beginner, 6 factors for intermediate, and 4 factors for advanced. Clinical performance ability and rehabilitation nursing competencies indicated a positive correlation for every clinical career stage. The Cronbach's ⍺ of the tool by clinical career stage were found to be .97, .98, and .99 for beginner, intermediate, and advanced stages respectively. @*Conclusion@#This study verified validity and reliability of the measurement tools for rehabilitation nursing competency and provided an opportunity to present the competency for rehabilitation nursing according to clinical career stage.

Unusual Tumors Obstructing the External Auditory Canal: Report of Two Cases

Primary tumors arising from the external auditory canal (EAC) are rare. We describe two cases of mass lesions within the EAC causing slowly progressive hearing loss without otorrhea or otalgia. Otoendoscopic examination demonstrated total obstruction of the EAC, and pure tone audiometry revealed conductive hearing loss. Based on the findings of the histopathologic examination, one patient was diagnosed with venous hemangioma that was treated using surgical resection, and the other patient was diagnosed with diffuse large B-cell lymphoma (DLBCL) that was treated using external-beam radiation therapy. Although primary tumors in the EAC are rare, both benign tumors such as venous hemangiomas and malignant lesions such as DLBCL should be considered as possible differential diagnoses of mass lesions in the EAC.

Direction-Changing and Direction-Fixed Positional Nystagmus in Patients With Vestibular Neuritis and Meniere Disease

OBJECTIVES: Direction-changing positional nystagmus (PN) was considered to indicate the presence of benign paroxysmal positional vertigo involving lateral semicircular canal in most cases. We investigated the incidence of PN on the supine head-roll test and compared the characteristics of nystagmus in patients with vestibular neuritis (VN) and Meniere disease (MD). METHODS: A retrospective review of patients, who were diagnosed with unilateral VN or unilateral definite MD between September 2005 and November 2011, was conducted. Sixty-five VN patients and 65 MD patients were enrolled. Eye movements were recorded for 30–60 seconds at the positions of sitting, head roll to the right, and head roll to the left, and maximum slow-phase eye velocity was calculated. PN was classified as direction-fixed (paretic or recovery) and direction-changing (geotropic or apogeotropic). RESULTS: Spontaneous nystagmus was observed in 57 patients (87%, the slow-phase eye velocity of 7°/sec±5°/sec) with acute VN, 39 (60%, 2°/sec±1°/sec) with follow-up VN, and 32 (49%, 2°/sec±2°/sec) with MD. Direction-fixed PN was the most common type. Direction-fixed paretic type was most common in acute VN (80%) and follow-up VN (42%), and direction-fixed recovery type was most common in MD (31%). Paretic type was significantly more common in acute VN (80%) than in follow-up VN (42%) and MD (26%), and the recovery type was significantly more common in MD (31%) than in acute VN (3%) and follow-up VN (14%). Direction-changing PN was more common in MD (22%), followed by follow-up VN (14%) and acute VN (9%). CONCLUSION: Though direction-fixed paretic PN was most common in VN and MD patients, direction-changing PN could be observed in a few patients (9%–20%) with peripheral vestibular disorders regardless of the duration from the onset of dizziness, suggesting the presence of otolith-related dizziness.

Semantic Network Analysis about Comments on Internet Articles about Nurse Workplace Bullying / 임상간호연구

PURPOSE@#A significant amount of public opinion about nurse bullying is expressed on the internet. The purpose of this study was to analyze the linkage structures among words extracted from comments on internet articles related to nurse workplace bullying using semantic network analysis.@*METHODS@#From February 2018 to April 2019, comments made on news articles posted to the Daum and Naver web portal containing keywords such as “nurse”, “Taeum”, and “bullying” were collected using a web crawler written in Python. A morphological analysis performed with Open Korean Text in KoNLPy generated 54 major nodes. The frequencies, eigenvector centralities, and betweenness centralities of the 54 nodes were calculated and semantic networks were visualized using the UCINET and NetDraw programs. Convergence of iterated correlations (CONCOR) analysis was performed to identify structural equivalence.@*RESULTS@#This paper presents results about March 2018 and January 2019 because these months had highest number of articles. Of the 54 major nodes, “nurse”, “hospital”, “patient”, and “physician” were the most frequent and had the highest eigenvector and betweenness centralities. The CONCOR analysis identified work environment, nurse, gender, and military clusters.@*CONCLUSION@#This study structurally explored public opinion about nurse bullying through semantic network analysis. It is suggested that various studies on nursing phenomena will be conducted using social network analysis.

The Light Cupula: An Emerging New Concept for Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common type of positional vertigo. A canalolithiasis-type of BPPV involving the lateral semicircular canal (LSCC) shows a characteristic direction-changing positional nystagmus (DCPN) which beats towards the lower ear (geotropic) on turning the head to either side in a supine position. Because geotropic DCPN in LSCC canalolithiasis is transient with a latency of a few seconds, the diagnosis can be challenging if geotropic DCPN is persistent without latency. The concept of “light cupula” has been introduced to explain persistent geotropic DCPN, although the mechanism behind it requires further elucidation. In this review, we describe the characteristics of the nystagmic pattern in light cupula and discuss the current evidence for possible mechanisms explaining the phenomenon.

Positional Vertigo Showing Direction-Changing Positional Nystagmus after Chronic Otitis Media Surgery: Is It Benign Paroxysmal Positional Vertigo? / 대한평형의학회지

This case report describes a patient who developed positional vertigo after surgery for chronic otitis media on the right side. Canal wall up mastoidectomy was performed, and the stapes was moderately mobilized during removal of the inflammatory granulation tissues that were attached to it. Immediately after the surgery, positional vertigo developed. The patient showed weakly left-beating spontaneous nystagmus in a seated position. Examination of positional nystagmus revealed geotropic direction-changing positional nystagmus with a prolonged duration and weak intensity in a supine head-roll test, which may be caused by a change in inner ear fluids due to a disruption of inner ear membrane around the oval window or penetration of toxic materials into the labyrinth during surgery.

Influence of Fatigability on the Timing of Reassessment in the Treatment of Posterior Canal Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The early assessment of treatment is not done for benign paroxysmal positional vertigo (BPPV) since the well-known phenomenon of fatigability after a repeated positional test can mimic successful treatment. The aim of this study is to evaluate the clinical implication of ‘fatigability’ after Epley maneuver and to identify the therapeutic efficacy of Epley maneuver in posterior canal BPPV (PC-BPPV). SUBJECTS AND METHOD: This study was prospectively conducted by two dizziness clinics on 51 consecutive patients diagnosed with PC-BPPV. All patients included in the study received Epley maneuver treatment. The therapeutic results were reassessed immediately after a single trial of Epley maneuver. After 30 minutes, results were reassessed repeatedly to confirm the fatigability of diagnostic procedure immediately after treatment. If the treatment was not successful after 30 minutes, Epley maneuver was repeatedly performed until complete resolution. RESULTS: Immediately after the first maneuver, 45 of 51 (88.2%) patients had neither vertigo nor nystagmus during the positional test. All patients demonstrated complete resolution after receiving one to three Epley maneuvers on the day of diagnosis. ‘Fatigability (false negative result)’ was confirmed for only one case (1 of 6 patients, 16.7%), in which nystagmus was observed after 30 minutes but not identified immediately after the first Epley maneuver. CONCLUSION: The therapeutic efficacy of Epley maneuver is very high in PC-BPPV. Considering the possibility of fatigability when reassessment is performed immediately after therapeutic maneuver, clinicians should avoid assessing the outcome immediately after treatment in patients with PC-BPPV.

Personalized Urination Activity Recognition Based on a Recurrent Neural Network Using Smart Band / 대한배뇨장애요실금학회지

PURPOSE: Though it is very important obtaining exact data about patients’ voiding patterns for managing voiding dysfunction, actual practice is very difficult and cumbersome. In this study, data about urination time and interval measured by smart band device on patients’ wrist were collected and analyzed to resolve the clinical arguments about the efficacy of voiding diary. By developing a smart band based algorithm for recognition of complex and serial pattern of motion, this study aimed to explore the feasibility of measurement the urination time and intervals for voiding dysfunction management. METHODS: We designed a device capable of recognizing urination time and intervals based on specific postures of the patient and consistent changes in posture. These motion data were obtained by a smart band worn on the wrist. An algorithm that recognizes the repetitive and common 3-step behavior for urination (forward movement, urination, backward movement) was devised based on the movement and tilt angle data collected from a 3-axis accelerometer. The sequence of body movements during voiding has consistent temporal characteristics, so we used a recurrent neural network and long short-term memory based framework to analyze the sequential data and to recognize urination time. Real-time data were acquired from the smart band, and for data corresponding to a certain duration, the value of the signals was calculated and then compared with the set analysis model to calculate the time of urination. A comparative study was conducted between real voiding and device-detected voiding to assess the performance of the proposed recognition technology. RESULTS: The accuracy of the algorithm was calculated based on clinical guidelines established by urologists. The accuracy of this detecting device was high (up to 94.2%), proving the robustness of the proposed algorithm. CONCLUSIONS: This urination behavior recognition technology showed high accuracy and could be applied in clinical settings to characterize patients’ voiding patterns. As wearable devices are developed and generalized, algorithms detecting consistent sequential body movement patterns reflecting specific physiologic behavior might be a new methodology for studying human physiologic behavior.

Rehabilitation Nursing Competencies of Korean Nurses by Type of Health Institute / 재활간호학회지

PURPOSE: This exploratory study aims to identify various factors influencing the rehabilitation nursing competencies (RNC) of nurses in various types of health institutes. METHODS: The researcher developed a questionnaire consisting of 45 items based on the ARN rehabilitation nursing competency model. Subjects were 434 nurses working at general hospitals, long-term care facilities, or community health centers. RESULTS: Nurses' RNC were significantly higher among those who have higher levels of education, receive continuing education in rehabilitation nursing, and practice more frequently in rehabilitation nursing. Age and duration of nursing career were significant only for interprofessional care domain. General hospital nurses scored highest in every domain while nurses working at long-term care facilities scored lowest in every domain. Multiple regression analysis showed that practicing daily or more than twice per week in rehabilitation nursing, achieving master's degree or higher, and working at long-term care facilities were statistically significant factors with RNC. These factors explained 31.1% of the total variability in RNC in this sample. CONCLUSION: Currently, there is no official certification program for rehabilitation nurse practitioners in South Korea. The results of this study would be useful in developing RNC training programs for Korean nurses, and provide strong evidence for necessity of certified rehabilitation nurse specialists.

Conflict Management Style, Communication Competence, and Collaboration among Hospital Nurses and Physicians / 재활간호학회지

PURPOSE: This study aimed to identify the relationship among conflict management style, communication competence and nurse-physician collaboration in hospital nurses and physicians. METHODS: This is a descriptive study. Using a questionnaire, data were collected from 230 nurses and 107 physicians at a university hospital in D city. With SPSS/WIN 22.0 program, data were analyzed by t-test, ANOVA, Scheffé test, and Pearson's correlation coefficient. RESULTS: Physicians scored the highest for communication competence in nurse-physician relationship and the lowest in medical decision making, while nurses scored the highest in patient information sharing and the lowest in nurse-physician relationship. Physicians with problem solving tendency scored higher in communication competence than those with avoiding tendency. Among the nurses, those with avoiding tendency scored the lowest. For both physicians and nurses, communication competence showed a significant negative correlation with avoidance. For nurses there was also a significant positive correlation with compromising tendency. Finally, there was a significant correlation between nurse-physician collaboration and communication competence in both groups. CONCLUSION: This study demonstrates that nurse-physician collaboration and communication competence are correlated with conflict management style. We suggest educational programs at more hospitals in various locations to improve nurse-physician collaboration reflecting conflict management style.

A Study on Failure Mode and Effect Analysis (FMEA) for Preoperative Risk Prevention / 간호행정학회지

PURPOSE: The purpose of this research was to provide patients with safe preoperative preparatory procedures by removing any risk factors from the preparatory procedures by using failure mode and effects analysis, which is a prospective risk-managing tool. METHODS: This was a research design in which before and after conditions of a single group were studied, Failure mode and effects analysis were applied for the preparatory procedures done before operations. RESULTS: The preparation omission rate before the operation decreased from 2.70% to 0.04%, and operation cancellation rate decreased from 0.48% to 0.08%. CONCLUSION: Failure mode and effects analysis which remove any risk factors for patients in advance of the operation is effective in preventing any negligent accidents.

Distribution of the Korean Dental Hygiene Research Agenda Suggested by the Korean Dental Hygienists Association and Affiliated Groups / 치위생과학회지

The objective of this study was to realize research demands by gathering the research agenda from the Korean Dental Hygienists Association and affiliated groups through a Delphi survey. The study subjects were the heads of eight groups. The Delphi survey was conducted by e-mail after a researcher explained the objective of the study to the heads. The research agenda was classified according to the Korean dental hygiene academic classification and the National Dental Hygiene Research Agenda classification. To compare the number of research agendas according to classification among the groups, we conducted a chi-squared test by using IBM SPSS 20.0. In total, 316 agendas were submitted. According to the Korean dental hygiene academic classification, there was a significant difference among the groups, and the agendas associated with clinical dental hygiene (36.7%) were the best. According to the National Dental Hygiene Research Agenda classification, there was no significant difference and the agendas associated with health promotion and disease prevention (27.8%) were the best. In conclusion, the Korean Dental Hygienists Association and affiliated groups demanded similar research agendas, corresponding to the purpose of each establishment. However, the groups did not seem to show unique characteristics according to the purpose of each establishment. In other words, the groups should corroborate such characteristics and suggest a corresponding agenda to establish specific areas of research in dental hygiene. Also, dental hygiene researchers should mark the academic classification of the studies they want to submit.

Alpha1-Adrenoceptor Antagonists Improve Memory by Activating N-methyl-D-Aspartate-Induced Ion Currents in the Rat Hippocampus / 대한배뇨장애요실금학회지

PURPOSE: Alpha1 (alpha1)-adrenoceptor antagonists are widely used to treat lower urinary tract symptoms. These drugs not only act on peripheral tissues, but also cross the blood-brain barrier and affect the central nervous system. Therefore, alpha1-adrenoceptor antagonists may enhance brain functions. In the present study, we investigated the effects of tamsulosin, an alpha1-adrenoceptor antagonist, on short-term memory, as well as spatial learning and memory, in rats. METHODS: The step-down avoidance test was used to evaluate short-term memory, and an eight-arm radial maze test was used to evaluate spatial learning and memory. TUNEL (terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling) staining was performed in order to evaluate the effect of tamsulosin on apoptosis in the hippocampal dentate gyrus. Patch clamp recordings were used to evaluate the effect of tamsulosin on ionotropic glutamate receptors, such as N-methyl-D-aspartate (NMDA), amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA), and kainate receptors, in hippocampal CA1 neurons. RESULTS: Tamsulosin treatment improved short-term memory, as well as spatial learning and memory, without altering apoptosis. The amplitudes of NMDA-induced ion currents were dose-dependently increased by tamsulosin. However, the amplitudes of AMPA- and kainate-induced ion currents were not affected by tamsulosin. CONCLUSIONS: Tamsulosin enhanced memory function by activating NMDA receptor-mediated ion currents in the hippocampus without initiating apoptosis. The present study suggests the possibility of using tamsulosin to enhance memory under normal conditions, in addition to its use in treating overactive bladder.

Persistent Positional Vertigo in a Patient with Sudden Sensorineural Hearing Loss: A Case Report

Because inner ear organs are interconnected through the endolymph and surrounding endolymphatic membrane, the patients with sudden sensorineural hearing loss (SSNHL) often complain of vertigo. In this study, we report a patient with SSNHL accompanied by persistent positional vertigo, and serial findings of head-roll tests are described. At acute stage, head-roll test showed persistent geotropic direction-changing positional nystagmus (DCPN), which led to a diagnosis of SSNHL and ipsilateral light cupula. Although vertigo symptom gradually improved, positional vertigo lasted for more than 3 weeks. At this chronic stage, persistent apogeotropic DCPN was observed in a head roll test, which led to a diagnosis of the heavy cupula. Although the mechanism for the conversion of nystagmus direction from geotropic to apogeotropic persistent DCPN is unclear, the change of specific gravity of the endolymph might be one of the plausible hypothetical explanations.

Bilateral Internal Auditory Canal Metastasis of Non-small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

We report on a patient with brain metastasis involving bilateral internal auditory canal from non-small cell lung cancer (NSCLC). A 49-year-old woman who had been diagnosed with NSCLC (T2aN1M0) complained of persistent vertigo and bilateral tinnitus for three months. The patient had refused all treatments, including surgery and chemotherapy; however, she sought alternative medicine. The patient's hearing loss showed rapid progression bilaterally, and rotatory vertigo with peripheral-type nystagmus developed. Magnetic resonance imaging of the brain showed irregular nodular enhancement within both internal auditory canals with leptomeningeal enhancement and multiple intracranial metastasis. The patient was treated with epidermal growth factor receptor-tyrosine kinase inhibitor, and the tumor showed partial response. This was a rare case of multiple brain metastases involving bilateral internal auditory canal from known NSCLC presenting with vertigo and hearing loss.

Hand-Assisted Retroperitoneoscopic Nephroureterectomy With Bladder Cuffing After Preperitoneal and Retroperitoneal Perivesical Ballooning

PURPOSE: We aimed to describe the surgical technique of hand-assisted retroperitoneoscopic nephroureterectomy (HARNU) with bladder cuffing after preperitoneal and retroperitoneal perivesical ballooning. MATERIALS AND METHODS: From March 2008 to September 2012, we performed HARNU and open bladder cuffing in 28 consecutive series of patients with upper urinary tract urothelial carcinoma. We performed HARNU according to the following procedure: (1) a camera port incision was made on the posterior axillary line; (2) multiple, repeated, preperitoneal and retroperitoneal ballooning was performed on both the posterior axillary line and in the umbilicus; (3) a 7.0 cm skin incision was made from the suprapubic to the lower inguinal with the balloon present in the extraperitoneal area; (4) hand-assisted laparoscopic retroperitoneal nephroureterectomy; (5) cessation of gas insufflation; and (6) extravesical cuffing as an open surgical procedure. RESULTS: The mean estimated blood loss was 250 mL. The mean operation time was 240 minutes. The mean time to oral intake and ambulation was 1.0 day and two days, respectively. As for postoperative complications due to the hand-assisted device, one patient developed febrile urinary tract infection within three weeks postoperatively and was hospitalized again to receive parenteral antibiotics. CONCLUSIONS: We made a low Gibson incision for a route for the hand-assisted procedure as well as a window for open surgery in dissecting the distal ureter and extracting the surgical specimens. Thus, our results indicate that the HARNU might be a feasible surgical modality.

The Relationship between Osteoarthritis of the Knee and Bone Mineral Density of Proximal Femur: A Cross-Sectional Study from a Korean Population in Women

BACKGROUND: The relationship between osteoarthritis (OA) and osteoporosis (OP) is complicated and it may differ according to the site or stage of disease. The purpose of this cross-sectional study is to examine the relationship between the severity of radiological knee OA and the degree of OP in the ipsilateral proximal femur as denoted by bone mineral density (BMD) in a Korean population, especially among women. METHODS: One hundred ninety-five female patients who had knee pain and radiological knee OA were investigated with respect to the relationship of knee OA severity with BMD. The BMD of the proximal femur and spine was measured by dual energy X-ray absorptiometry, and the severity of knee OA was evaluated based on Kellgren-Lawrence (K-L) radiographic criteria, joint space narrowing (JSN) and mechanical axis of knee alignment. Partial correlation analysis and ANCOVA adjusted for confounding factors (age and body mass index) were performed to assess the relationship. RESULTS: There was a statistically significant relationship between the BMD of the proximal femur and JSN, and the BMD of the proximal femur was positively associated with increased joint space width. There was a lack of association between the spine BMD and JSN. The BMD of the proximal femur was also significantly lower in patients who had a higher K-L grade. CONCLUSIONS: The radiographic finding of severe OA in the knee is associated with decreased BMD of the ipsilateral proximal femur including the femoral neck, trochanter, intertrochanter, and region of the entire hip (neck, trochanter, and Ward's triangle).