Facilitators and Barriers of the Triage Process based on Emergency Nurses’ Experience with the Korean Triage and Acuity Scale: A Qualitative Content Analysis

Purpose@#Since 2016, the Korean Triage and Acuity Scale (KTAS) algorithm has been applied to the triage process in the emergency departments (EDs) of Korea. This study aimed to investigate the facilitators of and barriers to a well-run triage function based on how Korean emergency nurses perceived the triage process and their experiences with it. @*Methods@#Data were collected using focus group interviews from June 2018 to January 2019. Twenty emergency nurses were divided into two junior and four senior groups based on their level of clinical experience. All interviews were recorded as they were spoken and transcribed. Data were analyzed using qualitative content analysis. @*Results@#The participants recognized the need for the KTAS algorithm to efficiently classify emergency patients and were working on it properly. According to the data, we extracted 4 themes and 20 subthemes. Four themes were as follows: (1) awareness about the necessity of triage, (2) facilitators to triage process, (3) barriers to triage process, and (4) suggestions for the establishment and development of triage. @*Conclusion@#From the findings of this study, various vulnerabilities of the triage process were identified, and solutions were suggested from the emergency nurses’ perspective. Educational, staffing, financial support, and periodic updates of the KTAS are needed to promote the triage process in the future.

Impact of Mixed Cognitive Intervention Training on Early Onset Dementia

Objectives@#The aim of this study was to investigate the impact of mixed cognitive intervention training using spaced retrieval training, and errorless learning in participants with early onset dementia.This was based on reality orientation therapy for cognitive function, depression, and occupational performance of patients. @*Methods@#Two early onset vascular dementia patients (> 65 years) with mild or moderate impairment were enrolled in a pre-test - post-test single-subject research design study. Prior to the study, the caregivers were interviewed about meaningful times, people, places, and areas of interest for the participant. A list of individual training words were selected based upon this information, and the participant was instructed to recall them after a 45-second, 90-second, 6-minute, and 12-minute delay. Baseline (3 sessions), intervention (20 sessions), and a second baseline period (3 sessions) were conducted. Activities of daily living were measured, and cognition was measured using the Consortium to Establish a Registry of Alzheimer’s Disease Korean version, whilst depression was measured using the Korean Form Geriatric Depression Scale, and task performance and satisfaction measured by the Canadian Occupational Performance Measure. @*Results@#After intervention, both participants showed improvements in activities of daily living (ADL), word list memory/recognition, trail making A, occupational performance, and satisfaction improvement, which was clinically significant in 1 participant who also had a reduced score in the scale of depression classifying him as not depressed. @*Conclusion@#Spaced retrieval training and errorless learning based on reality orientation therapy is an effective intervention in patients with early onset dementia and mild or moderate impairment.

Effects of activities of daily living-based dual-task training on upper extremity function, cognitive function, and quality of life in stroke patients

Objectives@#The aim of this study was to investigate the effect of daily living dual-task training focused on improving attention and executive function of the upper extremities, cognitive function, and quality of life in stroke patients. @*Methods@#We included 30 stroke patients who were hospitalized between July 2020 and October 2020. They were divided into experimental and control groups through randomization. The experimental group performed 20 minutes of dual-task training and received 10 minutes of conventional occupational therapy, while the control group performed 20 minutes of single-task training and received 10 minutes of conventional occupational therapy. Both groups underwent their respective rehabilitation for 30 minutes per session, 5 times per week for 5 weeks. @*Results@#Both groups showed significant improvements in upper extremity function, cognitive function, and quality of life; the experimental group showed higher results for all items. A significant between-group difference was observed in the magnitude of the changes. @*Conclusion@#In stroke patients, dual-task training that combined attention and executive function with daily living activities was found to be meaningful, as it encouraged active participation and motivation. This study is expected to be used as a foundation for future interventions for stroke patients.

A Study on the Physical Activities, Mental Health, and Health-Related Quality of Life of Osteoarthritis Patients

OBJECTIVES: The purpose of this study was to investigate the physical activities, mental health, and health-related quality of life (HRQOL) of osteoarthritis patients.METHODS: This study was conducted using data from the first year of the 7th Korea National Health and Nutritional Examination Survey. There were 8,150 participants included in the survey, and 665 participants had been diagnosed with osteoarthritis. This study analyzed the measurements of physical activities, depression, and HRQOL in participants with osteoarthritis.RESULTS: The mean age of the participants was 67 ± 9.9 years and 83.1% were female. Participants rarely engaged in work-related physical activity, and engaged in leisure-related physical activities infrequently. Most of the participants (85.9%) did not do regular exercise, but 1/3 of the participants walked for over 10 minutes a day. “Pain/discomfort” had the least impact upon HRQOL, and among the depression subcategories, “difficult to sleep and tiredness” had the most impact. Multiple logistic regression analysis showed that an adverse HRQOL score was statistically significantly associated with “location changes/physical activities” (p < 0. 01), “depression” (p < 0.001) and “age” (p < 0.001).CONCLUSION: Exercise programs should be in place which are manageable in everyday life for the elderly (> 65 years). Changes in daily routine so that patients become more active, should be supported by the family and community, together with assistance in managing psychological problems such as depression.

The Effect of a Complex Intervention Program for Unilateral Neglect in Patients with Acute-Phase Stroke: A Randomized Controlled Trial

OBJECTIVES: The purpose of this study was to examine the combined effects of Prism Adaptation (PA) plus functional electrical stimulation (FES) on stroke patients with unilateral neglect, and suggest a new intervention method for acute-phase stroke patients. METHODS: There were 30 patients included in this study from April to October 2016 that had unilateral neglect whilst hospitalized following a stroke (diagnosed by a professional). The participants, who were patients receiving occupational therapy, understood the purpose of the study and agreed to participate. The patients were randomly divided into 3 groups: PA plus FES group (Group A), PA group (Group B), and FES group (Group C). Treatments lasted for 50 minutes per day, 5 times per week, for 3 weeks in total. Reevaluation was conducted after 3 weeks of intervention. RESULTS: All 3 groups showed unilateral neglect reduction after the intervention, but PA plus FES (complex intervention method) was more effective than PA or FES alone [effect size: Motor-free Visual Perception Test (0.80), Albert test (0.98), CBS (0.92)]. CONCLUSION: The results of this study support further studies to examine complex intervention for the treatment of unilateral neglect.

The Effects of Restricted Physical Activity on Health-Related Quality of Life in Adult Patients with Depression

OBJECTIVES: The objective was to identify restricted physical activity in patients with depression, and to determine the effects of that restricted activity, on their health-related quality of life (HRQOL). METHODS: Data was analysed from Year 1 of the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII-1). From a total sample of 8,150 subjects, 277 adults aged ≥19 years who were diagnosed with depression were selected. The results were derived using restricted activity and HRQOL data measured from the subjects. RESULTS: Most of the participants were females ≥ 50 years old. HRQOL scores were high in the “self-care” dimension and low in the “pain/discomfort” and “anxiety/depression” dimensions. Their restricted activity due to illness in the past year, led to increases in participants being bedridden or absent from work. Many participants reported being bedridden for more than 3 months. A higher number of absences owing to illness in the past year, and longer durations of being bedridden, had a negative impact on HRQOL. Age, marital status, educational level, income level, and occupation were the sociodemographic variables that had an impact on HRQOL. CONCLUSION: Patients with depression experiencing stress in their daily lives should take measures to avoid illness and pain that may lead to them becoming bedridden, and employ lifestyle habits with support from families and community health promotion centres, where mental health counselling can be accessed.

Effects of Physical Activity on Depression in Adults with Diabetes

OBJECTIVES: The purpose of this study was to identify the current state of physical activity in adults with diabetes and to investigate the effect of physical activity on depression. METHODS: The present study was conducted using data from the 2nd year of the 6th Korea National Health and Nutritional Examination Survey. From the total of 7,550 individuals, 418 adults diagnosed with diabetes were selected as participants, and their physical activity and depression levels were examined. RESULTS: The physical activity status of the participants showed that they did not usually engage in physical activities at work, and only a few participants were involved in moderate intensity physical leisure activity. Apart from walking for 10 minutes each day, which accounted for 1/3 of the participants, most of the participants did not engage in specific forms of exercise. An examination of the effects of physical activity on depression revealed that moderate intensity physical activity at work and leisure influenced depression. In terms of demographic characteristics, gender, occupation, income quintile, and subjective health status were all found to affect depression. CONCLUSION: For elderly (60 years or older) patients with diabetes, which accounted for the majority of the diabetic population, a systematic leisure program and professional education are necessary to help them to manage stress and depression in daily life. Additionally, provision of community and family support should encourage regular, moderate intensity exercise and promote lifestyle changes to encourage increased physical activity.

Study on Cardiopulmonary Function, Maximal Oxygen Uptake, and Obesity Index according to Smoking Status in Middle-Aged and Older Office Workers

OBJECTIVES: To investigate the effect of smoking upon cardiopulmonary function, maximal oxygen uptake, and obesity index, in middle-aged and older workers to propose guidelines on healthcare for these age groups. METHODS: This study analyzed medical data from 2,753 white-collar workers aged 50 years or older from workplaces located in Seoul, South Korea. Blood pressure (BP), resting heart rate, maximal oxygen uptake (VO2max), and body mass index (BMI) of each subject were measured. The collected data were analyzed using SPSS 21.0. RESULTS: In the smoking group BP and resting heart rate were significantly higher than in the non-smoking and smoking-cessation groups (p < 0.05). In addition, VO2max was lower in the smoking group compared to the other 2 groups. BP closely correlated with resting heart rate, abdominal fat ratio, and BMI. BMI was the highest in the group that stopped smoking and, BMI and abdominal fat ratio negatively correlated with VO2max. CONCLUSION: Smoking increases the risk of cardiopulmonary disease but obesity may be caused by stopping smoking. Therefore, healthcare guidelines on smoking cessation should also include nutritional advice.

Randomized Controlled Trial for Preventing Stomatitis and Discomfort among Acute Leukemic Patients / 종양간호학회지

PURPOSE: This study compared the effect of two oral care agents on preventing stomatitis and discomfort for acute leukemic patients. METHODS: A total of forty patients was enrolled and randomly assigned to sodium bicarbonate or chlorhexidine group. WHO oral toxicity scale was used for measuring stomatitis and Beck's subjective oral discomfort scale for evaluating oral comfort. Data was collected from August 2009 to February 2010. The data was analyzed using Chi-square test, Fisher's exact test, and Mann-Whitney test. RESULTS: Data analyzed was thirty five one. The incidence of stomatitis was 47.4%, 68.8% in sodium bicarbonate and chlohexidine group respectively. The onset of stomatitis was about the 10th and 9th day after chemotherapy initiation, and the duration was 8.0 and 8.67 day respectively. The severity of stomatitis was highest on the 21st day after chemotherapy initiation. There were no statistical differences in the status of stomatitis and the levels of oral comfort during treatment periods. CONCLUSION: Nurses should routinely assess oral cavity and encourage patients to do oral care actively from second to third week after chemotherapy initiation. Also sodium bicarbonate agent can be recommended to for preventing stomatitis.

Predictors Related to the Non-alcoholic Fatty Liver Disease / 가정의학회지

BACKGROUND: As the metabolic syndrome is increased, the prevalence of non-alcoholic fatty liver disease (NAFLD) is increased. In recent studies, metabolic syndrome is related to serum uric acid. And some authors reported the association of uric acid and NAFLD. We have studied the association of serum uric acid and NAFLD. METHODS: The authors conducted a cross-sectional survey of 3,430 subjects out of 6,731 individuals who had visited the Health Promotion Center at the National Insurance Corporation Ilsan Hospital for the purpose of a regular check-up from January 2005 to April 2008. We excluded who showed evidence of more than moderate alcohol consumption, hepatitis B or C, or severe hepatic dysfunction. RESULTS: Among 3,430 participants, 1,775 subjects (51.7%) were diagnosed with NAFLD and 1,655 subjects (48.3%) were control. Age, BMI, triglyceride, fasting glucose, uric acid were greater in the patients with NAFLD than in the controls. The severity of NAFLD is related to uric acid. When uric acid is divided in 4 groups, elevation of uric acid is associated with risk for NAFLD. This relationship is showed in similar pattern when adjusting for age, sex, BMI, triglyceride, fasting glucose. The uric acid elevation of 1mg/dL is associated with the increase of 1.11 fold in risk for NAFLD. CONCLUSION: The risk for non-alcoholic fatty liver disease is related to uric acid. And the severity of non-alcoholic fatty liver disease is associated with uric acid.