Attitudes of Medical Staff and Factors Related to Nutritional Support for Patient Care in a University Hospital

PURPOSE: Knowledge of nutritional support and attitudes of medical staff both affect patient care. We identified attitudes regarding nutritional support among medical staff as well as changes in attitudes when a nutritional support team is present. METHODS: Data were collected from 172 medical staff members who served at a university hospital located in Gyeongju by self-administered questionnaire from June 12~August 30, 2013. The questionnaire inquired about importance of nutritional support, self-confidence about nutritional support, consideration of nutritional support for patient care, consideration of nutritional support when a nutritional support team is present, and nutritional knowledge training during the past year. RESULTS: A total of 169 subjects (98.3%) thought that nutritional support is important for patient care. Only 19 subjects (11.0%) were highly self-confident about nutritional support. In total, 147 subjects (85.5%) considered nutritional support for some or all patients, whereas 169 (98.3%) considered nutritional support for patient care when a nutritional support team is present. Thirty-eight subjects (22.1%) received nutritional knowledge training during the past year. High self-confidence for nutritional support was related to nutritional knowledge training and service part. Positive changes regarding nutritional support when a nutritional support team is present were associated with nutritional knowledge training and high self-confidence for nutritional support. CONCLUSION: No differences in nutritional support attitudes for patient care were observed among the medical staff. Nutritional knowledge training and service part affected self-confidence of nutritional support and induced positive changes in attitudes for nutritional support.

Clinical Factors Related to Frailty Estimated by the Korean Frailty Index

BACKGROUND: On the point of entering into the aged society, frailty will be recognized as a new geriatric problem in Korea. This study was conducted to identify clinical factors related to frailty in the community dwelling elderly. METHODS: This was a cross-sectional study comprised of 515 participants among 834 potential subjects who were residents of three towns in Gyeong-ju and had health check-ups at a university hospital in the same region. Using the Korean Frailty Index, those with a total score of 5 or more were considered frail and those with scores 3 to 4 as prefrail. Socio-demographics, anthropometry and laboratory data were the selected clinical factors. Those younger than 65 years or with incomplete data were excluded. Finally, 447 participants were analyzed. RESULTS: Among the participants, those identified as frail were 20 (4.5%), prefrail 72 (16.1%) and robust 355 (79.4%). By gender, the percentage of frail, prefrail and robust individuals were 3.2%, 17.4% and 79.5%, respectively, in men and 5.4, 15.2% and 79.4% in women (p=0.447). On ordinal logistic regression analysis, factors related to frailty were increased age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.01 to 1.17), functional disability (OR, 8.88; 95% CI, 4.46 to 17.68), chronic disease such as pulmonary disease (OR, 4.69; 95% CI, 1.47 to 14.99) or hypertension (OR, 2.23; 95% CI, 1.15 to 4.32), increased waist circumference (OR, 1.06; 95% CI, 1.01 to 1.11), decreased serum cholesterol (OR, 0.98; 95% CI, 0.97 to 0.99) and elevated blood urea nitrogen (OR, 1.07; 95% CI, 1.01 to 1.14). CONCLUSION: Clinical factors related to frailty were age, functional disability, chronic disease, waist circumference, serum cholesterol and blood urea nitrogen. Primary physicians should assess frailty when seeing elderly patients who have these factors.

Perception and Performance of Preventive Behaviors for the Pandemic Influenza in Hospital Employees and Outpatients

PURPOSE: A new strain of the H1N1 subtype of influenza A virus resulted in a pandemic outbreak. In South Korea, cases of pandemic influenza have increased. Therefore, we explored perception or preventive behaviors for this virus in hospital employees and outpatients. MATERIALS AND METHODS: Data was collected from hospital employees and outpatients at three university hospitals located in Daegu, Gyeongju in South Korea between the 21st and 30th of September, 2009 using a self-administrated questionnaire. We estimated perception by components of The Health Belief Model (HBM), preventive behaviors consisted of avoidance behaviors, and the recommended behaviors by the Korea Center of Disease Control and Prevention (KCDC). Desire for vaccination was identified. RESULTS: The 1,837 participants comprised hospital employees (n = 880, 47.9%) and outpatients (n = 957, 52.1%). Of all hospital employees, 491 (55.8%) and 708 (80.5%) perceived susceptibility of the pandemic influenza and benefits of the preventive behaviors, respectively. Among all outpatients, 490 (51.2%) and 651 (68.0%) perceived susceptibility of the pandemic influenza and benefits of the preventive behaviors, respectively. Recommended preventative behaviors were adopted by 674 (76.6%) of hospital employees and 631 (65.9%) of outpatients. Vaccination was desired by 479 (54.4%) of hospital employees and 484 (50.6%) of outpatients. Factors influencing preventative behaviors included gender, economic status (for hospital employees) and educational level (for outpatients). All HBM components except perception of barriers were associated with the preventive behaviors in both groups. CONCLUSION: The majority of the surveyed hospital employees and outpatients perceived the benefits of preventive behaviors for pandemic influenza and performed them.

Perception and Performance of Preventive Behaviors for the Pandemic Influenza in Hospital Employees and Outpatients

PURPOSE: A new strain of the H1N1 subtype of influenza A virus resulted in a pandemic outbreak. In South Korea, cases of pandemic influenza have increased. Therefore, we explored perception or preventive behaviors for this virus in hospital employees and outpatients. MATERIALS AND METHODS: Data was collected from hospital employees and outpatients at three university hospitals located in Daegu, Gyeongju in South Korea between the 21st and 30th of September, 2009 using a self-administrated questionnaire. We estimated perception by components of The Health Belief Model (HBM), preventive behaviors consisted of avoidance behaviors, and the recommended behaviors by the Korea Center of Disease Control and Prevention (KCDC). Desire for vaccination was identified. RESULTS: The 1,837 participants comprised hospital employees (n = 880, 47.9%) and outpatients (n = 957, 52.1%). Of all hospital employees, 491 (55.8%) and 708 (80.5%) perceived susceptibility of the pandemic influenza and benefits of the preventive behaviors, respectively. Among all outpatients, 490 (51.2%) and 651 (68.0%) perceived susceptibility of the pandemic influenza and benefits of the preventive behaviors, respectively. Recommended preventative behaviors were adopted by 674 (76.6%) of hospital employees and 631 (65.9%) of outpatients. Vaccination was desired by 479 (54.4%) of hospital employees and 484 (50.6%) of outpatients. Factors influencing preventative behaviors included gender, economic status (for hospital employees) and educational level (for outpatients). All HBM components except perception of barriers were associated with the preventive behaviors in both groups. CONCLUSION: The majority of the surveyed hospital employees and outpatients perceived the benefits of preventive behaviors for pandemic influenza and performed them.

Evaluation of Risk for Pressure Ulcers Using the Braden Scale in Elderly Patients Receiving Long-Term Care

BACKGROUND: Elderly patients receiving long-term care are at high risk for pressure ulcers. This study was done to identify histories of pressure ulcers and to evaluate the risk of pressure ulcers using the Braden scale. METHODS: We enrolled 103 subjects receiving nursing homecare from a university hospital in Gyeongju or admitted to nursing homes in Pohang between April 1, 2010 and June 30, 2010. Assessment tools included demographic information, level of care, activities of daily living (ADL), presence of pressure ulcer, history of pressure ulcers and the Braden scale scores. RESULTS: Twenty-six subjects (25.2%) had previous pressure ulcers. The mean Braden scale score was 15.02+/-4.23 (range, 6 to 23). And categorized into two groups based on previous pressure ulcers, the mean score was 11.92+/-3.59 for the group with previous pressure ulcers and 16.06+/-3.93 for the group without previous (p<0.001). The number of subjects with a risk for pressure ulcers according to the Braden scale was 71 (69.9%). The Braden scale had a positive correlation with level of care (p<0.001) and a negative correlation with ADL (p<0.001). Factors related to the history of pressure ulcers were homecare services (p=0.010), concurrent diabetes (p=0.023) and a low Braden scale score (p=0.028). CONCLUSION: We recommend that a pressure ulcer risk assessment be done routinely in elderly patients receiving long-term care services to minimize their occurrence.

Factors Influencing Willingness for Human Papilloma Virus (HPV) Vaccination in Female Students at One University

BACKGROUND: This study was done to identify factors that influence the willingness to be vaccinated with the human papilloma virus (HPV) vaccine in female college students eligible for a catch-up vaccination program. METHODS: This cross-sectional study included 572 female students aged 18-26 years attending one selected university in the Gyeongbuk Province. From March 2 to 6, 2009, they completed a self-administered questionnaire on their HPV vaccination status. Thereafter, unvaccinated participants were educated about the vaccination program, and each participant's willingness to be vaccinated was assessed. RESULTS: Of the 572 participants, 18 (3.1%) were already vaccinated with the HPV vaccine. The number of participants advised to be vaccinated was 102 (17.8%). Of the 554 unvaccinated participants, 305 (55.1%) were willing to be vaccinated after being educated about the vaccination program. Of the remaining 249 unvaccinated participants, 116 (48.7%) refused the vaccine due to its high cost. Advice by family members was related significantly to the willingness to be vaccinated (odds ratio, 2.37; 95% confidence interval, 1.09-5.14). CONCLUSIONS: The results of this study suggest that the willingness to be vaccinated with the HPV vaccine could be increased in female college students if they are advised to do so by their family members after being educated about the vaccination program.

Relationship between the Content of the Medical Knowledge Written Examination and Clinical Skill Score in Medical Students / 한국의학교육

PURPOSE: This study was planned to investigate which medical knowledge examination score-written examination on basic medicine, individual clinical medicine, and comprehensive clinical medicine-was closely related to clinical skill score in medical students. METHODS: Scores on basic medicine, clinical medicine, graduation assessment, clinical performance examination (CPX), and objective structured clinical examination (OSCE) for 106 students who graduated Dongguk University Medical School from 2010 to 2011 were included, and correlations between them were analyzed using T scores. RESULTS: All scores of basic medicine, clinical medicine, graduation assessment, CPX, and OSCE correlated significantly with each other. In connection with clinical skill, graduation assessment score showed a strong correlation (r=0.547, p<0.001) with the CPX. Regarding detailed scores on the CPX, history taking score correlated significantly with medical knowledge examination scores (r=0.435~0.406, p<0.001). By regression analysis, the score on graduation assessment was 1 point higher, and that of the CPX increased by 0.538 (p<0.001). CONCLUSION: Based on our study, comprehensive clinical knowledge is required for medical students to gain the appropriate clinical skills. Therefore, clinical skill practice and lectures that are based on the level of comprehensive clinical knowledge are recommended in the education of clinical skills in medical students.

The Effect of Relaxation Music on Anxiety in Subjects Performed Unsedated Esophagogastroduodenoscopy / 가정의학회지

BACKGROUND: Esophagogastroduodenoscopy is a very important method to detect gastroduodenal lesions. But the investigation might be delayed due to its own discomfort and anxiety. This study was performed to evaluate the effect of relaxation music on relief of anxiety and physical discomfort during unsedated esophagogastroduodenoscopy. METHODS: From March 3 to May 14 2009, 104 clients who have undergone unsedated esophagogastroduodenoscopy more than once in the past were enrolled in this study. The subjects were randomly assigned to receive either relaxation music (music, N = 52) or no music (control, N = 52) before esophagogastroduodenoscopy. The subjects recorded their anxiety and physical discomfort about latest and today endoscopy by visual analogue scale (VAS). At pre and post music listening, systolic, diastolic blood pressure and heart rate were measured. RESULTS: There was a significant difference of anxiety VAS between music and control group (music, decrease 1.1 +/- 2.1; control, increase 0.0 +/- 1.9; P = 0.008). Throat discomfort VAS was not significant (music, decrease 0.9 +/- 1.8; control, decrease 0.5 +/- 2.7; P = 0.33). Dyspnea VAS decreased in both groups (music, 0.6 +/- 2.2; control, 0.4 +/- 2.5; P = 0.68). Nausea & vomitting VAS also decreased in both group (music, 0.9 +/- 2.2; control, 1.1 +/- 2.1, P = 0.71). There were no significant vital sign changes premusic and postmusic, In both group vital signs increased. Mean differences of systolic pressure(1.0 +/- 11.4 vs. 1.6 +/- 11.1) and diastolic pressure (0.7 +/- 7.3 vs. 1.3 +/- 5.7) were lower in music group, and mean difference of heart rate (1.8 +/- 9.5 vs. 1.5 +/- 8.0) was lower in control group. But There were no significant vital sign changes premusic and postmusic (each P = 0.8, P = 0.62, P = 0.89). CONCLUSION: Listening relaxation music before unsedated esophagogastroduodenoscopy may reduced anxiety.

Comprehension of Lung Sounds for Family Medicine Residents in Daegu, Gyeongbuk / 가정의학회지

BACKGROUND: Understanding lung sound is important physical examination of chest. We studied to identify the state of the understanding, the education and the self-learning experience for lung sound's interpretation during the residentship training period. METHODS: Data were collected from 45 family medicine residents who had trained in Daegu and Gyeongbuk from April 1st to May 31th 2008. Residents completed self-administered questionnaire about the education and the self-learning experience for lung sound's interpretation and had been estimated the understanding of lung sound by using the audio file of five lung sounds. RESULTS: The median score (inter-quartile range, IQR) of lung sound's interpretation was 2 (1, 3) between 0 and 5 range. The number of residents who were educated for the interpretation of lung sounds during the training period were 10 (22.2%). Twenty-four (53.3%) had the self-learning experience for lung sounds. CONCLUSION: The understanding for lung sounds of family medicine residents in Daegu, Gyeungbuk was not high and the majority of residents were not educated the interpretation of lung sounds during the training period. Directors of family medicine should consider to make the regular education program for interpretation of lung sound during the training period.

Factors Related to Pre-Procedural Anxiety for Gastroscopy in Health Check Examinee / 가정의학회지

BACKGROUND: Gastroscopy is the useful method to detect the upper gastrointestinal condition, but examinee have recognized it as the procedure causing the discomfort and anxiety. This study was conducted to identify the factors related to pre-procedural anxiety for gastroscopy . METHODS: From 9th March to 12th June 2009, Data were collected from 463 examinee undergone gastroscopy at a health promotion center of a university hospital by self-administered questionnaires about general characteristics (age, sex, education state, economic state, family history of gastric cancer), gastrointestinal symptom, histroy of gastrointestinal disease, sedated gastroscopy and previous experience of gastroscopy. Before gastroscopy procedure, pre-procedural anxiety was assessed using 20-items by Korean version of Spielberger State Triat Anxiety Inventory Form-Y (STAI-Y). RESULTS: The mean score of pre-procedural state anxiety was 38.1 +/- 10.2 in all participants. The mean score was the most highest in participants who had no previous experience of gastroscopy and would perform non-sedated gastroscopy as 42.1 +/- 10.3. Factors related to pre-procedural anxiety were female (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.94 to 4.64), low education state (OR, 1.68; 95% CI, 1.05 to 2.71) and the previous experience of gastroscopy (OR, 0.46; 95% CI, 0.24 to 0.88). Among participants who had the previous experienced gastroscopy, female (OR, 3.20; 95% CI, 1.97 to 5.22), low education state (OR, 1.79; 95% CI, 1.06 to 3.02) and the good tolerance at previous gastroscopy (OR, 0.35; 95% CI 0.21 to 0.59) were related to pre-procedural anxiety. CONCLUSION: In health check examinee, female, low education state and the no previous experience of gastroscopy were related to pre-procedural anxiety. Endoscopists should be provide efforts to lower pre-procedural anxiety in those subjects as to increase effectiveness of interventions.

Technical Competency of the Esophgogastroduodenoscopy (EGD) during the First 50 EGDs: The Training Result of Family Medicine Residents in a University Hospital / 가정의학회지

BACKGROUND: A previous Korean study recommended minimal 50 cases of Esophgogastroduodenoscopy (EGD) to achieve technical competency, based on director's opinion. Therefore, this study was conducted to evaluate the achievement of EGD's technical skills during the first 50 EGD cases. METHODS: The data were collected from the first 50 EGDs consecutively performed by six family medicine residents trained the EGD procedure in one residency program from 2004 to 2006. Technical competency of the EGD procedure was evaluated in 4 steps divided with anatomical landmarks (the gastroesophageal junction, the antrum, the fundus of the stomach, and the second portion of the duodenum). Authors measured the procedure time of EGDs performed by residents in 4 steps and calculated the rate of success cases satisfied with author's own criteria made by procedure time. RESULTS: The success rate of EGD procedure in all steps was 26.7% at 10 EGDs, but sharply increased to 80.0% at 30 EGDs, reached 88.0% at 50 EGDs. Fail to perform esophageal intubation and retroversion to the fundus of the stomach was none after 30 EGDs. However, in steps from gastroesphageal junction to the antrum of the stomach and from the antrum of the stomach to the second portion of the duodenum, the failure rate kept up less than 10% during the first 50 EGDs. A statistically significant reduction of the procedure time in success cases was observed between 20 and 30 EGDs in all steps. CONCLUSION: The technical competency of EGD was achieved approximately 90% during the first consecutive 50 EGDs.

Risk factors related to progressive traumatic intracerebral hematomas in the early post head injury period

PURPOSE: In this study, patients in whom two computed tomography (CT) scans had been obtained within 24 hours of injury were analyzed to determine the incidence, risk factors and clinical significance of a progressive intracerebral hematoma (PIH). METHODS: Participants were 182 patients with a traumatic intracerebral hematoma and contusion who underwent a repeat CT scan within 24 hours of injury. Univarite and multivariate statistics were used to define growth (volume increase) and to examine the relationship between the risk factors and hemorrhage expansion. RESULTS: Fifty-four percent of the patients experienced progression in the size of the lesion in the initial 24 hours postinjury. A PIH was independently associated with worsened Glasgow coma scale (GCS) score (2.99, 1.04~8.60), the presence of subarachnoid hemorrhage (6.29, 2.48~16.00), the presence of a subdural hematoma (6.18, 2.13~17.98), the presence of an epidural hematoma (5.73, 1.18~27.76), and the presence of a basal cistern effacement (10.93, 1.19~99.57). CONCLUSION: For patients undergoing scanning within 2 hours of injury, the rate of PIH approaches 61%. Early repeated CT scanning is indicated in patients with a nonsurgically-treated hemorrhage revealed on the first CT scan. Worsened GCS score, significant hematoma growth and effacement of the basal cisterns on the initial CT scan are powerful predictors of which patients will require surgery. These findings should be important factors in understanding and managing of PIH.

Influence of Anxiety, Depression and Stress on Adjustment to College in Freshmen of a University / 가정의학회지

BACKGROUND: Freshmen maladaptation to university life has brought a lot of attention recently. Therefore, we intended to investigate about the relationship between anxiety, depression, stress and freshmen adaptation to university life. METHODS: We recruited 861 freshmen of a university located in Gyeongju, Gyeongbuk, and measured their degree of anxiety, depression, and stress by questionnaire from March 10 to 14, 2008. After 8 weeks, we examined their adaptation to university life by questionnaire and finally, analyzed the data of 600 freshmen. RESULTS: Among the freshmen, 285 (47.5%) had anxiety, 95 (15.8%) depression, and 70 (11.7%) stress. Adaptation to university life significantly associated with college-entrance exam experience, the number of close friends in class, willingness to join the club, major satisfaction and distance from the university to hometown, in addition to anxiety, depression, and stress. Risk factors of maladaptation to university life were stress (odds ratio: 2.66, 95% confidence interval: 1.60 to 4.45), depression (2.45; 1.56 to 3.84), one experience of college entrance exam (1.83; 1.24 to 2.69), anxiety (1.73; 1.27 to 2.37) and fewer than 5 close friends (1.60; 1.17 to 2.20). Short distance from the university to hometown (0.72; 0.53 to 0.98), willingness to join the club (0.60; 0.41 to 0.87) and major satisfaction (0.42; 0.29 to 0.61) were identified as lowering the risk of maladaptation to university life. CONCLUSION: Anxiety, depression, and stress closely related to freshmen adaptation to university life. During freshmen's health examination, we need to identify the degree of anxiety, depression and stress in order to predict maladaptation to university life.

Sexual Desire and Behavior of Residents at Nursing Homes

BACKGROUND: Sexual Problems of the elderly carry weight with the quality of life. Sexual desire and behavior among the aged in the community are well known, but not at nursing homes. METHODS: The study subjects were 131 residents at two nursing homes in Po-hang and Gyeong-ju city from May 1st 2007 to May 22nd 2007. We interviewed the residents using 10-items which were made by investigators. 31 subjects were excluded due to impossible interview. We analyzed 100 subjects. RESULTS: Subjects were 45% men and 55% women, aged 63 to 92 and the mean age was 77 years old. Men and Women felt sexual desires in 64.4% and 18.2%, performed sexual activity in 35.6% and 5.5%. Obscene jokes and patting were common among sexual behaviors. CONCLUSION: Men's sexual desire was much higher than women, but sexual behaviors were rare in all subjects except obscene jokes.